PET/Computed Tomography and Lymphoma

Fluorodeoxyglucose-positron emission tomography staging can replace bone marrow biopsy in Hodgkin's lymphoma. Results from Brazilian Hodgkin's Lymphoma Study Group

Objective

To investigate, in a large prospective multicenter study, whether 2-[18F]-fluoro-2-deoxy-d-glucose-positron emission tomography is sufficiently accurate to identify clinically important bone marrow involvement by Hodgkin's lymphoma to replace routine bone marrow biopsy in a developing tropical country.

Methods

Patients newly diagnosed with Hodgkin's lymphoma were recruited from six cancer centers in Brazil. All were staged by the results of positron emission tomography/computed tomography that were centrally reviewed and by iliac crest bone marrow biopsy. Patients were classified as having marrow disease if they had lymphoma identified by marrow biopsy histology or had focal 2-[18F]-fluoro-2-deoxy-d-glucose marrow uptake that resolved following chemotherapy.

Results

A total of 246 participants were recruited from six different centers and 62 (25.2%) were judged to have Hodgkin's lymphoma in the bone marrow. Positron emission tomography and biopsies were concordant in 206 patients (83%). Positron emission tomography correctly identified marrow disease in 59/62 patients (95.1%) and marrow biopsy in 25/62 patients (40.3%). In 22/62 (35.4%) patients, the two techniques were concordant in the diagnosis of marrow involvement. Of the forty discordant results, positron emission tomography found bone marrow involvement in 37 patients, upstaging 22 to stage IV and having an impact on therapeutic decision in nine cases given their reallocation from early to advanced stage. Three false negative positron emission tomography results were obtained with bone marrow biopsy giving positive findings. All three cases were classified as stage IV regardless of bone marrow findings implying no modification in the clinical management. The sensitivity, specificity and accuracy of positron emission tomography for detecting bone marrow disease were 95%, 100% and 98% and for bone marrow biopsy they were 40%, 100% and 84%, respectively.

Conclusion

We conclude that positron emission tomography can replace marrow biopsy in Brazilian patients with Hodgkin's lymphoma without compromising clinical management.

Feasibility of a multimodal (18)F-FDG-directed lymph node surgical excisional biopsy approach for appropriate diagnostic tissue sampling in patients with suspected lymphoma

Background

¹⁸F-FDG PET/CT imaging is widely utilized in the clinical evaluation of patients with suspected or documented lymphoma. The aim was to describe our cumulative experience with a multimodal ¹⁸F-FDG-directed lymph node surgical excisional biopsy approach in patients with suspected lymphoma.

Methods

Thirteen patients (mean age 51 (±16;22–76) years), with suspected new or suspected recurrent lymphoma suggested by ¹⁸F-FDG-avid lesions seen on prior diagnostic whole-body PET/CT imaging, were injected IV with ¹⁸F-FDG prior to undergoing same-day diagnostic lymph node surgical excisional biopsy in the operating room. Various ¹⁸F-FDG detection strategies were used on the day of surgery, including, (1) same-day pre-resection patient PET/CT; (2) intraoperative gamma probe assessment; (3) clinical scanner specimen PET/CT imaging of whole surgically excised tissue specimens; (4) specimen gamma well counts; and/or (5) same-day post-resection patient PET/CT.

Results

Same-day ¹⁸F-FDG injection dose was 14.8 (±2.4;12.5-20.6) millicuries or 548 (±89;463–762) megabecquerels. Sites of ¹⁸F-FDG-avid lesions were 4 inguinal, 3 cervical, 3 abdominal/retroperitoneal, 2 axillary, and 1 gluteal region subcutaneous tissue. Same-day pre-resection patient PET/CT was performed on 6 patients. Intraoperative gamma probe assessment was performed on 13 patients. Clinical scanner PET/CT imaging of whole surgically excised tissue specimens was performed in 10 cases. Specimen gamma well counts were performed in 6 cases. Same-day post-resection patient PET/CT imaging was performed on 8 patients. Time from ¹⁸F-FDG injection to same-day pre-resection patient PET/CT, intraoperative gamma probe assessment, and same-day post-resection patient PET/CT were 76 (±8;64–84), 240 (±63;168–304), and 487 (±104;331–599) minutes, respectively. Time from ¹⁸F-FDG injection to clinical scanner PET/CT of whole surgically excised tissue specimens was 363 (±60;272–446) minutes. Time from ¹⁸F-FDG injection to specimen gamma well counts was 591 (±96;420–689) minutes. Intraoperative gamma probe assessment successfully identified ¹⁸F-FDG-avid lesions in 12/13 patients. Histopathologic evaluation confirmed lymphoma in 12/13 patients and benign disease in 1/13 patients.

Conclusions

A multimodal approach to ¹⁸F-FDG-directed lymph node surgical excisional biopsy for suspected lymphoma is technically feasible for guiding appropriate diagnostic tissue sampling of lymph nodes seen as ¹⁸F-FDG-avid lesions on diagnostic ¹⁸F-FDG PET/CT imaging.

Multiple myeloma

This article presents a review of multiple myeloma, precursor states, and related plasma cell disorders. The clinical roles of fluorodeoxyglucose PET/computed tomography (CT) and the potential to improve the management of patients with multiple myeloma are discussed. The clinical and research data supporting the utility of PET/CT use in evaluating myeloma and other plasma cell dyscrasias continues to grow.

Bone marrow FDG-PET/CT in Hodgkin lymphoma revisited: do imaging and pathology match?

PURPOSE

To directly compare visual and quantitative (18)F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) to bone marrow biopsy (BMB) findings in the right posterior iliac crest in patients with newly diagnosed Hodgkin lymphoma.

MATERIALS AND METHODS

This retrospective study included 26 patients with newly diagnosed Hodgkin lymphoma in whom FDG-PET/CT was performed before BMB of the right posterior iliac crest. The right posterior iliac crest was assessed for bone marrow involvement, both visually and semi-quantitatively [using maximum standardized uptake value (SUVmax) measurements]. BMB of right the posterior iliac crest was used as reference standard.

RESULTS

BMB of the right posterior iliac crest was positive in 5 (19.2 %) of 26 patients. There was full agreement between visual FDG-PET/CT and BMB findings in the right posterior iliac crest (i.e. no false-positive or false-negative FDG-PET/CT findings). Accordingly, sensitivity, specificity, positive predictive value, and negative predictive value of visual FDG-PET/CT assessment for the detection of bone marrow involvement in the right posterior iliac crest were 100 % (5/5) (95 % CI 51.1-100 %), 100 % (21/21) (95 % CI 81.8-100 %), 100 % (5/5) (95 % CI 51.1-100 %), and 100 % (21/21) (95 % CI 81.8-100 %), respectively. SUVmax of BMB-positive cases (mean ± SD: 3.4 ± 0.85) was nearly significantly higher (P = 0.052) than that of BMB-negative cases (mean ± SD 2.7 ± 0.63).

CONCLUSION

This histopathological correlation study confirms the very high diagnostic value of FDG-PET/CT in the detection of bone marrow involvement in newly diagnosed Hodgkin lymphoma, and supports the substitution of BMB with FDG-PET/CT in this setting.