18F-FDG PET/CT Accurately Identifies Bone Marrow Involvement in Pediatric Hodgkin's Lymphoma

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Previous evidence has shown that 18F-FDG PET/CT may be a viable alternative and complementary procedure to biopsy during staging.
Previous evidence has shown that 18F-FDG PET/CT may be a viable alternative and complementary procedure to biopsy during staging.

F-18-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) has diagnostic utility when determining bone marrow involvement (BMI) among pediatric patients with Hodgkin lymphoma (HL), according to a study published in Clinical Lymphoma, Myeloma, and Leukemia.

Bone marrow biopsy (BMB) is used to definitively identify bone marrow involvement — a clinically relevant feature in Hodgkin lymphoma that can dictate treatment and disease staging — but is not without its challenges; bone marrow biopsy is invasive, painful, produces a small sample size, and may not detect bone marrow involvement in the case of localized disease. Previous evidence has shown that 18F-FDG PET/CT may be a noninvasive alternative and complementary procedure to biopsy during staging, but its value in detecting bone marrow involvement in lymphoma requires further investigation.

For this retrospective study, researchers assessed the outcomes of 224 previously untreated pediatric patients with Hodgkin lymphoma. Eligible patients underwent 18F-FDG PET/CT at staging (baseline) and had bone marrow biopsy results available for analysis.

Results showed that 193 of 224 patients were negative for bone marrow involvement according to the 18F-FDG PET/CT scans. Sixteen of 193 patients were initially reported as doubtful, but were later thought to be negative for BMI after confirmation by imaging follow-up and biopsy.

Biopsy revealed that only 1 of the 16 patients had bone marrow involvement, and overall, 192/193 patients had a negative biopsy.

18F-FDG PET/CT produced accurate, true negative-results in 192/193 patients and just 1 false-negative for bone involvement.

The authors concluded that the “results show that 18F-FDG PET/CT has a high diagnostic power for the evaluation of BMI involvement in HL supporting the concept that BMB should not be systematically performed in all the patients, but may be reserved exclusively for patients with doubtful 18-FDG bone marrow findings.”

Reference

Cistaro A, Cassalia L, Ferrara C, et al. Italian multicenter study on accuracy of 18F-FDG PET/CT in assessing bone marrow involvement in pediatric Hodgkin's lymphoma[published online April 14, 2018]. Clin Lymphoma Myeloma Leuk. doi: 10.1016/j.clml.2018.04.002

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