ISSN: 0034-8376
eISSN: 2564-8896






18f-Fluorodeoxyglucose Positron Emission Tomography Versus Bone Marrow Biopsy for the Evaluation of Bone Marrow Infiltration in Newly Diagnosed Lymphoma Patients



Tania M. Aguado-Vázquez, Department of Hematology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
Antonio Olivas-Martínez, Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Uvi Cancino-Ramos, Department of Nuclear Medicine, Instituto Nacional de Cancerología, Mexico City, Mexico
Diego A. Zúñiga-Tamayo, Hematopathology Division, Instituto Nacional de Cancerología, Mexico City, Mexico
María del C. A. Lome-Maldonado, Hematopathology Division, Instituto Nacional de Cancerología, Mexico City, Mexico
Silvia Rivas-Vera, Department of Hematology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
Francisco O. García-Pérez, Department of Nuclear Medicine, Instituto Nacional de Cancerología, Mexico City, Mexico
Myrna Candelaria-Hernández, Pharmacogenetics Laboratory; Hematology Department, Instituto Nacional de Cancerología, Mexico City, Mexico


Background: Bone marrow evaluation (BME) is crucial for establishing an accurate staging and prognosis in lymphoma patients. Objective: The objective of the study was to study the diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) against bone marrow biopsy (BMB) for BME. Methods: Five hundred patient files of newly diagnosed lymphoma patients treated at an academic medical center were reviewed for BME at diagnosis by BMB and FDG PET-CT. Diagnostic performance of FDG PET-CT for detecting bone marrow infiltration (BMI) was assessed, as well as clinical predictors for positive BMB and positive FDG PET-CT. Results: BMB was positive in 16.3% of all patients, and 28.7% had a positive FDG PET-CT for BMI. Overall, the sensitivity of FDG PET-CT was 74.1% and specificity 80.1%. As for predictors for BMB and FDG PET-CT positivity, B symptoms and thrombocytopenia were independent factors for BMI. Seventy-four patients had discordant results between BMB and FDG PET-CT, non-Hodgkin lymphoma (NHL) having the most significant discordance. This discrepancy did not affect treatment. Conclusions: FDG PET-CT shows excellent performance for the detection of BMI in Hodgkin lymphoma. For diffuse large B-cell lymphoma, we recommend performing BMB and FDG PET-CT as complementary tests. In all other NHL, a unilateral BMB is mandatory at diagnosis.



Keywords: Bone marrow infiltration. Bone marrow biopsy. 18F-Fluorodeoxyglucose. Positron Emission Tomography. Lymphoma.