Utility of Bone Marrow Biopsy in the Staging of Diffuse Large B-Cell Lymphoma in the Era of PET-CT

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5637-5637
Author(s):  
Prakash Vishnu ◽  
Andrew Wingerson ◽  
David M Aboulafia
Keyword(s):  
Bone Marrow ◽  
Predictive Value ◽  
Bone Marrow Involvement ◽  
Stage Iv ◽  
B Cell Lymphoma ◽  
Newly Diagnosed ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Pre Treatment ◽  
Pet Ct Scan

Abstract BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma (NHL). Recent advances in imaging, use of prognostic indices and molecular profiling has improved our ability to characterize disease and predict outcomes in DLBCL. About one-third of patients with DLBCL have bone marrow involvement at the time of diagnosis, and bone marrow aspirate/biopsy (BMAB) is considered gold standard to detect such involvement. 18 F-fluro-2-deoxy-D-glucose positron emission tomography combined with computed tomography (PET-CT), has become standard pre-treatment imaging in DLBCL and may be a non-invasive alternative to BMAB. Prior studies have suggested that PET-CT scan may obviate the need for BMAB as a component for staging patients with newly-diagnosed DLBCL, but owing to a variety of reasons this is not yet a standard of practice. We investigated whether FDG uptake-based bone marrow assessment can replace BMAB in newly-diagnosed DLBCL. METHODS This study is a single institution retrospective medical records' review. All patients with newly-diagnosed DLBCL at Virginia Mason Medical Center between January 2003 to December 2013 who underwent pre-treatment PET-CT and BMAB were included. FDG-PET/CT images were visually assessed for bone marrow involvement in posterior iliac crest. Patients with primary mediastinal DLBCL, previous history or coexistence of another lymphoma subtype and those with a non-diagnostic BMAB, and in whom the PET-CT did not show marrow signal abnormality were excluded from the analysis. Ann Arbor stage was determined using PET-CT with and without the contribution of BMAB, and the proportion of stage IV cases by each method was measured. RESULTS 105 eligible patients were identified. The median age was 62 years (range, 24-88), 62 (59%) were male, 53 (50%) had elevated LDH and 17 (16%) had an ECOG performance status of >2. Thirteen (12%) patients had > 1 extra-nodal site of lymphoma involvement. R-IPI score was 0-1 in 39 (37%), 2 in 42 (40%), 3 in 20 (19%), and 4 in 4 (4%) patients. A total of 38 (36%) patients had bone marrow involvement established by either PET-CT (n=24, 19%), BMAB (n=14, 13%), or both (n=12, 11%). 12 of the 24 patients (50%) with positive PET-CT had marrow involvement by DLBCL, while only 2 of the 81 patients (2%) with negative PET/CT showed marrow involvement. BMAB upstaged 1 of the 53 (2%) stage I/II patients to stage IV. The sensitivity of PET-CT scan to detect marrow involvement by DLBCL was 86% while the specificity was 87%. The positive predictive value of PET-CT was only 50% while the negative predictive value was 98%. CONCLUSIONS In patients with newly diagnosed DLBCL, PET-CT is complementary to BMAB in detecting marrow involvement by lymphoma. Although PET-CT has a high negative predictive value for bone marrow involvement, it overestimates the number of cases with marrow involvement by lymphoma. In clinical practice, routine BMAB may no longer be necessary for all patients with DLBCL, who are staged by PET-CT, unless the results would change both staging and therapy. The prognostic implication of marrow involvement identified by PET-CT compared to BMAB remains unknown. Disclosures No relevant conflicts of interest to declare.

