Cancer Res Treat.  2024 Apr;56(2):688-696. 10.4143/crt.2023.1049.

Assessment of Bone Marrow Involvement in Extranodal NK/T-Cell Lymphoma: Positron Emission Tomography versus Bone Marrow Biopsy, and the Significance of Minimal Involvement by EBV+ Cells (KROG 18-09)

• Lee TH
• Kim HJ
• Lee JH
• Lee J
• Kim JH
• Oh D
• Eom KY

• KMID: 2554358
• DOI: http://doi.org/10.4143/crt.2023.1049

Abstract

Purpose
This study aims to investigate the diagnostic significance of positron emission tomography/computed tomography (PET/CT) in assessing bone marrow (BM) involvement through a comparison of PET/CT findings with BM biopsy in extranodal natural killer/T-cell lymphoma.
Materials and Methods
The medical records of 193 patients were retrospectively reviewed. Patients were categorized as having early-stage (PET-ES) or advanced-stage (PET-AS) disease based on PET/CT results. The BM involvement was classified into three groups according to BM biopsy: gross BM involvement, minimal BM involvement (defined as the presence of a limited number of Epstein-Barr virus–positive cells in BM), and no involvement. Calculations of the accuracy of PET/CT in detecting BM involvement and analysis of the clinical outcomes (progression-free survival [PFS] and overall survival [OS]) according to the BM biopsy status were performed.
Results
PET/CT exhibited a sensitivity of 64.7% and a specificity of 96.0% in detecting gross BM involvement. For detecting any (both gross and minimal) BM involvement, the sensitivity was 30.4%, while the specificity was 99.0%. Only one patient (0.7%) demonstrated gross BM involvement among the PET-ES group. Survival outcomes of the PET-ES group with minimal BM involvement (3-year PFS, 55.6%; OS, 77.0%) were closer to those of the PET-ES group with no BM involvement (3-year PFS, 62.2%; OS, 80.6%) than to those of the PET-AS group (3-year PFS, 20.1%; OS, 29.9%).
Conclusion
PET/CT exhibits high specificity, but moderate and low sensitivity in detecting gross and minimal BM involvement, respectively. The clinical significance of minimal BM involvement for patients in the PET-ES group may be limited.

Keyword

NK/T-cell lymphoma; Bone marrow; Positron emission tomography; Minimal involvement

Figure

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  Fig. 1. Actuarial rates of progression-free survival (A) and overall survival (B) for 155 patients. Patients who designated to early stage by positron emission tomography/computed tomography (PET/CT) without available Epstein-Barr encoding region in situ hybridization for bone marrow (BM) biopsy were excluded.

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  Fig. 2. Actuarial rates of progression-free survival (A) and overall survival (B) for patients who designated to early stage by positron emission tomography/computed tomography (PET/CT), and progression-free survival (C) and overall survival (D) for patients who designated to advanced stage by PET/CT, according to the bone marrow (BM) biopsy status. EBER-ISH, Epstein-Barr encoding region in situ hybridization.

Reference

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