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Skeletal Radiology
Published in: Skeletal Radiology 9/2014

01-09-2014 | Scientific Article

Utility of quantitative FDG-PET/CT for the detection of bone marrow involvement in follicular lymphoma: a histopathological correlation study

Authors: Hugo J. A. Adams, Thomas C. Kwee, Rob Fijnheer, Stefan V. Dubois, Peter E. Blase, Rutger A. J. Nievelstein, John M. H. de Klerk

Published in: Skeletal Radiology | Issue 9/2014

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Abstract

Objective

To determine the value of visual and quantitative 18 F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) for the detection of bone marrow involvement in follicular lymphoma, using direct histopathological examination at the right posterior iliac crest as reference standard.

Materials and methods

This retrospective study included 22 patients with newly diagnosed follicular lymphoma who had undergone FDG-PET/CT before BMB of the right posterior iliac crest. FDG-PET/CT images were visually evaluated for bone marrow involvement in the right posterior iliac crest. Volumes of interest were placed in the right posterior iliac crest to calculate the 3D partial volume corrected mean standardized uptake value (cSUVmean), maximum standardized uptake value (SUVmax) and peak standardized uptake value (SUVpeak).

Results

Sensitivity and specificity of visual FDG-PET/CT analysis for the detection of bone marrow involvement in the right posterior iliac crest were 0.0 % (95 % confidence interval (CI): 0–32.4 %) and 100 % (95 % CI: 78.5–100 %), respectively. Areas under the receiver-operating characteristic curve of cSUVmean, SUVmax and SUVpeak for the detection of bone marrow involvement in the right posterior iliac crest were 0.85 (95 % CI: 0.63–0.96), 0.89 (95 % CI: 0.68–0.98) and 0.87 (95 % CI: 0.65–0.97), respectively. Optimal cutoff values for cSUVmean, SUVmax and SUVpeak were 1.3, 2.1 and 1.7, and yielded sensitivity and specificity combinations of 75.0 % and 85.7 %, 87.5 % and 85.7 % and 87.5 % and 85.7 %, respectively.

Conclusion

This histopathological correlation study shows that, unlike visual interpretation of FDG-PET/CT images, quantitative FDG-PET/CT analysis may be beneficial in diagnosing bone marrow involvement by follicular lymphoma.
Literature
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Ghielmini M, Vitolo U, Kimby E, Montoto S, Walewski J, Pfreundschuh M, et al. ESMO Guidelines consensus conference on malignant lymphoma 2011 part 1: diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL) and chronic lymphocytic leukemia (CLL). Ann Oncol. 2013;24(3):561–76.PubMedCrossRef
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Dreyling M, Ghielmini M, Marcus R, Salles G, Vitolo U. Newly diagnosed and relapsed follicular lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2011;22 Suppl 6:vi59–63.PubMed
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Cheson BD, Pfistner B, Juweid ME, Gascoyne RD, Specht L, Horning SJ, et al. Revised response criteria for malignant lymphoma. J Clin Oncol. 2007;25(5):579–86.PubMedCrossRef
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Weiler-Sagie M, Bushelev O, Epelbaum R, Dann EJ, Haim N, Avivi I, et al. (18)F-FDG avidity in lymphoma readdressed: a study of 766 patients. J Nucl Med. 2010;51(1):25–30.PubMedCrossRef
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Chen YK, Yeh CL, Tsui CC, Liang JA, Chen JH, Kao CH. F-18 FDG PET for evaluation of bone marrow involvement in non-Hodgkin lymphoma: a meta-analysis. Clin Nucl Med. 2011;36(7):553–9.PubMedCrossRef
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El-Najjar I, Montoto S, Mc-Dowell A, Matthews J, Gribben J, Szyszko TA. The value of semiquantitative analysis in identifying diffuse bone marrow involvement in follicular lymphoma. Nucl Med Commun. 2013;35(3):311–5.CrossRef
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Adams HJ, Kwee TC, de Keizer B, Fijnheer R, de Klerk JM, Littooij AS, et al. Systematic review and meta-analysis on the diagnostic performance of FDG-PET/CT in detecting bone marrow involvement in newly diagnosed Hodgkin lymphoma: is bone marrow biopsy still necessary? Ann Oncol. 2014.
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Adams HJ, Kwee TC, de Keizer B, Fijnheer R, de Klerk JM, Nievelstein RA. FDG PET/CT for the detection of bone marrow involvement in diffuse large B-cell lymphoma: systematic review and meta-analysis. Eur J Nucl Med Mol Imaging. 2014;41(3):565–74.PubMedCrossRef
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Sovani V, Harvey C, Haynes AP, McMillan AK, Clark DM, O’Connor SR. Bone marrow trephine biopsy involvement by lymphoma: review of histopathological features in 511 specimens and correlation with diagnostic biopsy, aspirate and peripheral blood findings. J Clin Pathol. 2013. doi:10.​1136/​jclinpath-2013-201520.PubMed
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Adams HJ, Kwee TC, Vermoolen MA, de Keizer B, de Klerk JM, Adam JA, et al. Whole-body MRI for the detection of bone marrow involvement in lymphoma: prospective study in 116 patients and comparison with FDG-PET. Eur Radiol. 2013;23(8):2271–8.PubMedCrossRef
Metadata
Title
Utility of quantitative FDG-PET/CT for the detection of bone marrow involvement in follicular lymphoma: a histopathological correlation study
Authors
Hugo J. A. Adams
Thomas C. Kwee
Rob Fijnheer
Stefan V. Dubois
Peter E. Blase
Rutger A. J. Nievelstein
John M. H. de Klerk
Publication date
01-09-2014
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 9/2014
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-014-1919-1

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