FDG PET/CT to detect bone marrow involvement in the initial staging of patients with aggressive non-Hodgkin lymphoma: results from the prospective, multicenter PETAL and OPTIMAL>60 trials

• Published in: European journal of nuclear medicine and molecular imaging 2021-10, Vol.48 (11), p.3550-3559
• Main Authors: Kaddu-Mulindwa, Dominic, Altmann, Bettina, Held, Gerhard, Angel, Stephanie, Stilgenbauer, Stephan, Thurner, Lorenz, Bewarder, Moritz, Schwier, Maren, Pfreundschuh, Michael, Löffler, Markus, Menhart, Karin, Grosse, Jirka, Ziepert, Marita, Herrmann, Ken, Dührsen, Ulrich, Hüttmann, Andreas, Barbato, Francesco, Poeschel, Viola, Hellwig, Dirk
• Format: Article
• Language: English
• Subjects: Biopsy; Bone marrow; Bone Marrow - diagnostic imaging; Bone Marrow - pathology; Cardiology; Clinical trials; Computed tomography; Confidence intervals; Fluorine; Fluorodeoxyglucose F18; Hematology; Humans; Imaging; Lymphocytes B; Lymphoma; Lymphoma, Non-Hodgkin - diagnostic imaging; Magnetic resonance imaging; Medical diagnosis; Medical imaging; Medicine; Medicine & Public Health; Neoplasm Staging; Non-Hodgkin's lymphoma; Nuclear Medicine; Oncology; Original; Original Article; Orthopedics; Patients; Positron emission; Positron emission tomography; Positron Emission Tomography Computed Tomography; Prospective Studies; Radiology; Retrospective Studies; Tomography
• ISSN: 1619-7070; 1619-7089; 1619-7089
• DOI: 10.1007/s00259-021-05348-6

Purpose Fluorine-18 fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG PET/CT) is the standard for staging aggressive non-Hodgkin lymphoma (NHL). Limited data from prospective studies is available to determine whether initial staging by FDG PET/CT provides treatment-relevant information of bone marrow (BM) involvement (BMI) and thus could spare BM biopsy (BMB). Methods Patients from PETAL (NCT00554164) and OPTIMAL>60 (NCT01478542) with aggressive B-cell NHL initially staged by FDG PET/CT and BMB were included in this pooled analysis. The reference standard to confirm BMI included a positive BMB and/or FDG PET/CT confirmed by targeted biopsy, complementary imaging (CT or magnetic resonance imaging), or concurrent disappearance of focal FDG-avid BM lesions with other lymphoma manifestations during immunochemotherapy. Results Among 930 patients, BMI was detected by BMB in 85 (prevalence 9%) and by FDG PET/CT in 185 (20%) cases, for a total of 221 cases (24%). All 185 PET-positive cases were true positive, and 709 of 745 PET-negative cases were true negative. For BMB and FDG PET/CT, sensitivity was 38% (95% confidence interval [CI]: 32–45%) and 84% (CI: 78–88%), specificity 100% (CI: 99–100%) and 100% (CI: 99–100%), positive predictive value 100% (CI: 96–100%) and 100% (CI: 98–100%), and negative predictive value 84% (CI: 81–86%) and 95% (CI: 93–97%), respectively. In all of the 36 PET-negative cases with confirmed BMI patients had other adverse factors according to IPI that precluded a change of standard treatment. Thus, the BMB would not have influenced the patient management. Conclusion In patients with aggressive B-cell NHL, routine BMB provides no critical staging information compared to FDG PET/CT and could therefore be omitted. Trial registration NCT00554164 and NCT01478542