[18f]PET-CT Scan Is Highly Accurate in Identifying Marrow Involvement of Diffuse Large B-Cell Lymphoma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2355-2355
Author(s):  
Prakash Vishnu ◽  
Andrew Wingerson ◽  
Marie Lee ◽  
Margaret Mandelson ◽  
David M Aboulafia
Keyword(s):  
Ct Scan ◽  
De Novo ◽  
Cell Lymphoma ◽  
Stage Iv ◽  
B Cell Lymphoma ◽  
Newly Diagnosed ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Pet Ct Scan ◽  
Large B Cell

Abstract BACKGROUND: Recent advances in imaging and the use of prognostic indices and molecular profiling have improved our ability to characterize disease and predict outcomes in diffuse large B cell lymphoma (DLBCL). About 1/3rd of patients with DLBCL have bone marrow involvement (BMI) at the time of diagnosis, and bone marrow aspirate/biopsy (BMAB) is considered the gold standard to detect such involvement. [18F] fluorodeoxyglucose (FDG) positron emission tomography combined with computed tomography (PET-CT), has become a standard pre-treatment imaging in DLBCL and may be a noninvasive alternative to BMAB to ascertain BMI. Prior studies have suggested that PET-CT scan may obviate the need for BMAB as a component for staging patients with newly diagnosed DLBCL, but owing to a variety of reasons this is not yet a standard of practice. The aim of this retrospective study which included 99 patients with newly diagnosed de-novo DLBCL, who had undergone both BMAB and PET-CT, was to determine the accuracy of PET-CT in detecting BMI in DLBCL and define overall survival (OS) in these patients based on BMI by BMAB vs. PET-CT. METHODS: This study is a single institution retrospective review of patients' medical records. All patients with newly diagnosed DLBCL at Virginia Mason Medical Center between January 2004 to December 2013 who underwent pretreatment PET-CT and BMAB were included. PET-CT images were visually assessed for BMI including the posterior iliac crest. Patients with primary mediastinal DLBCL, previous history or co-existence of another lymphoma subtype and those with a non-diagnostic BMAB, and in whom the PET-CT did not show marrow signal abnormality were excluded from the analysis. Ann Arbor stage was determined using PET-CT with and without the contribution of BMAB, and the proportion of stage IV cases by each method was measured. RESULTS: 99 eligible patients were identified. The median age was 62 years (range, 24-88), 62 (59%) were male, 53 (50%) had elevated LDH and 17 (16%) had an ECOG performance status of >2. Thirteen (12%) patients had > 1 extra-nodal site of lymphoma involvement. R-IPI score was 1 in 39 (37%), 2 in 42 (40%), 3 in 20 (19%), and 4 in 4 (4%) patients. A total of 38 (36%) patients had BMI established by either PET-CT (n=24, 19%), BMAB (n=14, 13%), or both (n=12, 11%). 12 of the 24 patients (50%) with positive PET-CT had BMI by DLBCL, while only 2 of the 81 patients (2%) with negative PET-CT showed BMI. BMAB upstaged 1 of the 53 (2%) stage I/II patients to stage IV. The sensitivity of PET-CT scan to detect BMI by DLBCL was 86% while the specificity was 87%. 84 patients (85%) had concordant results between lymphomatous BMAB and PET-CT (12 patients were positive for both, and 72 patients were negative for both), but 15 patients (15%) had a discordant interpretation (3 patients were positive by BMAB and negative by PET-CT, and 12 patients were negative by BMAB and positive by PET-CT). PET-CT was highly accurate for detecting BMI at diagnosis in de-novo DLBCL. Although patients with positive BMAB patients had inferior 5 year OS estimates compared to negative BMAB (66% vs. 85%), no difference was demonstrated between PET-CT positive vs. PET- CT negative patients. (79% vs. 83%) (Table 1) CONCLUSIONS: In patients with newly diagnosed DLBCL, PET-CT is highly accurate in detecting BMI by lymphoma. In clinical practice, routine BMAB may no longer be necessary for all patients with DLBCL, who are staged by PET-CT, unless the results would change both staging and therapy. The prognostic implication of BMI identified by PET-CT compared to BMAB remains unknown. Whether a PET-CT precludes the need for a BMAB in patients with DLBCL remains to be evaluated in a prospective study. Disclosures No relevant conflicts of interest to declare.

