The Clinical Utility of FDG PET-CT in Evaluation of Bone Marrow Involvement by Lymphoma
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
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.
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.
참고문헌 (25)
- Jost LM, "ESMO Minimum clinical recommendations for diagnosis, treatment and follow-up of Hodgkin's disease", Ann Oncol, 16(Suppl 1), pp.54~55 (2005)
- Hiddemann W, "Minimum clinical recommendations for diagnosis, treatment and follow-up of newly diagnosed follicular lymphoma", Ann Oncol, 16(Suppl 1), pp.56~57 (2005)
- Zhang QY, "Bone marrow involvement by Hodgkin and non-Hodgkin lymphomas", Hematol Oncol Clin North Am, 23, pp.873~902 (2009)
- Juneja SK, "Value of bilateral bone marrow biopsy specimens in non-Hodgkin's lymphoma", J Clin Pathol, 43, pp.630~632 (1990)
- Gronich N, "Clinical outcome of low-grade NHL patients with bone marrow involvement", Eur J Clin Invest, 37, pp.305~309 (2007)
- Sasaki M, "Clinical impact of whole body FDG-PET on the staging and therapeutic decision making for malignant lymphoma", Ann Nucl Med, 16, pp.337~345 (2002)
- Muslimani AA, "The utility of 18-F-fluorodeoxyglucose positron emission tomography in evaluation of bone marrow involvement by non-Hodgkin lymphoma", Am J Clin Oncol, 31, pp.409~412 (2008)
- Schaefer NG, "Bone involvement in patients with lymphoma : the role of FDG-PET", CT, 2007, pp.34, 60~67
- Khan AB, "PET-CT staging of DLBCL accurately identifies and provides new insight into the clinical significance of bone marrow involvement", Blood, 122, pp.61~67 (2013)
- Pelosi E, "FDG-PET in the detection of bone marrow disease in Hodgkin's disease and aggressive non-Hodgkin's lymphoma and its impact on clinical management", Q J Nucl Med Mol Imaging, 52, pp.9~16 (2008)
- Chen YK, "F-18FDG PET for evaluation of bone marrow involvement in non-Hodgkin lymphoma : a meta-analysis", Clin Nucl Med, 36, pp.553~559 (2011)
- Brunning RD, "Bilateral trephine bone marrow biopsies in lymphoma and other neoplastic diseases", Ann Intern Med, 82, pp.365~366 (1975)
- Coller BS, "Frequencies and patterns of bone marrow involvement in non-Hodgkin lymphomas : observations on the value of bilateral biopsies", Am J Hematol, 3, pp.105~119 (1977)
- Malempati S, "Videos in clinical medicine: bone marrow aspiration and biopsy", N Engl J Med, 361, pp.e28~ (2009)
- Arellano-Rodrigo E, "Successful treatment by selective arterial embolization of severe retroperitoneal hemorrhage secondary to bone marrow biopsy in post-polycythemic myelofibrosis", Ann Hematol, 83, pp.67~70 (2004)
- Moog F, "18-F-fluorodeoxyglucose-positron emission tomography as a new approach to detect lymphomatous bone marrow", J Clin Oncol, 16, pp.603~609 (1998)
- Carr R, "Detection of lymphoma in bone marrow by whole-body positron emission tomography", Blood, 91, pp.3340~3346 (1998)
- Campbell JK, "Optimum trephine length in the assessment of bone marrow involvement in patients with diffuse large cell lymphoma", Ann Oncol, 14, pp.273~276 (2003)
- Conlan MG, "Bone marrow involvement by non-Hodgkin's lymphoma: the clinical significance of morphologic discordance between the lymph node and bone marrow. Nebraska Lymphoma Study Group", J Clin Oncol, 8, pp.1163~1172 (1990)
- Bennett JM, "The significance of bone marrow involvement in non-Hodgkin's lymphoma : the Eastern Cooperative Oncology Group experience", J Clin Oncol, 4, pp.1462~1469 (1986)
- Kang YK, "Clinicopathologic charcteristics of Korean non-Hodgkin's lymphomas based on REAL classification", J Korean Cancer Assoc, 31, pp.641~652 (1999)
- Okada J, "Positron emission tomography using fluorine-18-fluorodeoxyglucose in malignant lymphoma : a comparison with proliferative activity", J Nucl Med, 33, pp.325~329 (1992)
- Goldberg MA, "Fluorodeoxyglucose PET of abdominal and pelvic neoplasms : potential role in oncologic imaging", Radiographics, 13, pp.1047~1062 (1993)
- Pakos EE, "18F-FDG PET for evaluation of bone marrow infiltration in staging of lymphoma : a meta-analysis", J Nucl Med, 46, pp.958~963 (2005)
- Divgi C., "Imaging: staging and evaluation of lymphoma using nuclear medicine", Semin Oncol, 32(1 Suppl 1), pp.S11~18 (2005)