Blood Res 2018; 53(4): 281-287  https://doi.org/10.5045/br.2018.53.4.281
Detection of bone marrow involvement with FDG PET/CT in patients with newly diagnosed lymphoma
H. Tahsin Özpolat1, Ebru Yilmaz2, Hasan Sami Goksoy3, Sahre Özpolat4, Öner Dogan5, Seher Nilgun Unal2, Meliha Nalcaci3
1Bloodworks Research Institute, Seattle, WA, USA, 2Department of Nuclear Medicine, 3Department of Hematology, Istanbul School of Medicine, 4Department of Biostatistics and Epidemiology, Marmara School of Medicine, 5Department of Pathology, Istanbul School of Medicine, Istanbul, Turkey
Correspondence to: H. Tahsin Özpolat, M.D., Bloodworks Research Institute, 1551 Eastlake Ave E Suite 100, Seattle, WA 98102, USA
E-mail: tahsino@bloodworksnw.org
Received: February 14, 2018; Revised: May 16, 2018; Accepted: May 27, 2018; Published online: December 31, 2018.
© The Korean Journal of Hematology. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0)which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background
Bone marrow involvement (BMI) affects the lymphoma stage, survival, and treatment. Bone marrow biopsy (BMB) and fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) are useful techniques to detect BMI. Both have advantages and disadvantages. We aimed to identify factors that could be used to predict BMI with positive and negative results on PET/CT compare them with BMB in newly diagnosed patients with lymphoma.
Methods
We included 22 non-Hodgkin and 16 Hodgkin lymphoma patients in this single center study. All patients had PET/CT examination and BMB before treatment. BMI in BMB was reported as negative or positive. Bone marrow was classified into 3 types by FDG uptake on PT/CT; diffuse involvement, focal involvement, and normal bone marrow.
Results
PET/CT and BMB results were concordant (7 positive, 15 negative) in 22 patients (57%). We evaluated concordant and discordant patient characteristics and risk-stratified patients for BMI. Our findings suggest that patients with diffuse FDG uptake on PET/CT, especially patients with advanced age and low platelet and white blood cell counts, are likely to have BMI and could potentially forego BMB. Patients with negative PET/CT findings and no significant laboratory abnormalities are very unlikely to have BMI.
Conclusion
Our results suggest that BMI should not be decided solely based PET/CT or BMB findings. It is reasonable to use both diagnostic assays along with clinical and laboratory findings. PET/CT result, clinical and laboratory findings could be useful for predicting BMI in patient for whom BMB is contraindicated.
Keywords: Lymphoma, Bone marrow biopsy, PET/CT, Bone marrow involvement, Diffuse, Focal involvement


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