C-A Voltin1, H Goergen2, C Baues3, M Fuchs2, J Mettler1, S Kreissl4, J Oertl1, B Klaeser5, A Moccia6, A Drzezga1, A Engert4, P Borchmann4, M Dietlein1, C Kobe7. 1. Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany. 2. German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany. 3. Departments of Radiation Oncology, University Hospital of Cologne, Cologne, Germany. 4. Departments of Internal Medicine I, University Hospital of Cologne, Cologne, Germany. 5. Department of Nuclear Medicine, Inselspital, Bern University Hospital and University of Bern, Bern; Swiss Group for Clinical Cancer Research (SAKK), Bern. 6. Swiss Group for Clinical Cancer Research (SAKK), Bern; Department of Medical Oncology, Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland. 7. Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany. Electronic address: carsten.kobe@uk-koeln.de.
Abstract
Background: Bone marrow (BM) involvement defines advanced-stage Hodgkin lymphoma and thus has impact on the assignment to treatment. Our aim was to evaluate whether the established BM biopsy may be omitted in patients if 18F-fluorodeoxyglucose positron emission tomography (PET) scanning is carried out during staging. Patients and methods: Our analysis set consisted of 832 Hodgkin lymphoma patients from the German Hodgkin Study Group trials HD16, HD17, and HD18 who underwent both PET scanning and BM biopsy before treatment. All PET studies were centrally reviewed and BM was categorized as showing focal involvement or not. Results: Taking BM biopsy as reference standard, baseline PET showed a negative predictive value of 99.9% [95% confidence interval (CI) 99.2% to 100%] with true-negative results in 702 of 703 cases. The sensitivity of PET for detecting BM involvement was 95.0% (95% CI 75.1% to 99.9%) as it could identify 19 out of 20 patients with positive BM biopsy. Moreover, PET found 110 additional subjects with focal BM lesions who would have been considered negative by biopsy. Conclusions: When compared with BM biopsy, PET was able to detect focal BM lesions in a large number of additional patients. This indicates that conventional BM biopsy may substantially underestimate the actual incidence of BM involvement. Given the high negative predictive value, baseline PET scanning can safely be used to exclude BM involvement in Hodgkin lymphoma. BM biopsy should be considered only in such patients in whom PET-detected lesions lead to a change of treatment protocol. Registered trials: The trials included in this analysis were registered at ClinicalTrials.gov: HD16-NCT00736320, HD17-NCT01356680, and HD18-NCT00515554.
Background: Bone marrow (BM) involvement defines advanced-stage Hodgkin lymphoma and thus has impact on the assignment to treatment. Our aim was to evaluate whether the established BM biopsy may be omitted in patients if 18F-fluorodeoxyglucose positron emission tomography (PET) scanning is carried out during staging. Patients and methods: Our analysis set consisted of 832 Hodgkin lymphomapatients from the German Hodgkin Study Group trials HD16, HD17, and HD18 who underwent both PET scanning and BM biopsy before treatment. All PET studies were centrally reviewed and BM was categorized as showing focal involvement or not. Results: Taking BM biopsy as reference standard, baseline PET showed a negative predictive value of 99.9% [95% confidence interval (CI) 99.2% to 100%] with true-negative results in 702 of 703 cases. The sensitivity of PET for detecting BM involvement was 95.0% (95% CI 75.1% to 99.9%) as it could identify 19 out of 20 patients with positive BM biopsy. Moreover, PET found 110 additional subjects with focal BM lesions who would have been considered negative by biopsy. Conclusions: When compared with BM biopsy, PET was able to detect focal BM lesions in a large number of additional patients. This indicates that conventional BM biopsy may substantially underestimate the actual incidence of BM involvement. Given the high negative predictive value, baseline PET scanning can safely be used to exclude BM involvement in Hodgkin lymphoma. BM biopsy should be considered only in such patients in whom PET-detected lesions lead to a change of treatment protocol. Registered trials: The trials included in this analysis were registered at ClinicalTrials.gov: HD16-NCT00736320, HD17-NCT01356680, and HD18-NCT00515554.
Authors: Lucia Baratto; K Elizabeth Hawk; Lisa States; Jing Qi; Sergios Gatidis; Louise Kiru; Heike E Daldrup-Link Journal: J Nucl Med Date: 2021-10 Impact factor: 10.057
Authors: Julian M M Rogasch; Ronald Boellaard; Lucy Pike; Peter Borchmann; Peter Johnson; Jürgen Wolf; Sally F Barrington; Carsten Kobe Journal: Eur J Nucl Med Mol Imaging Date: 2021-05-14 Impact factor: 9.236