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

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Abstract

Purpose

To directly compare visual and quantitative 18F-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.

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Acknowledgments

This project was financially supported by an Alpe d’HuZes/Dutch Cancer Society Bas Mulder Award for T.C.K. (Grant No. 5409) and by a ZonMW. AGIKO stipend for T.C.K. (Grant No. 92003497). Data collection, data analysis, and interpretation of data, writing of the paper, and decision to submit were left to the authors’ discretion and were not influenced by Alpe d’HuZes/Dutch Cancer Society and ZonMW.

Conflict of interest

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Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Hugo J. A. Adams, Thomas C. Kwee & Rutger A. J. Nievelstein

  2. Department of Hematology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands

    Rob Fijnheer

  3. Department of Pathology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands

    Steven V. Dubois

  4. Department of Nuclear Medicine, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands

    John M. H. de Klerk

Authors
  1. Hugo J. A. Adams
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  2. Thomas C. Kwee
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  3. Rob Fijnheer
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  4. Steven V. Dubois
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  5. Rutger A. J. Nievelstein
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  6. John M. H. de Klerk
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Correspondence to Hugo J. A. Adams.

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Adams, H.J.A., Kwee, T.C., Fijnheer, R. et al. Bone marrow FDG-PET/CT in Hodgkin lymphoma revisited: do imaging and pathology match?. Ann Nucl Med 29, 132–137 (2015). https://doi.org/10.1007/s12149-014-0920-z

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  • DOI: https://doi.org/10.1007/s12149-014-0920-z

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