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18F-FDG PET-CT imaging versus bone marrow biopsy in pediatric Hodgkin’s lymphoma: a quantitative assessment of marrow uptake and novel insights into clinical implications of marrow involvement

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Objective

To evaluate whether positron emission tomography/computed tomography using fluorine-18 fluoro-deoxyglucose (18F-FDG PET-CT) predicts bone marrow involvement (BMI) in pediatric Hodgkin’s lymphoma (pHL) with sufficient accuracy to supplant routine staging bone marrow biopsy (BMB), and to assess the clinical importance of marrow disease by comparing the prognosis of stage IV HL with BMI versus that without BMI.

Methods

Data were retrospectively analyzed for all cases of pHL between July 2010 and June 2015 referred for staging 18F-FDG PET-CT scan and BMB. The reference standard was BMB. Stage IV patients were divided into three groups to compare their progression-free and overall survival: PET+ BMB−, PET+ BMB+, and PET– BMB−.

Results

Of the 784 patients, 83.3% were male and 16.7% female, with age ranging from 2 to 18 years (mean 10.3 years). Among the total cases, 104 (13.3%) had BMI; of these, 100 were detected by PET imaging and 58 by BMB. BMB and 18F-FDG PET/CT scans were concordant for BMI detection in 728 patients (93%): positive concordance in 54 and negative in 674. Of the 56 discordant cases, four had a false-negative PET scans and were upstaged by BMB, 46 with focal uptake were PET/CT-positive and BMB-negative (not obtained from active sites), and six with diffuse uptake were false-positive on PET due to paraneoplastic marrow activation. The sensitivity, specificity, PPV, and NPV of PET for identifying BMI was 93.6, 94, 53, and 99.4% respectively. On quantitative assessment, mean iBM-SUVmax of bilateral iliac crests was significantly higher in those with BMI versus those without (p < 0.05).

Conclusions

18F-FDG PET-CT imaging is more sensitive than BMB for BMI detection in pHL staging. BMB should be limited to those with normal marrow uptake in the presence of poor risk factors or those with diffusely increased uptake to exclude marrow involvement in the background of reactive marrow.

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Acknowledgements

Author contributions

Aamna Hassan and Maimoona Siddique reviewed the literature and were primarily responsible for analyzing data and manuscript writing. Maimoona Siddique and Asma Mahreen performed the data collection. Saima Riaz conducted the data analysis. Humayun Bashir, Rabia Wali, and M. Khalid Nawaz made revisions to the manuscript.

All authors have read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7-A, Block R-3, Johar Town, Lahore, Pakistan, 54000

    Aamna Hassan, Maimoona Siddique, Humayun Bashir, Saima Riaz & M. Khalid Nawaz

  2. Paediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan

    Rabia Wali & Asma Mahreen

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  1. Aamna Hassan
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  2. Maimoona Siddique
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Correspondence to Aamna Hassan.

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This study was approved by the Institutional Review Board. This research work is original and has been neither published elsewhere nor submitted for publication simultaneously. All authors confirm adherence to ethical standards.

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Hassan, A., Siddique, M., Bashir, H. et al. 18F-FDG PET-CT imaging versus bone marrow biopsy in pediatric Hodgkin’s lymphoma: a quantitative assessment of marrow uptake and novel insights into clinical implications of marrow involvement. Eur J Nucl Med Mol Imaging 44, 1198–1206 (2017). https://doi.org/10.1007/s00259-017-3647-y

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