Role of FDG-PET/CT in detecting lymphomatous bone marrow involvement in patients with newly diagnosed diffuse large B-cell lymphoma

2011 ◽  
Vol 91 (5) ◽  
pp. 687-695 ◽  
Author(s):  
Junshik Hong ◽  
Yukyung Lee ◽  
Yeonjeong Park ◽  
Seog Gyun Kim ◽  
Kyung Hoon Hwang ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Cell Lymphoma ◽  
Bone Marrow Involvement ◽  
B Cell Lymphoma ◽  
Newly Diagnosed ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Large B Cell

scholarly journals The Role of Integrated Positron Emission Tomography/Computed Tomography (PET/CT) and Bone Marrow Examination in Staging Large B-Cell Lymphoma

2020 ◽  
Vol 14 ◽  
pp. 117955492095309
Author(s):  
Ahmad Al-Sabbagh ◽  
Feryal Ibrahim ◽  
Lajos Szabados ◽  
Dina S Soliman ◽  
Ruba Y Taha ◽  
...  
Keyword(s):  
Bone Marrow ◽  
B Cell ◽  
Bone Marrow Biopsy ◽  
Predictive Value ◽  
Cell Lymphoma ◽  
Bone Marrow Involvement ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Large B Cell

Introduction: In the era of routine use of positron emission tomography/computed tomography (PET/CT) for staging, it is not yet clear whether PET/CT can replace bone marrow biopsy for the assessment of bone marrow involvement in large B-cell lymphoma. Objectives: To compare the clinical utility of bone marrow biopsy and PET/CT scanning in the staging of large B-cell lymphoma. Methods: This was a retrospective analysis of all patients who presented to single center over a 4-year period with large B-cell lymphoma who had concurrent PET/CT and bone marrow biopsy performed in the assessment and staging of the lymphoma. Results: Out of 89 patients, 24 had bone marrow involvement either by PET/CT, by bone marrow biopsy, or by both. Bone marrow biopsy identified 12 patients (sensitivity 50%, specificity 100%, negative predictive value 84%), whereas PET/CT identified 23 patients (sensitivity 96%, specificity 100%, negative predictive value 98%). No patients were upstaged by the bone marrow biopsy result, and no patients had their treatment plan changed based on the bone marrow biopsy result. Conclusion: The results show that PET-CT is more sensitive and has better negative predictive value than bone marrow biopsy. This suggests that PET-CT could replace bone marrow biopsy in detecting bone marrow involvement for staging of large B-cell lymphoma.

Role of Bone Marrow Biopsy in the Staging of Diffuse Large B-Cell Lymphoma in the PET/CT Era

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2960-2960
Author(s):  
Musa F. Alzahrani ◽  
Tarec Christoffer El-Galaly ◽  
Martin Hutchings ◽  
Jakob Werner Hansen ◽  
Peter de Nully Brown ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Negative Predictive Value ◽  
Bone Marrow Biopsy ◽  
Predictive Value ◽  
Bone Marrow Involvement ◽  
Stage Iv ◽  
B Cell Lymphoma ◽  
University Hospital ◽  
Pet Ct ◽  
Skeletal Lesions

