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Biopsy remains indispensable for evaluating bone marrow involvement in DLBCL patients despite the use of positron emission tomography

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Abstract

Initial staging by positron emission tomography/computed tomography (PET/CT) scanning is recommended for patients with diffuse large B-cell lymphoma (DLBCL). Whether both PET/CT and bone marrow biopsy (BMB) are required remains unclear. This study examined whether staging by PET/CT is sufficient. Participants with untreated DLBCL assessed using both PET/CT and BMB were included. Patients received independent diagnostic assessments from a radiologist and a hematopathologist. Both hematoxylin–eosin staining and CD20 immunostaining were performed to determine the bone marrow involvement in BMB. A total of 84 patients were included. The number of patients with positive bone marrow involvement identified by PET/CT and BMB was 16 (19%) and 22 (26%), respectively. Eight (10%) patients showed positive results in both tests. When considering BMB as a reference, PET/CT showed 36% sensitivity and 87% specificity, with positive and negative predictive values of 50% and 79%, respectively. BMB-positive patients had shorter progression-free (PFS) and overall (OS) survival than their BMB-negative counterparts. Compared to PET/CT-negative patients, patients with positive results did not show any significant differences in PFS and OS. However, among 16 PET/CT-positive patients, poor PFS and OS were observed among patients who were also BMB positive. BMB remains a mandatory step in staging of untreated DLBCL patients.

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Authors and Affiliations

  1. Division of Hematology and Oncology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan

    Yusuke Saiki, Naoto Tomita, Akiko Uchida, Yu Uemura, Yoshinori Suzuki, Tsuneaki Hirakawa, Masayuki Kato, Ikuo Miura & Ayako Arai

  2. Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan

    Masahiro Hoshikawa

  3. Department of Radiology, YUAI Clinic, Yokohama, Japan

    Tsuyoshi Kawano

  4. Department of Pathology, Tokai University School of Medicine, Isehara, Japan

    Naoya Nakamura

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  1. Yusuke Saiki
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Correspondence to Naoto Tomita.

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Saiki, Y., Tomita, N., Uchida, A. et al. Biopsy remains indispensable for evaluating bone marrow involvement in DLBCL patients despite the use of positron emission tomography. Int J Hematol 113, 675–681 (2021). https://doi.org/10.1007/s12185-021-03080-3

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  • DOI: https://doi.org/10.1007/s12185-021-03080-3

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