Skip to main content
SpringerLink
Log in

Predictive value of 18 F-FDG PET/CT versus bone marrow biopsy and aspiration in pediatric neuroblastoma

  • Research
  • Published:
Clinical & Experimental Metastasis Aims and scope Submit manuscript

Abstract

Background

Neuroblastoma (NB) is the most prevalent solid extracranial malignancy in children, often with bone marrow metastases (BMM) are present. The conventional approach for detecting BMM is bone marrow biopsy and aspiration (BMBA). 18 F-fluorodeoxyglucose-positron emission tomography/computed tomography (18 F-FDG PET/CT) has become a staple for staging and is also capable of evaluating marrow infiltration. The consensus on the utility of 18 F-FDG PET/CT for assessing BMM in NB patients is still under deliberation.

Methods

This retrospective study enrolled 266 pediatric patients with pathologically proven NB. All patients had pretherapy FDG PET/CT. BMBA, clinical, radiological, and follow-up data were also collected. The diagnostic accuracy of BMBA and 18 F-FDG PET/CT was assessed.

Results

BMBAs identified BMM in 96 cases (36.1%), while 18 F-FDG PET/CT detected BMI in 106 cases (39.8%) within the cohort. The initial sensitivity, positive predictive value (PPV), specificity, and negative predictive value (NPV) of 18 F-FDG PET/CT were 93.8%, 84.9%, 90.6%, and 96.3%, respectively. After treatment, these values were 92.3%, 70.6%, 97.3%, and 99.4%, respectively. The kappa statistic, which measures agreement between BMBA and 18 F-FDG PET/CT, was 0.825 before treatment and 0.784 after treatment, with both values indicating a substantial agreement (P = 0.000). Additionally, the amplification of MYCN and a positive initial PET/CT scan were identified as independent prognostic factors for overall survival (OS).

Conclusion

18 F-FDG-PET/CT is a valuable method for evaluating BMM in NB. The routine practice of performing a BMBA without discrimination may need to be reassessed. Negative result from 18 F-FDG-PET/CT could potentially spare children with invasive bone marrow biopsies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

No datasets were generated or analysed during the current study.

References

  1. Pastor ER, Mousa SA (2019) Current management of neuroblastoma and future direction. Crit Rev Oncol Hematol 138:38–43

    Article  PubMed  Google Scholar 

  2. Cheung NK, Dyer MA (2013) Neuroblastoma: developmental biology, cancer genomics and immunotherapy. Nat Rev Cancer 13(6):397–411

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. DuBois SG, Kalika Y, Lukens JN et al (1999) Metastatic sites in stage IV and IVS neuroblastoma correlate with age, tumor biology, and survival. J Pediatr Hematol Oncol 21(3):181–189

    Article  CAS  PubMed  Google Scholar 

  4. Cohn SL, Pearson AD, London WB et al (2009) The International Neuroblastoma Risk Group (INRG) classification system: an INRG Task Force report. J Clin Oncol 27(2):289–297

    Article  PubMed  PubMed Central  Google Scholar 

  5. Davidoff AM (2021) Neonatal neuroblastoma. Clin Perinatol 48(1):101–115

    Article  PubMed  Google Scholar 

  6. Bosse KR, Maris JM (2016) Advances in the translational genomics of neuroblastoma: from improving risk stratification and revealing novel biology to identifying actionable genomic alterations. Cancer 122(1):20–33

    Article  CAS  PubMed  Google Scholar 

  7. Lister TA, Crowther D, Sutcliffe SB et al (1989) Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin’s disease: Cotswolds meeting. J Clin Oncol 7(11):1630–1636

    Article  CAS  PubMed  Google Scholar 

  8. Merugu S, Chen L, Gavens E et al (2020) Detection of circulating and disseminated neuroblastoma cells using the ImageStream Flow Cytometer for Use as predictive and pharmacodynamic biomarkers. Clin Cancer Res 26(1):122–134