Abstract Background Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive non-Hodgkin lymphoma (NHL) and bone marrow involvement by lymphoma is seen in up to one third of cases, as assessed by iliac crest bone marrow biopsy (BMB) at the time of diagnosis. Traditionally, BMB has been the gold standard test to detect bone marrow infiltration by lymphoma. 18-Fluoro-deoxyglucose positron emission tomography combined with computed tomography (PET/CT), has become standard in the initial staging of DLBCL. Prior studies have suggested that PET/CT staging may obviate the need for staging BMB in patients with Hodgkin lymphoma. However, because of limited evidence, this approach has not been adopted in patients with DLBCL. We investigated whether BMB adds useful information to PET/CT staging in patients with an initial diagnosis of DLBCL. Patients and Methods Patients with a new diagnosis of DLBCL who underwent both staging PET/CT and BMB were retrospectively identified across three institutions: British Columbia Cancer Agency (n=149, 2011-2013), Aalborg University Hospital (n=179, 2007-2013), and Copenhagen University Hospital (n=202, 2009-2012). We reviewed the reports of PET/CT scans and BMBs from each academic institution performed at the time of diagnosis prior to treatment of DLBCL. Ann Arbor stage was determined including PET/CT with and without the contribution of BMB, and the proportion of stage IV cases by each method was calculated. Results 530 patients were identified: median age 65 years (range 16-90), 294 (56%) male, 137 (26%) largest mass >10cm, 263 (50%) elevated LDH, 105 (20%) performance status >2, and 149 (28%) with more than one extranodal site. International Prognostic Index score was 0-1 in 159 (30%), 2 in 145 (27%), 3 in 119 (23%), and 4-5 in 107 (20%) patients. 520 (98%) received rituximab-containing chemotherapy, 130 (25%) radiotherapy, and 3 (<1%) consolidative autologous stem cell transplantation. A total of 181 (34%) patients had bone marrow involvement established by either PET/CT (n=146, 28%), BMB (n=87, 16%), or both (n=52, 10%). Focal skeletal lesions on PET/CT were unifocal (n=42), bifocal (n=15), multifocal/diffuse (n=89). 52 of the 146 patients (36%) with positive PET/CT had a positive BMB (39 DLBCL, 13 iNHL), while 35 of the 384 patients (9%) with negative PET/CT had a positive BMB (12 DLBCL, 23 iNHL). Table 1 shows the distribution of Ann Arbor staging as defined by PET/CT alone and with inclusion of BMB results. BMB upstaged 12/209 (6%) stage I/II patients to stage IV, including 3 patients with DLBCL and 9 patients with iNHL in the bone marrow. Focal skeletal lesions on PET/CT identified bone marrow involvement by lymphoma (DLBCL or iNHL) with sensitivity 60%, specificity 79%, positive predictive value 36%, and negative predictive value 91%. In a subgroup analysis excluding the 36 patients with iNHL in the bone marrow, focal skeletal lesions on PET/CT identified bone marrow involvement by DLBCL with sensitivity 78%, specificity 79%, positive predictive value 29%, and negative predictive value 97%. Conclusions In patients with DLBCL, staging PET/CT does not identify all cases with bone marrow involvement. BMB upstaged 6% of patients with stage I/II who had a PET/CT negative for any skeletal involvement. However, the majority had indolent histologies in the bone marrow, and only 1% were upstaged due to involvement of the bone marrow with DLBCL. Although PET/CT has a high negative predictive value for ruling out bone marrow involvement by high grade lymphoma, BMB remains a necessary component in the evaluation of patients with a new diagnosis of DLBCL mainly because of its ability to detect iNHL that was missed by PET/CT which may have implications in the post-treatment surveillance setting. Table 1. Clinical staging by PET/CT alone and with inclusion of bone marrow biopsy results. Clinical Stage Staging Modality Patients upstaged to stage IV by bone marrow biopsy PET/CT alone PET/CT and bone marrow biopsy N (%) N (%) N I 121 (23) 114 (21) 7 (2 DLBCL, 5 iNHL) II 88 (17) 83 (16) 5 (1 DLBCL, 4 iNHL) III 92 (17) 77 (15) 15 (5 DLBCL, 10 iNHL) IV 229 (43) 256 (48) Not applicable Disclosures No relevant conflicts of interest to declare.

scholarly journals Utility of Bone Marrow Biopsy in the Staging of T-Cell Lymphoma in the PET-CT Era

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4039-4039
Author(s):  
Suchitra Sundaram ◽  
Matthew Gravina ◽  
Kristopher Attwood ◽  
Francisco J. Hernandez-Ilizaliturri ◽  
Pallawi Torka
Keyword(s):  
Bone Marrow ◽  
T Cell ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Bone Marrow Involvement ◽  
Stage Iv ◽  
Stage I ◽  
Newly Diagnosed ◽  
Pet Ct

