A more precise method for determining bone marrow involvement in patients with diffuse large B-cell lymphoma (DLBCL)-a key factor in tailoring patient management plans-has been identified by researchers in a study published in the August issue of The Journal of Nuclear Medicine. Imaging with 18F-FDG positron emission tomography/computed tomography (PET/CT), when compared to bone marrow biopsy, was more sensitive, showed a higher negative predictive value and was more accurate, changing treatment for 42 percent of patients with bone marrow involvement.
DLBCL is the most frequent subtype of high-grade non-Hodgkin lymphoma, accounting for nearly 30 percent of all newly diagnosed cases in the United States. In recent decades, there has been a 150 percent increase in incidence of DLBCL.
“In our study, we showed that in diffuse large B-cell lymphoma, 18F-FDG PET/CT has better diagnostic performance than bone marrow biopsy to detect bone marrow involvement and provides a better prognostic stratification. While bone marrow biopsy is considered the gold standard to evaluate bone marrow involvement by high-grade lymphomas, 18F-FDG PET/CT is in fact the best method to evaluate extension of the disease, as well as avoid invasive procedures,†said Louis Berthet, MD, lead author of the study “In Newly Diagnosed Diffuse Large B-Cell Lymphoma, Determination of Bone Marrow Involvement with 18F-FDG PET/CT Provides Better Diagnostic Performance and Prognostic Stratification Than Dose Biopsy.â€
The retrospective study included 133 patients diagnosed with DLBCL. All patients received both a whole-body 18F-FDG PET/CT scan, as well as a bone marrow biopsy to determine bone marrow involvement. A final diagnosis of bone marrow involvement was made if the biopsy was positive, or if the positive PET/CT scan was confirmed by a guided biopsy, by targeted magnetic resonance imaging (MRI) or, after chemotherapy, by the concomitant disappearance of focal bone marrow uptake and uptake in other lymphoma lesions on 18F-FDG PET/CT reassessment. Progression-free survival and overall survival were then analyzed.