Assessing bone marrow involvement in diffuse large B-cell lymphoma with 18F-FDG PET/CT: A preliminary experience at Hospital Pulau Pinang.

BACKGROUND

Bone marrow biopsy (BMB) is the standard of care for detecting bone marrow involvement (BMI) in newly diagnosed diffuse large B-cell lymphoma (DLBCL). The role of 18F-FDG PET/CT has been explored as a non-invasive method for detecting BMI in newly diagnosed DLBCL. Due to limited evidence, this method has not been adopted as a mainstream investigation for BMI in Malaysia. The aim of this study was to identify the role of 18F-FDG PET/CT for the detection of BMI in newly diagnosed DLBCL patients at Hospital Pulau Pinang (HPP).

METHODS

DLBCL patients at HPP who underwent 18F-FDG PET/CT and BMB were recruited between November 2016 to February 2018. Two reviewers, blinded to the BMB results, evaluated the 18F-FDG PET/CT scans to identify and characterize BMI. The diagnostic performance of 18F-FDG PET/CT was calculated using the BMB histopathological evaluation as the reference standard.

RESULTS

A total of 21 DLBCL patients were enrolled. Seven patients demonstrated BMI on PET/CT (3 with multifocal uptake were concordant with BMB). Fourteen scans were negative for BMI and concordant with BMB. The sensitivity and specificity of 18F-FDG PET/CT scans for detecting BMI is 100% and 77.8%, respectively.

CONCLUSION

18F-FDG PET/CT is excellent for ruling-out the presence of BMI. A negative 18F-FDG PET/CT scan for BMI can preclude the need for BMB in certain cases. Although 18F-FDG PET/CT can accurately detect BMI in multifocal pattern of infiltration, it cannot fully replace BMB, which is still considered as the gold standard for evaluating BMI in DLBCL.