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. 2017 Jan 18;12(1):e0170299.
doi: 10.1371/journal.pone.0170299. eCollection 2017.

PET/CT Scanner and Bone Marrow Biopsy in Detection of Bone Marrow Involvement in Diffuse Large B-Cell Lymphoma

Fadi El Karak  1 , Ibrahim R Bou-Orm  1 , Marwan Ghosn  1 , Joseph Kattan  1 , Fadi Farhat  1 , Toni Ibrahim  1 , Mario Jreige  2 , Jean El Cheikh  3 , Mohamad Haidar  4
Affiliations

PET/CT Scanner and Bone Marrow Biopsy in Detection of Bone Marrow Involvement in Diffuse Large B-Cell Lymphoma

Fadi El Karak et al. PLoS One. .

Abstract

Evaluation of bone marrow involvement (BMI) is paramount in diffuse large B-cell lymphoma (DLBCL) for prognostic and therapeutic reasons. PET/CT scanner (PET) is now a routine examination for the staging of DLBCL with prognostic and therapeutic implications. This study evaluates the role of PET for detecting marrow involvement compared to bone marrow biopsy (BMB). This monocentric study included 54 patients diagnosed with DLBCL between 2009 and 2013 and who had FDG PET/CT in a pre-treatment setting. A correlation analysis of the detection of BMI by PET and BMB was performed. A prognostic evaluation of BMI by BMB and/or PET/CT and correlation with an overall 2-year survival were analyzed. PET was more sensitive for the detection of BMI than BMB (92.3% vs. 38.5%). It can be considered a discriminatory Pre-BMB test with a negative predictive value of 97.6%. In addition, BMI by PET had a prognostic value with strong correlation with progression-free survival (PFS) (HR = 3.81; p = 0.013) and overall survival (OS) (HR = 4.12; p = 0.03) while the BMB had not. PET shows superior performance to the BMB for the detection of marrow involvement in DLBCL. It may be considered as the first line examination of bone marrow instead of the biopsy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PFS curves.
The PFS curves are provided according to the result of bone marrow involvement (a) BMB results (HR: 0.61 [0.13–2.78]; p = 0.517) (b) PET results (HR: 3.81 [1.23–11.87]; p = 0.013).
Fig 2
Fig 2. OS curves.
OS curves are provided according to the result of bone marrow involvement. (a) BMB results (HR: 0.83 [0.10–6.77]; p = 0.864) (b) PET results (HR: 4.12 [1.03–16.5]; p = 0.03).
Fig 3
Fig 3. BMI evaluation.
Proposed algorithm for the evaluation of Bone Marrow Involvement (BMI) in DLBCL patients.
See this image and copyright information in PMC

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