Cancer Research and Treatment

Original Article

The Clinical Utility of FDG PET-CT in Evaluation of Bone Marrow Involvement by Lymphoma: Ho Young Kim, Ju-Seok Kim, Dae Ro Choi, Hyeong Su Kim, Jung Hye Kwon, Geun-Doo Jang, Jung Han Kim, Joo Young Jung, Hun Ho Song, Young Kyung Lee, Soo Kee Min, Hee Sung Hwang, Hwa Jung Kim, Dae Young Zang, Hyo Jung Kim; Cancer Res Treat. 2015;47(3):458-464. Published online November 24, 2014; DOI: https://doi.org/10.4143/crt.2014.091

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.

Citations

Citations to this article as recorded by

FDG PET/CT versus Bone Marrow Biopsy for Diagnosis of Bone Marrow Involvement in Non-Hodgkin Lymphoma: A Systematic Review
Jawaher Almaimani, Charalampos Tsoumpas, Richard Feltbower, Irene Polycarpou
Applied Sciences.2022; 12(2): 540. CrossRef
Comparison of the RECIST and EORTC PET criteria in the tumor response assessment: a pooled analysis and review
Jung Han Kim, Bum Jun Kim, Hyun Joo Jang, Hyeong Su Kim
Cancer Chemotherapy and Pharmacology.2017; 80(4): 729. CrossRef
Comparison of the RECIST and PERCIST criteria in solid tumors: a pooled analysis and review
Seon Jeong Min, Hyun Joo Jang, Jung Han Kim
Oncotarget.2016; 7(19): 27848. CrossRef

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Case Report

F-18 FDG PET-positive Fibrous Dysplasia in a Patient with Intestinal Non-Hodgkin's Lymphoma: Mi Kim, Hyeong Su Kim, Jung Han Kim, Joo Hyun Jang, Kook Jin Chung, Mi Kyung Shin, Hee Sung Hwang, Byung Chun Kim, So Young Jung; Cancer Res Treat. 2009;41(3):171-174. Published online September 28, 2009; DOI: https://doi.org/10.4143/crt.2009.41.3.171

Abstract PDF PubReader ePub

Fibrous dysplasia (FD) is a common benign bone disorder of an unclear etiology. It is known that FD can appear without an increased FDG uptake on F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). However, there are also several reports that FD showed increased FDG uptake and this mimicked malignant bone involvement on FDG-PET. Herein we describe a case of biopsy-proven FDG-PET positive FD in a patient with intestinal non-Hodgkin's lymphoma (NHL). A 45-year-old woman was diagnosed with intestinal NHL, which was removed by right hemicolectomy. After the operation, the FDG-PET/CT scan showed hypermetabolic activity in the right transverse process of the T10 vertebra. The patient then received a total of 6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy every 3 weeks. After completion of the planned chemotherapy, the 2^nd FDG-PET/CT showed increased FDG uptake (SUVmax=6.0 g/mL) of the previous bone lesion. The MR images revealed a T1-hypointense lesion with sharp borders in the same region, and this showed homogenous contrast enhancement on the fat-suppressed T1-weighted images. After the radiologic studies were carefully reviewed, the bone lesion was assumed to be benign such as FD. We performed bone biopsy and the histological examination confirmed the diagnosis of FD. In conclusion, bone lesions with FDG uptake need to be carefully interpreted when evaluating patients with known malignancy.

Citations

Citations to this article as recorded by

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Acta Haematologica.2021; 144(2): 212. CrossRef
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International Journal of Oncology.2020;[Epub] CrossRef
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