Introduction: T-cell lymphomas (TCL) are a heterogenous group of lymphoid malignancies that account for 10-15% of all lymphoproliferative disorders. Histological bone marrow involvement (BMI) ranges between 20-40% of all TCLs at time of diagnosis with bone marrow aspirate and biopsy (BMAB) considered the gold standard test to detect BMI. 18-Fluoro-deoxyglucose positron emission tomography combined with computed tomography (PET-CT) is a standard pretreatment imaging in the staging of TCL. In other lymphomas like DLBCL, PET-CT may obviate the need for BMAB as a component for staging, but this has not been studied in TCL. The aim of this retrospective study is to determine the accuracy of PET-CT in detecting BMI in newly diagnosed TCL. Methods: This is a single institution retrospective medical chart review study. All TCL patients(pts) diagnosed at Roswell Park Cancer Institute between January 2003 to December 2017 and underwent pre-treatment PET-CT and BMAB were included. PET-CT images were visually assessed for BMI. We excluded cases in which BMAB specimens were qualitatively and/or quantitatively insufficient to determine the presence or absence of BMI. Ann Arbor staging was determined using PET-CT and BMAB and the proportion of patients upstaged to Stage IV due to BMI detected by either modality was calculated. The BMAB and PET-CT results were summarized using a 2x2 contingency table. The performance of the PET-CT was evaluated using the sensitivity, specificity, positive predictive value, and negative predictive value. Confidence intervals for these measures were obtained using Jeffrey's prior method. Results: In total 89 pts were included in the analysis. Median age at time of diagnosis was 60 (range 20-92), 52 were male (58%), 20 had elevated LDH (22%), 7 had ECOG greater or equal to 2 (8%), 66 had an IPI score 0-2 (74%) and 23 had an IPI score 3-4 (26%), 7 had >2 extra-nodal sites of involvement (8%). In total, 38 pts (42.6%) had BMI at time of diagnosis, established by either BMAB (n= 25; 28%), PET-CT (n=13; 15%) or by both modalities (n=10 pts; 11%). There were 15 pts (17%) that were negative for BMI on PET-CT but had positive involvement of TCL on BMAB. The sensitivity and specificity of PET-CT to detect BMI by TCL was 40% (95% CI 22.7, 59.4) and 95.3% (95% CI 88.0, 98.7), respectively. Seventy-one pts (79.7%) had concordant results between lymphomatous BMAB and PET-CT (10 pts were positive for both, 61 pts were negative for both) and 18 pts (20.2%) had discordant interpretation (15 pts were negative by PET-CT and positive by BMAB and 3 pts were negative by BMAB and positive on PET-CT). BMAB upstaged 4 out of the 32 (12.5%) stage I-II pts to stage IV; out of these only 1 patient had positive BMI detected by PET-CT. The positive predictive value of PET-CT for detecting BMI was found to be 76.9 % (50.3, 93.0) with a negative predictive value of 80.3 % (70.3, 88.0) (Figure 1). Conclusion:In our cohort of TCL pts, staging PET-CT does not identify all cases with BMI. BMAB upstaged more pts with Stage I/II to Stage IV than PET-CT. Although PET-CT has high negative predictive value for ruling out marrow involvement by TCL, BMAB remains a necessary component in the evaluation of pts with newly diagnosed TCL because of its ability to detect lymphomatous involvement of bone marrow missed by PET-CT which has implications in staging and treatment of TCL. Disclosures No relevant conflicts of interest to declare.

scholarly journals Prognostic significance of bone marrow infiltration detected by PET-CT in newly diagnosed diffuse large B cell lymphoma

Oncotarget ◽  
2016 ◽  
Vol 7 (14) ◽  
pp. 19072-19080 ◽  
Author(s):  
Jin-Hua Liang ◽  
Jin Sun ◽  
Li Wang ◽  
Lei Fan ◽  
Yao-Yu Chen ◽  
...  
Keyword(s):  
Bone Marrow ◽  
B Cell ◽  
Cell Lymphoma ◽  
Prognostic Significance ◽  
B Cell Lymphoma ◽  
Bone Marrow Infiltration ◽  
Newly Diagnosed ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Large B Cell

