El-Galaly, Tarec Christoffer2; d'Amore, Francesco3; Mylam, Karen Juul3; de Nully Brown, Peter3; Bøgsted, Martin4; Bukh, Anne5; Specht, Lena11; Loft, Annika3; Iyer, Victor Vishwanath7; Hjorthaug, Karin8; Nielsen, Anne Lerberg9; Christiansen, Ilse5; Madsen, Charlotte Øland10; Johnsen, Hans Erik5; Hutchings, Martin3
1 Section of Surgery and Internal Medicine, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet2 Institut for Klinisk Medicin - Hæmatologisk Afd. R, THG3 unknown4 Institut for Matematiske Fag, Københavns Universitet5 Institut for Klinisk Medicin - Hæmatologisk Afdeling, Aalborg Sygehus6 Department of Clinical Medicine, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet7 Institut for Klinisk Medicin - Nuklearmedicinsk Afdeling, Aalborg Sygehus8 Klinisk fysiologi og nuclearmedicin, SKS9 Klinisk Fysiologi og Nuklearmedicin10 Institut for Økonomi og Ledelse11 Department of Clinical Medicine, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet
PURPOSETo investigate whether bone marrow biopsy (BMB) adds useful information to [(18)F]fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) staging in patients with Hodgkin lymphoma (HL). PATIENTS AND METHODSNewly diagnosed patients with HL undergoing a pretherapeutic staging that encompasses both PET/CT and BMB were included in this retrospective study. The pattern of skeletal FDG uptake was categorized as uni-, bi-, or multifocal (≥ three lesions). Clinical stage, risk assessment, and treatment plan were determined with and without the contribution of BMB results according to the Ann Arbor classification and the guidelines from the German Hodgkin Study Group.ResultsA total of 454 patients with HL were included of whom 82 (18%) had focal skeletal PET/CT lesions and 27 (6%) had positive BMB. No patients with positive BMB were assessed as having stage I to II disease by PET/CT staging. BMB upstaged five patients, assessed as being stage III before BMB; none of the 454 patients would have been allocated to another treatment on the basis of BMB results. Focal skeletal PET/CT lesions identified positive and negative BMBs with a sensitivity and specificity of 85% and 86%, respectively. The positive and negative predictive values of focal skeletal PET/CT lesions for BMB results were 28% and 99%, respectively. CONCLUSIONA consistent finding of this study was the absence of positive BMBs in PET/CT-assessed stage I to II disease. The omission of staging BMB would not have changed the risk assessment or treatment strategy in this cohort of 454 newly diagnosed patients with HL.
Journal of Clinical Oncology, 2012, Vol 30, Issue 36, p. 4508-14