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Kaddu-Mulindwa, Dominic; Altmann, Bettina; Held, Gerhard; Angel, Stephanie; Stilgenbauer, Stephan; Thurner, Lorenz; Bewarder, Moritz; Schwier, Maren; Pfreundschuh, Michael; Löffler, Markus; Menhart, Karin; Grosse, Jirka; Ziepert, Marita; Herrmann, Ken; Dührsen, Ulrich; Hüttmann, Andreas; Barbato, Francesco; Poeschel, Viola; Hellwig, Dirk

FDG PET/CT to detect bone marrow involvement in the initial staging of patients with aggressive non-Hodgkin lymphoma: results from the prospective, multicenter PETAL and OPTIMAL60 trials

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  • Media type: E-Article
  • Title: FDG PET/CT to detect bone marrow involvement in the initial staging of patients with aggressive non-Hodgkin lymphoma: results from the prospective, multicenter PETAL and OPTIMAL60 trials
  • Contributor: Kaddu-Mulindwa, Dominic; Altmann, Bettina; Held, Gerhard; Angel, Stephanie; Stilgenbauer, Stephan; Thurner, Lorenz; Bewarder, Moritz; Schwier, Maren; Pfreundschuh, Michael; Löffler, Markus; Menhart, Karin; Grosse, Jirka; Ziepert, Marita; Herrmann, Ken; Dührsen, Ulrich; Hüttmann, Andreas; Barbato, Francesco; Poeschel, Viola; Hellwig, Dirk
  • imprint: Springer Science and Business Media LLC, 2021
  • Published in: European Journal of Nuclear Medicine and Molecular Imaging
  • Language: English
  • DOI: 10.1007/s00259-021-05348-6
  • ISSN: 1619-7070; 1619-7089
  • Origination:
  • Footnote:
  • Description: <jats:title>Abstract</jats:title><jats:sec> <jats:title>Purpose</jats:title> <jats:p>Fluorine-18 fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG PET/CT) is the standard for staging aggressive non-Hodgkin lymphoma (NHL). Limited data from prospective studies is available to determine whether initial staging by FDG PET/CT provides treatment-relevant information of bone marrow (BM) involvement (BMI) and thus could spare BM biopsy (BMB).</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Patients from PETAL (NCT00554164) and OPTIMAL&gt;60 (NCT01478542) with aggressive B-cell NHL initially staged by FDG PET/CT and BMB were included in this pooled analysis. The reference standard to confirm BMI included a positive BMB and/or FDG PET/CT confirmed by targeted biopsy, complementary imaging (CT or magnetic resonance imaging), or concurrent disappearance of focal FDG-avid BM lesions with other lymphoma manifestations during immunochemotherapy.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Among 930 patients, BMI was detected by BMB in 85 (prevalence 9%) and by FDG PET/CT in 185 (20%) cases, for a total of 221 cases (24%). All 185 PET-positive cases were true positive, and 709 of 745 PET-negative cases were true negative. For BMB and FDG PET/CT, sensitivity was 38% (95% confidence interval [CI]: 32–45%) and 84% (CI: 78–88%), specificity 100% (CI: 99–100%) and 100% (CI: 99–100%), positive predictive value 100% (CI: 96–100%) and 100% (CI: 98–100%), and negative predictive value 84% (CI: 81–86%) and 95% (CI: 93–97%), respectively. In all of the 36 PET-negative cases with confirmed BMI patients had other adverse factors according to IPI that precluded a change of standard treatment. Thus, the BMB would not have influenced the patient management.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>In patients with aggressive B-cell NHL, routine BMB provides no critical staging information compared to FDG PET/CT and could therefore be omitted.</jats:p> </jats:sec><jats:sec> <jats:title>Trial registration</jats:title> <jats:p>NCT00554164 and NCT01478542</jats:p> </jats:sec>