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PET/CT predicts bone marrow involvement in paediatric non-Hodgkin lymphoma and may preclude the need for bone marrow biopsy in selected patients

  • Paediatric
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Abstract

Objectives

To investigate the role of 18F-FDG PET/CT to detect bone marrow (BM) involvement in paediatric non-Hodgkin lymphoma (NHL).

Methods

Pretreatment PET/CT scans from 93 consecutive paediatric patients with NHL were retrospectively reviewed. Patterns of BM FDG uptake and standardized uptake value of the fifth lumbar vertebra (SUVBM) were compared with bone marrow biopsy (BMB) for diagnosis of BM involvement.

Results

Of 93 patients, 41 were judged to have BM involvement. Thirty-nine were identified by PET/CT, versus 23 by BMB. Sensitivity and specificity were 95 % and 98 % for PET/CT and 56 % and 100 % for BMB, respectively. None of the patients with BM FDG uptake lower than liver had positive BMB. In 45 patients presenting homogeneously increased BM uptake, positive BMB was achieved in 93 % (14/15) of patients with FDG uptake expanding to the distal portion of extremities, compared to 7 % (2/30) of those without. A multifocal pattern was observed in 25 patients and 18 had negative BMB. SUVBM differentiated BM involvement from benign BM activation with an area under the curve of 0.885 (p < 0.001).

Conclusions

PET/CT had a high level of accuracy for detecting BM involvement in paediatric NHL. BMB might be omitted in selected patients.

Key Points

• PET/CT allows for accurate detection of bone marrow involvement.

• Patterns of bone marrow FDG uptake are highly correlated with marrow disease.

• Bone marrow biopsy could be omitted in selected paediatric patients.

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Abbreviations

ALCL:

Anaplastic large-cell lymphoma

AUC:

Area under the curve

BM:

Bone marrow

BMB:

Bone marrow biopsy

BMP:

Pattern of FDG uptake in bone marrow

B-NHL:

B-cell lymphoma/leukaemia

LBL:

Lymphoblastic lymphoma/leukaemia

LDH:

Lactate dehydrogenase

NHL :

Non-Hodgkin lymphoma

ROC:

Receiver operating characteristic

SUVBM :

Average standardized uptake value of bone marrow

SUVL :

Average standardized uptake value of the liver

SUVT :

Maximum standardized uptake value of tumour

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Funding

This study has received funding by the National Natural Science Fund (51233007, 81271612 and 81401439).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Suyun Chen, Shaoyan Wang, Chao Ma, Hongliang Fu & Hui Wang

  2. Department of Pediatric Hematology/Oncology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Kejun He

Authors
  1. Suyun Chen
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  2. Shaoyan Wang
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  4. Chao Ma
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Corresponding author

Correspondence to Hui Wang.

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Guarantor

The scientific guarantor of this publication is Prof. Hui Wang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Chen, S., Wang, S., He, K. et al. PET/CT predicts bone marrow involvement in paediatric non-Hodgkin lymphoma and may preclude the need for bone marrow biopsy in selected patients. Eur Radiol 28, 2942–2950 (2018). https://doi.org/10.1007/s00330-018-5306-5

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  • DOI: https://doi.org/10.1007/s00330-018-5306-5

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