F. Moog et al., 18-F-FLUORODEOXYGLUCOSE POSITRON-EMISSION-TOMOGRAPHY AS A NEW APPROACH TO DETECT LYMPHOMATOUS BONE-MARROW, Journal of clinical oncology, 16(2), 1998, pp. 603-609
Purpose: Bone marrow involvement in patients with malignant lymphoma i
s considered a sign of generalised disease with less favorable prognos
is. Bone marrow biopsy (BMB), which represents the standard diagnostic
procedure, however, is associated with a high rate of false-negative
findings, which may lead to errors in management. The present study wa
s undertaken to investigate the efficacy of positron emission tomograp
hy (PET) with 18-F-fluorodeoxyglucose (FDG-PET) as a new method to eva
luate bone marrow involvement in patients with malignant lymphoma. Met
hods: Seventy-eight consecutive, untreated patients with either non-Ho
dgkin's lymphoma (NHL; n = 39) or Hodgkin's disease (HD; n = 39) were
prospectively evaluated. Static FDG-PET imaging was performed followin
g application of 270 MBq (F-18)-FDG. Attenuation correction was perfor
med in 63 of 78 patients. Visual evaluation was performed by two exami
ners unaware of the clinical data. Material for BMB (70 bilateral, 8 u
nilateral) was obtained from the posterior iliac crest. Discordant res
ults of PET and biopsy were settled, when possible, on the basis of fu
rther biopsy or magnetic resonance imaging (MRI). Results: In addition
to seven concordant positive and 57 concordant negative findings, bio
psy revealed another four cases with bone marrow involvement not detec
table by FDG-PET analysis (+5.1%). On the contrary, PET showed bone ma
rrow areas of intensive FDG uptake that suggested bone marrow lymphoma
in 10 patients with negative biopsies (+12.8%). In eight patients, FD
G-PET findings were confirmed by either histologic verification (n = 4
), MRI (n = 2), polymerase chain reaction (PCR) for rearranged immunog
lobulin H sequences (n = 1), or clinical presentation (n = 1). Two cas
es remained unresolved. Conclusion: The results indicate that FDG-PET
has a high potential to detect bone marrow involvement in malignant ly
mphoma. Besides confirming lesions found at BMB, FDG-PET provided addi
tional information, which, in eight of 78 patients (10.3%),led to an u
pgrade of the tumor stage. (C) 1998 by American Society of Clinical On
cology.