Prognostic Significance of Bone Marrow Infiltration Detected By PET-CT in Newly Diagnosed Diffuse Large B Cell Lymphoma

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1473-1473
Author(s):  
Jin-Hua Liang ◽  
Jin Sun ◽  
Li Wang ◽  
Lei Fan ◽  
Li Tian-Nv ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Cell Lymphoma ◽  
Risk Group ◽  
Univariate Analysis ◽  
Stage Iv ◽  
B Cell Lymphoma ◽  
Survival Outcomes ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Large B Cell

Abstract Purpose The aim of this study was to examine the prognostic value of bone marrow involvement (BMI) assessed by PET-CT in treatment-naïve patients with diffuse large B-cell lymphoma (DLBCL). Patients and methods All patients from a single centre diagnosed as DLBCL between 2005 and 2014 had data extracted from staging PET-CT, bone marrow biopsy (BMB), and treatment records. The final diagnosis of BMI was defined as: (i) positive bone marrow biopsy; (ii) positive PET-BMI confirmed by guided biopsy or targeted MR imaging; (iii) concomitant disappearance of bone marrow uptake and uptake in other lymphoma lesions on PET-CT after R-chemotherapy. Results Of 169 patients, 20 patients (12%) had BMI on BMB, whereas 35 patients (21%) had positive BMI according to PET-CT findings (PET-BMI(+)). Thirty-three out of the 35 patients with PET-BMI(+) showed a focal pattern and 2 a diffuse pattern, respectively. In multivariate analyses, PET-BMI(+) remained significant for overall survival (OS) (HR 2.90, 95%CI 1.21−6.96, P=0.017) while progressive-free survival (PFS) was significant only in univariate analysis (P<0.001) (Table 1). Among patients with PET-BMI(+) at diagnosis (N=35), patients with SUVmax of bone marrow (SUVmax(BM)) more than 8.6 were significantly associated with high IPI score (3−5) (P=0.002) and worse PFS and OS (P=0.025 and P=0.002, respectively) (Figure 1). In the 68 stage IV cases, three-year OS was higher for patients with negative PET-BMI (PET-BMI (−)) than patients with PET-BMI(+) (84.2%¡À6.5% vs. 44.1%¡À8.6%, respectively; P=0.003) while PFS only shown a trend of statistic significance (P=0.077) between the 2 groups, with estimates of 3-year PFS at 49.3%¡À9.2% and 28.6%¡À7.6%, respectively (Figure 2). Among the 69 patients with inter-risk of IPI (2−3), patients with PET-BMI(+) (N=21) had significantly inferior PFS and OS than patients with PET-BMI(−) (N=48) (P =0.009 and P<0.001, respectively) (Figure 3). Conclusions Our data raised several important issues about the predictive significance of BMI assessed by PET-CT in DLBCL: (i) The bone marrow status assessed by PET-CT is an independent predictor of OS independent of IPI; (ii) For baseline PET-BMI(+) patients, the optimal cutoff value of SUVmax(BM) to predict the survival outcomes was 8.6; (iii) In patients with stage IV disease, worse survival outcomes were observed in patients with BMI than that without BMI; (iV) Patients with PET-BMI(+) in the intermediate risk-group should be managed as high-risk group patients. Table 1. Cox regression analysis for PFS and OS for all the patients with DLBCL (N=169) PFS OS Univariate analysis Multivariate analysis Univariate analysis Multivariate analysis HR (95%CI) P HR (95%CI) P HR (95%CI) P HR (95%CI) P PET-BMI+ 3.96 (2.38-6.59) <0.001 - - 6.73 (3.40-13.34) <0.001 2.90 (1.21-6.96) 0.017 BMB-BMI+ 4.49 (2.53-7.98) <0.001 - - 6.24 (3.06-12.73) <0.001 - - IPI>2 7.27 (4.19-12.63) <0.001 3.12 (1.31-7.47) 0.010 9.02 (3.94-20.61) <0.001 3.62 (1.01-13.03) 0.049 Age >60 1.61 (0.98-2.64) 0.060 1.18 (0.61-2.27) 0.627 Stage III or IV 6.08 (2.77-13.36) <0.001 - - 6.78 (2.08-22.12) 0.002 - - ECOG 2-4 2.79 (1.65-4.71) <0.001 1.97 (1.12-3.47) 0.019 3.39 (1.75-6.55) <0.001 - - LDH>ULN 4.68 (2.82-7.78) <0.001 - - 4.31 (1.96-9.48) <0.001 - - Extranodal site >1 3.15 (1.91-5.18) <0.001 - - 3.04 (1.58-5.86) 0.001 - - Figure 1. Survivals according to SUVmax in patients with PET-BMI(+) at diagnosis Figure 1. Survivals according to SUVmax in patients with PET-BMI(+) at diagnosis Figure 2. Survivals according to PET-BMI status in cases with stage IV Figure 2. Survivals according to PET-BMI status in cases with stage IV Figure 3. Survivals according to PET-BMI status in cases with IPI score of 2-3 Figure 3. Survivals according to PET-BMI status in cases with IPI score of 2-3 Disclosures No relevant conflicts of interest to declare.