    Article  CAS  PubMed  Google Scholar 

  9. Orr KE, McHugh K (2019) The new international neuroblastoma response criteria. Pediatr Radiol 49(11):1433–1440

    Article  PubMed  Google Scholar 

  10. Boubaker A, Bischof Delaloye A (2003) Nuclear medicine procedures and neuroblastoma in childhood. Their value in the diagnosis, staging and assessment of response to therapy. Q J Nucl Med 47:31–40

    CAS  PubMed  Google Scholar 

  11. Biasotti S, Garaventa A, Villavecchia GP, Cabria M, Nantron M, De Bernardi B (2000) False-negative metaiodobenzylguanidine scintigraphy at diagnosis of neuroblastoma. Med Pediatr Oncol 35:153–155

    Article  CAS  PubMed  Google Scholar 

  12. Kushner BH, Yeh SD, Kramer K, Larson SM, Cheung NK (2003) Impact of metaiodobenzylguanidine scintigraphy on assessing response of high-risk neuroblastoma to dose-intensive induction chemotherapy. J Clin Oncol 21:1082–1086

    Article  PubMed  Google Scholar 

  13. Bar-Sever Z, Biassoni L, Shulkin B et al (2018) Guidelines on nuclear medicine imaging in neuroblastoma. Eur J Nucl Med Mol Imaging 45:2009–2024

    Article  CAS  PubMed  Google Scholar 

  14. Völker T, Denecke T, Steffen I et al (2007) Positron emission tomography for staging of pediatric sarcoma patients: results of a prospective multicenter trial. J Clin Oncol 25(34):5435–5441

    Article  PubMed  Google Scholar 

  15. Boellaard R, Delgado-Bolton R, Oyen WJ et al (2015) FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging 42(2):328–354

    Article  CAS  PubMed  Google Scholar 

  16. Cheng G, Chen W, Chamroonrat W, Torigian DA, Zhuang H, Alavi A (2011) Biopsy versus FDG PET/CT in the initial evaluation of bone marrow involvement in pediatric lymphoma patients. Eur J Nucl Med Mol Imaging 38(8):1469–1476

    Article  PubMed  Google Scholar 

  17. Zapata CP, Cuglievan B, Zapata CM et al (2018) PET/CT versus bone marrow biopsy in the initial evaluation of bone marrow infiltration in various pediatric malignancies. Pediatr Blood Cancer. 65(2)

  18. Tezol Ö, Sağcan F, Özcan PP, Çıtak EÇ (2020) Bone marrow involvement in pediatric malignancies: a comparison study of Positron emission tomographycomputed tomography and bone marrow biopsy. Turk J Pediatr 62(2):182–190

    Article  PubMed  Google Scholar 

  19. Hassan A, Siddique M, Bashir H et al (2017) (18)F-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

    Article  CAS  PubMed  Google Scholar 

  20. Chen S, Wang S, He K, Ma C, Fu H, Wang H (2018) 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

    Article  PubMed  Google Scholar 

  21. Purz S, Mauz-Körholz C, Körholz D et al (2011) [18F]fluorodeoxyglucose positron emission tomography for detection of bone marrow involvement in children and adolescents with Hodgkin’s lymphoma. J Clin Oncol 29:3523–3528

    Article  PubMed  Google Scholar 

  22. Vik TA, Pfluger T, Kadota R et al (2009) (123)I-mIBG scintigraphy in patients with known or suspected neuroblastoma: results from a prospective multicenter trial. Pediatr Blood Cancer 52:784–790

    Article  PubMed  Google Scholar 

  23. Melzer HI, Coppenrath E, Schmid I et al (2011) 123I-MIBG scintigraphy/SPECT versus 18F-FDG PET in paediatric neuroblastoma. Eur J Nucl Med Mol Imaging 38:1648–1658

    Article  PubMed  Google Scholar 

  24. Dhull VS, Sharma P, Patel C et al (2015) Diagnostic value of 18F-FDG PET/CT in paediatric neuroblastoma: comparison with 131I-MIBG scintigraphy. Nucl Med Commun 36:1007–1013

    Article  PubMed  Google Scholar 

  25. Papathanasiou ND, Gaze MN, Sullivan K et al (2011) 18F-FDG PET/CT and 123I-metaiodobenzylguanidine imaging in high-risk neuroblastoma: diagnostic comparison and survival analysis. J Nucl Med 52:519–525

