Bone marrow trephine biopsy (BMTB) is the gold standard test for identification of marrow infiltration by lymphoma. Literature supports the use of bilateral iliac crest biopsy for appropriate staging of lymphoma.18F-FDG PET/CT has an advantage of evaluating the entire skeleton for bone or bone marrow (BM) uptake. We calculated the predictive values of PET/CT in detecting the BM infiltration in lymphoma patients. We also assessed the increment in the yield of bilateral BMTB over unilateral BMTB in detecting BM infiltration by lymphoma.
This study is a retrospective and prospective single center observational study done in tertiary care hospital in Chandigarh, India. The study included 230 newly diagnosed lymphoma patients who underwent both baseline staging PET CT and staging bilateral Bone Marrow Trephine Biopsy (BMTB). The bone marrow trephine biopsy slides were reviewed independently by two experienced pathologists (one hematopathologist and one histopathologist).
The sensitivity, specificity, PPV and NPV of 18-FDG PET/CT in detecting BM infiltration in patients with lymphoma
The incremental yield of diagnosing BM infiltration by lymphoma by doing bilateral posterior superior iliac spine biopsies over unilateral biopsy was 25% for all subtype of lymphoma and 57% for HL. The most common pattern of BM infiltration was nodular (37%), followed by diffuse (22%), para-trabecular (21%) and interstitial (20%) in the whole study cohort. There was a strong aggreement between the two pathologists in reporting BMTB. The accuracy of SUVmax in differentiating patients with and without true BM involvement in our study cohort was less than optimal.
Opting for unilateral trephine biopsy for lymphoma staging may lead to inadvertent under-staging, especially in Hodgkin Lymphoma. We may consider avoiding bone marrow biopsy in patients with Hodgkin Lymphoma with no FDG avid skeletal lesions in PET/CT. The BMTB has got a high reproducibility and lesser inter observer variability in detection of bone marrow infiltration by lymphoma.
Clinical trial identification
Legal entity responsible for the study
Has not received any funding.
All authors have declared no conflicts of interest.