scholarly journals Diagnostic accuracy of pelvic magnetic resonance imaging for the assessment of bone marrow involvement in diffuse large B-cell lymphoma

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252226
Author(s):  
Qing Ke ◽  
Cheng-Cheng Liao ◽  
Xiao-Hong Tan ◽  
Bao-Ping Guo ◽  
Hong Cen ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Cell Lymphoma ◽  
Bone Marrow Involvement ◽  
B Cell Lymphoma ◽  
Diagnostic Value ◽  
Whole Body ◽  
Pelvic Mri ◽  
Pelvic Magnetic Resonance Imaging ◽  
Large B Cell Lymphoma ◽  
Pet Ct

Purpose We investigated the efficacy of pelvic magnetic resonance imaging (MRI) in the diagnosis of bone marrow involvement (BMinv) in diffuse large B-cell lymphoma (DLBCL) patients. Patients and methods This was a retrospective study of data from a previous study (NCT02733887). We included 171 patients who underwent bone marrow biopsy (BMB) and bone marrow smear (BMS), pelvic MRI, and whole-body positron emission tomography-computed tomography (PET/CT) from January 2016 to December 2019 at a single center. BMB/BMS and whole-body PET/CT results were used as reference standards against which we calculated the diagnostic value of pelvic MRI for BMinv in DLBCL patients. A chi-square test was used to compare detection rates, and a receiver operating characteristic curve was used to evaluate diagnostic value of pelvic MRI. Propensity-score matching was performed according to clinical information, and Kaplan-Meier curves were constructed to compare progression-free survival (PFS) and overall survival (OS) of patients. Results The BMinv detection rate of pelvic MRI (42/171) was higher (P = 0.029) than that of BMB/BMS (25/171), and similar to that of PET/CT (44/171; P = 0.901). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of pelvic MRI were 83.33%, 98.37%, 94.15%, 95.24%, and 93.80%, respectively. Median PFS values were as follows: BMB/BMS-positive, 17.8 months vs. BMB/BMS-negative, 26.9 months (P = 0.092); PET/CT-positive, 24.8 months vs. PET/CT-negative, 33.0 months (P = 0.086); pelvic MRI-positive, 24.9 months vs. pelvic MRI-negative, 33.1 months (P<0.001). Median OS values were as follows: BMB/BMS-positive, 22.3 months vs. BMB/BMS-negative, 29.8 months (P = 0.240); PET/CT-positive, 27.9 months vs. PET/CT-negative, 33.9 months (P = 0.365); pelvic MRI-positive, 27.3 months vs. pelvic MRI-negative, 35.8 months (P = 0.062). Conclusion Pelvic MRI is effective for detecting BMinv in DLBCL patients, providing a more accurate indication of PFS than BMB/BMS and PET/CT do. It may ultimately be used to improve the accuracy of clinical staging, guide patient treatment, and evaluate prognosis.

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