Bone marrow 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography cannot replace bone marrow
Hugo J A Adams1, Thomas C Kwee, Rob Fijnheer
1Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
American Journal of Hematology
|April 9, 2014
Summary
18F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) cannot replace bone marrow biopsy (BMB) for detecting bone marrow involvement in diffuse large B-cell lymphoma (DLBCL). BMB remains a superior prognostic factor for patient survival.
Area of Science:
- Nuclear Medicine
- Oncology
- Hematology
Background:
- Accurate staging of diffuse large B-cell lymphoma (DLBCL) is crucial for treatment planning.
- Bone marrow involvement (BMI) is a key factor in DLBCL staging and prognosis.
- 18F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) is increasingly used, but its role in replacing bone marrow biopsy (BMB) for BMI assessment in DLBCL requires clarification.
Purpose of the Study:
- To evaluate if visual and quantitative FDG-PET/CT can substitute for BMB in detecting BMI in newly diagnosed DLBCL.
- To compare the prognostic value of FDG-PET/CT findings with BMB status in DLBCL patients.
Main Methods:
- Retrospective analysis of 78 newly diagnosed DLBCL patients who underwent both FDG-PET/CT and BMB.
- Visual assessment of FDG-PET/CT for BMI, with BMB as the reference standard.
- Quantitative analysis of FDG-avid lesions (metabolically active volume, SUVmax, cMVPmean).
- Cox regression analysis to determine prognostic factors for progression-free survival (PFS) and overall survival (OS).
Main Results:
- FDG-PET/CT detected BMI in 43.6% of cases, while BMB detected it in 20.5%.
- Patient-based sensitivity of visual FDG-PET/CT for BMI was 68.8%.
- In multivariate analysis, only BMB status independently predicted PFS (P=0.016) and OS (P=0.004).
Conclusions:
- FDG-PET/CT misses a significant proportion of bone marrow involvement detectable by BMB in DLBCL.
- Both visual and quantitative FDG-PET/CT assessments are prognostically inferior to BMB.
- FDG-PET/CT cannot replace BMB for staging and prognostication in newly diagnosed DLBCL.
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