M Alzahrani1, T C El-Galaly2, M Hutchings3, J W Hansen3, A Loft4, H E Johnsen2, V Iyer5, D Wilson6, L H Sehn7, K J Savage7, J M Connors7, R D Gascoyne8, P Johansen9, E Clasen-Linde10, P Brown3, D Villa11. 1. Department of Hematology, Faculty of Medicine, University of British Columbia, Vancouver, Canada Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia. 2. Department of Hematology and Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg. 3. Departments of Hematology. 4. Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen. 5. Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark. 6. Department of Functional Imaging, British Columbia Cancer Agency and the University of British Columbia, Vancouver. 7. Division of Medical Oncology. 8. Department of Pathology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, Vancouver, Canada. 9. Department of Pathology, Aalborg University Hospital, Aalborg. 10. Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 11. Division of Medical Oncology dvilla@bccancer.bc.ca.
Abstract
BACKGROUND: The added diagnostic and prognostic value of routine bone marrow biopsy (BMB) in patients with diffuse large B-cell lymphoma (DLBCL) undergoing positron emission tomography combined with computed tomography (PET/CT) staging is controversial. PATIENTS AND METHODS: Patients with newly diagnosed DLBCL who underwent both staging PET/CT and BMB were retrospectively identified in British Columbia, Aalborg, and Copenhagen. Original written PET/CT and pathology reports were retrospectively reviewed to determine Ann Arbor stage and outcomes, with and without the contribution of BMB. RESULTS: A total of 530 patients were identified: 146 (28%) had focal bone marrow (BM) lesions on PET/CT and 87 (16%) had positive BMB. Fifty-two of 146 patients (36%) with positive PET/CT had a positive BMB [39 DLBCL, 13 indolent non-Hodgkin lymphoma (iNHL)], while 35 of 384 patients (9%) with negative PET/CT had positive BMB (12 DLBCL, 23 iNHL). BMB upstaged 12/209 (6%) of stage I/II patients to stage IV, although this was the case for only 3 (1%) patients with DLBCL in the BMB. PET/CT identified BM involvement by BMB with sensitivity 60%, specificity 79%, positive predictive value 36%, and negative predictive value 91%. Concordant histological involvement of the BM by DLBCL was associated with worse overall survival and progression-free survival than discordant or no involvement in univariate and multivariate analyses. CONCLUSIONS: In patients with DLBCL, staging PET/CT can miss BM involvement with concordant DLBCL (less common) or discordant iNHL (more common). Routine BMB does not add relevant diagnostic or prognostic value over PET/CT alone in the majority of patients with DLBCL.
BACKGROUND: The added diagnostic and prognostic value of routine bone marrow biopsy (BMB) in patients with diffuse large B-cell lymphoma (DLBCL) undergoing positron emission tomography combined with computed tomography (PET/CT) staging is controversial. PATIENTS AND METHODS: Patients with newly diagnosed DLBCL who underwent both staging PET/CT and BMB were retrospectively identified in British Columbia, Aalborg, and Copenhagen. Original written PET/CT and pathology reports were retrospectively reviewed to determine Ann Arbor stage and outcomes, with and without the contribution of BMB. RESULTS: A total of 530 patients were identified: 146 (28%) had focal bone marrow (BM) lesions on PET/CT and 87 (16%) had positive BMB. Fifty-two of 146 patients (36%) with positive PET/CT had a positive BMB [39 DLBCL, 13 indolent non-Hodgkin lymphoma (iNHL)], while 35 of 384 patients (9%) with negative PET/CT had positive BMB (12 DLBCL, 23 iNHL). BMB upstaged 12/209 (6%) of stage I/II patients to stage IV, although this was the case for only 3 (1%) patients with DLBCL in the BMB. PET/CT identified BM involvement by BMB with sensitivity 60%, specificity 79%, positive predictive value 36%, and negative predictive value 91%. Concordant histological involvement of the BM by DLBCL was associated with worse overall survival and progression-free survival than discordant or no involvement in univariate and multivariate analyses. CONCLUSIONS: In patients with DLBCL, staging PET/CT can miss BM involvement with concordant DLBCL (less common) or discordant iNHL (more common). Routine BMB does not add relevant diagnostic or prognostic value over PET/CT alone in the majority of patients with DLBCL.
Authors: S Jemaa; J N Paulson; M Hutchings; L Kostakoglu; J Trotman; S Tracy; A de Crespigny; R A D Carano; T C El-Galaly; T G Nielsen; T Bengtsson Journal: Cancer Imaging Date: 2022-08-12 Impact factor: 5.605
Authors: Tzu-Hua Chen-Liang; Taida Martín-Santos; Andrés Jerez; Guillermo Rodríguez-García; Leonor Senent; Cristina Martínez-Millán; Begoña Muiña; Mayte Orero; Anabel Teruel; Alejandro Martín; Joaquín Gómez-Espuch; Kyra Kennedy; Carmen Benet; José María Raya; Marta Fernández-González; Fátima de la Cruz; Marta Guinot; Carolina Villegas; Isabel Ballester; Mónica Baile; María Moya; Javier López-Jiménez; Laura Frutos; José Luis Navarro; Jon Uña; Rosa Fernández-López; Carolina Igua; José Contreras; Raquel Sánchez-Vañó; María Del Puig Cozar; Pilar Tamayo; Jorge Mucientes; José Javier Sánchez-Blanco; Elena Pérez-Ceballos; Francisco José Ortuño Journal: Cancer Med Date: 2017-09-27 Impact factor: 4.452