Cancer Res Treat.  2015 Jul;47(3):458-464. 10.4143/crt.2014.091.

The Clinical Utility of FDG PET-CT in Evaluation of Bone Marrow Involvement by Lymphoma

• Kim HY
• Kim JS
• Choi DR
• Kim HS
• Kwon JH
• Jang GD
• Kim JH
• Jung JY
• Song HH
• Lee YK
• Min SK
• Hwang HS
• Kim HJ
• Zang DY
• Kim HJ

• KMID: 2148495
• DOI: http://doi.org/10.4143/crt.2014.091

Abstract

PURPOSE
Bone marrow biopsy is a standard method for the evaluation of bone marrow infiltration by lymphoma; however, it is an invasive and painful procedure. Fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) is a noninvasive imaging technique with the potential to detect bone marrow involvement by lymphoma.
MATERIALS AND METHODS
We retrospectively reviewed medical records of lymphoma patients. All patients were examined by FDG PET-CT and iliac crest bone marrow biopsy for initial staging work-up.
RESULTS
The study population comprised 94 patients (median age, 60 years; 56 males) with Hodgkin's lymphoma (n=8) or non-Hodgkin's lymphoma (n=86). Maximum standardized uptake values on the iliac crest of patients with lymphoma infiltrated bone marrow were significantly higher than those of patients with intact bone marrow (2.2+/-1.2 g/mL vs. 1.3+/-0.4 g/mL; p=0.001). The calculated values for FDG PET-CT during evaluation of bone marrow involvement were as follows: sensitivity 50%, specificity 96%, positive predictive value 80%, negative predictive value 85%, and positive likelihood ratio (LR+) 11.7. The value of LR+ was 16.0 in patients with aggressive subtypes of non-Hodgkin's lymphoma (NHL).
CONCLUSION
FDG PET-CT could not replace bone marrow biopsy due to the low sensitivity of FDG PET-CT for detection of bone marrow infiltration in lymphoma patients. Conversely, FDG PET-CT had high specificity and LR+; therefore, it could be a useful tool for image-guided biopsy for lymphoma staging, especially for aggressive subtypes of NHL. In addition, unilateral bone marrow biopsy could be substituted for bilateral bone marrow biopsy in lymphoma patients with increased FDG uptake on any iliac crest.

Keyword

Lymphoma; Positron-emission tomography; Bone marrow examination

MeSH Terms

Biopsy
Bone Marrow Examination
Bone Marrow*
Electrons
Hodgkin Disease
Humans
Image-Guided Biopsy
Lymphoma*
Lymphoma, Non-Hodgkin
Medical Records
Positron-Emission Tomography
Retrospective Studies
Sensitivity and Specificity

Figure

• 

  Fig. 1. Comparison of the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of fluorodeoxyglucose positron emission tomography– computed tomography during detection of bone marrow involvement between the semi-quantitative and qualitative method; 95% confidence intervals are displayed as a line.

• 

  Fig. 2. A 40-year-old female patient with angioimmunoblastic T-cell lymphoma. (A) Maximum intensity projection of positron emission tomography–computed tomography (PET-CT) shows multiple enlarged lymph nodes with increased fluorodeoxyglucose (FDG) uptake in the bilateral neck, axillar, retroperitoneal, iliac, and inguinal areas. Increased FDG uptakes in both lower lung fields suggest lung involvement. Transaxial PET (B) and fusion PET-CT (C) images demonstrate mild increased FDG uptake in bone marrow of iliac crests (arrows). The maximum standardized uptake value at the posterior iliac crest is 2.2 g/mL on the right and 2.4 g/mL on the left, respectively.

Reference

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