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The Value of PET/CT in Detecting Bone Marrow Involvement in Patients With Follicular Lymphoma

Follicular lymphoma (FL) is the 2nd most common type of lymphoma diagnosed in the Western World. Bone marrow (BM) involvement is an adverse prognostic factor in FL, routinely assessed by an arbitrary biopsy of the iliac crest. This study was aimed to investigate the role of positron emission tomogra...

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Autores principales: Perry, Chava, Lerman, Hedva, Joffe, Erel, Sarid, Nadav, Amit, Odelia, Avivi, Irit, Kesler, Mikhail, Ben-Ezra, Jonathan, Even-Sapir, Einat, Herishanu, Yair
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4782871/
https://www.ncbi.nlm.nih.gov/pubmed/26945387
http://dx.doi.org/10.1097/MD.0000000000002910
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author Perry, Chava
Lerman, Hedva
Joffe, Erel
Sarid, Nadav
Amit, Odelia
Avivi, Irit
Kesler, Mikhail
Ben-Ezra, Jonathan
Even-Sapir, Einat
Herishanu, Yair
author_facet Perry, Chava
Lerman, Hedva
Joffe, Erel
Sarid, Nadav
Amit, Odelia
Avivi, Irit
Kesler, Mikhail
Ben-Ezra, Jonathan
Even-Sapir, Einat
Herishanu, Yair
author_sort Perry, Chava
collection PubMed
description Follicular lymphoma (FL) is the 2nd most common type of lymphoma diagnosed in the Western World. Bone marrow (BM) involvement is an adverse prognostic factor in FL, routinely assessed by an arbitrary biopsy of the iliac crest. This study was aimed to investigate the role of positron emission tomography/computed tomography (PET/CT) in identifying BM involvement by FL. In this retrospective, single-center study we reviewed the records of consecutive patients with FL at diagnosis or relapse who underwent staging/restaging workup visual assessment of BM uptake was categorized as either normal, diffusely increased, or focally increased. Quantitative BM fluorine-18-fluro-deoxyglucose (FDG) uptake was measured using mean standardized uptake value (BM-SUV(mean)). The diagnosis of BM involvement was based on either BM histological findings or disappearance of increased uptake at end-treatment PET/CT in patients who responded to treatment. Sixty eight cases with FL were included. Sixteen (23.5%) had BM involvement, 13 (19.1%) had a biopsy proven involvement, and 3 (4.4%) had a negative BM biopsy, but increased medullary uptake that normalized post-treatment. BM FDG uptake in these patients was diffuse in 8 (50%) and focal in 8 (50%). Focal increased uptake was indicative of BM involvement; however, diffuse uptake was associated with 17 false positive cases (32.7%). Overall, visual assessment of BM involvement had a negative predictive value (NPV) of 100% and a positive predictive value (PPV) of 48.5%. On a quantitative assessment, BM-SUV(mean) was significantly higher in patients with BM involvement (SUV(mean) of 3.7 [1.7–6] vs 1.4 [0.4–2.65], P < 0.001). On receiver operator curve (ROC) analysis, BM-SUV(mean) > 2.7 had a PPV of 100% for BM involvement (sensitivity of 68%), while BM-SUV(mean) < 1.7 had an NPV of 100% (specificity of 73%). Visual assessment of PET/CT is appropriate for ruling out BM involvement by FL. Although focal increased uptake indicates marrow involvement, diffuse uptake is nonspecific. SUV measurement improves PET/CT diagnostic accuracy, identifying additional 19% of patients with BM involvement that would have been otherwise missed.
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spelling pubmed-47828712016-03-24 The Value of PET/CT in Detecting Bone Marrow Involvement in Patients With Follicular Lymphoma Perry, Chava Lerman, Hedva Joffe, Erel Sarid, Nadav Amit, Odelia Avivi, Irit Kesler, Mikhail Ben-Ezra, Jonathan Even-Sapir, Einat Herishanu, Yair Medicine (Baltimore) 4800 Follicular lymphoma (FL) is the 2nd most common type of lymphoma diagnosed in the Western World. Bone marrow (BM) involvement is an adverse prognostic factor in FL, routinely assessed by an arbitrary biopsy of the iliac crest. This study was aimed to investigate the role of positron emission tomography/computed tomography (PET/CT) in identifying BM involvement by FL. In this retrospective, single-center study we reviewed the records of consecutive patients with FL at diagnosis or relapse who underwent staging/restaging workup visual assessment of BM uptake was categorized as either normal, diffusely increased, or focally increased. Quantitative BM fluorine-18-fluro-deoxyglucose (FDG) uptake was measured using mean standardized uptake value (BM-SUV(mean)). The diagnosis of BM involvement was based on either BM histological findings or disappearance of increased uptake at end-treatment PET/CT in patients who responded to treatment. Sixty eight cases with FL were included. Sixteen (23.5%) had BM involvement, 13 (19.1%) had a biopsy proven involvement, and 3 (4.4%) had a negative BM biopsy, but increased medullary uptake that normalized post-treatment. BM FDG uptake in these patients was diffuse in 8 (50%) and focal in 8 (50%). Focal increased uptake was indicative of BM involvement; however, diffuse uptake was associated with 17 false positive cases (32.7%). Overall, visual assessment of BM involvement had a negative predictive value (NPV) of 100% and a positive predictive value (PPV) of 48.5%. On a quantitative assessment, BM-SUV(mean) was significantly higher in patients with BM involvement (SUV(mean) of 3.7 [1.7–6] vs 1.4 [0.4–2.65], P < 0.001). On receiver operator curve (ROC) analysis, BM-SUV(mean) > 2.7 had a PPV of 100% for BM involvement (sensitivity of 68%), while BM-SUV(mean) < 1.7 had an NPV of 100% (specificity of 73%). Visual assessment of PET/CT is appropriate for ruling out BM involvement by FL. Although focal increased uptake indicates marrow involvement, diffuse uptake is nonspecific. SUV measurement improves PET/CT diagnostic accuracy, identifying additional 19% of patients with BM involvement that would have been otherwise missed. Wolters Kluwer Health 2016-03-07 /pmc/articles/PMC4782871/ /pubmed/26945387 http://dx.doi.org/10.1097/MD.0000000000002910 Text en Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0
spellingShingle 4800
Perry, Chava
Lerman, Hedva
Joffe, Erel
Sarid, Nadav
Amit, Odelia
Avivi, Irit
Kesler, Mikhail
Ben-Ezra, Jonathan
Even-Sapir, Einat
Herishanu, Yair
The Value of PET/CT in Detecting Bone Marrow Involvement in Patients With Follicular Lymphoma
title The Value of PET/CT in Detecting Bone Marrow Involvement in Patients With Follicular Lymphoma
title_full The Value of PET/CT in Detecting Bone Marrow Involvement in Patients With Follicular Lymphoma
title_fullStr The Value of PET/CT in Detecting Bone Marrow Involvement in Patients With Follicular Lymphoma
title_full_unstemmed The Value of PET/CT in Detecting Bone Marrow Involvement in Patients With Follicular Lymphoma
title_short The Value of PET/CT in Detecting Bone Marrow Involvement in Patients With Follicular Lymphoma
title_sort value of pet/ct in detecting bone marrow involvement in patients with follicular lymphoma
topic 4800
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4782871/
https://www.ncbi.nlm.nih.gov/pubmed/26945387
http://dx.doi.org/10.1097/MD.0000000000002910
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