    Article  CAS  PubMed  Google Scholar 

  26. Piccardo A, Lopci E, Conte M et al (2012) Comparison of 18F-dopa PET/CT and 123I-MIBG scintigraphy in stage 3 and 4 neuroblastoma: a pilot study. Eur J Nucl Med Mol Imaging 39:57–71

    Article  CAS  PubMed  Google Scholar 

  27. Piccardo A, Lopci E, Foppiani L, Morana G, Conte M (2014) (18)F-DOPA PET/CT for assessment of response to induction chemotherapy in a child with high-risk neuroblastoma. Pediatr Radiol 44:355–361

    Article  PubMed  Google Scholar 

  28. Piccardo A, Morana G, Puntoni M et al (2020) Diagnosis, treatment response, and prognosis: the role of (18)F-DOPA PET/CT in children affected by Neuroblastoma in comparison with (123)I-mIBG scan: the first prospective study. J Nucl Med 61:367–374

    Article  CAS  PubMed  Google Scholar 

  29. Piccardo A, Puntoni M, Lopci E et al (2014) Prognostic value of 18F-DOPA PET/CT at the time of recurrence in patients affected by neuroblastoma. Eur J Nucl Med Mol Imaging 41:1046–1056

    Article  PubMed  Google Scholar 

  30. Liu CJ, Lu MY, Liu YL et al (2017) Risk stratification of Pediatric patients with Neuroblastoma using volumetric parameters of 18F-FDG and 18F-DOPA PET/CT. Clin Nucl Med 42:e142–e148

    Article  PubMed  Google Scholar 

  31. Ko KY, Yen RF, Ko CL et al (2022) Prognostic value of interim 18F-DOPA and 18F-FDG PET/CT findings in Stage 3–4 Pediatric Neuroblastoma. Clin Nucl Med 47:21–25

    Article  PubMed  Google Scholar 

  32. Li C, Zhang J, Chen S et al (2018) Prognostic value of metabolic indices and bone marrow uptake pattern on preoperative 18F-FDG PET/CT in pediatric patients with neuroblastoma. Eur J Nucl Med Mol Imaging 45(2):306–315

    Article  PubMed  Google Scholar 

  33. Liu J, Li C, Yang X et al (2022) The Diagnostic Value of (18)F-FDG PET/CT Bone Marrow Uptake Pattern in Detecting Bone Marrow Involvement in Pediatric Neuroblastoma Patients. Contrast Media Mol Imaging. 2022: 7556315

  34. Shah S, Purandare N, Kembhavi S et al (2022) FDG PETCT for assessing marrow involvement at staging pediatric nonhematological round cell malignancies. Nucl Med Commun 43(1):56–63

    Article  CAS  PubMed  Google Scholar 

  35. Fu Z, Ren J, Zhou J, Shen J (2022) Comparing the diagnostic value of 18F-FDG PET/CT scan and bone marrow biopsy in newly diagnosed pediatric neuroblastoma and ganglioneuroblastoma. Front Oncol 12:1031078

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

None declared.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Surgical oncology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, 400014, China

    Zhenzhen Zhao & Chao Yang

  2. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China

    Chao Yang

Authors
  1. Zhenzhen Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chao Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Zhenzhen Zhao: Data collecting, statistical analysis, investigation, writing-original draft, writing-reviewing and editing.Chao Yang: conceptualisation, methodology, supervision, writing-reviewing and editing.

Corresponding author

Correspondence to Chao Yang.

Ethics declarations

Competing interests

The authors declare no competing interests.

Chao Yang

conceptualisation, methodology, supervision, writing-reviewing and editing.

Ethics approval

This study was approved by the Review committee of the Children’s Hospital of Chongqing Medical University.

Consent to participate

Written informed consent was obtained from the parents.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhao, Z., Yang, C. Predictive value of 18 F-FDG PET/CT versus bone marrow biopsy and aspiration in pediatric neuroblastoma. Clin Exp Metastasis (2024). https://doi.org/10.1007/s10585-024-10286-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10585-024-10286-2

Keywords

Search

Navigation