The Role of PET/CT to Detect Bone Marrow Involvement in Hodgkin Lymphoma

Objective: Bone marrow involvement (BMI) is a significant component of staging of Hodgkin’s lymphoma (HL). Unilateral bone marrow biopsy (BMB) from dorsal iliac bone is the standard method to determine BMI. Positron emission tomography/computerized tomography (PET/CT) is recommended as a complimentary technique to determine BMI and to evaluate response to treatment. The aim of this study is to determine whether PET/CT can replace BMB to detect BMI in patients with HL. Methods: A total of 159 patients diagnosed as having HL were evaluated retrospectively. One hundred and four patients who met the criteria were included in the study. BMB and PET/CT were performed on all patients during initial staging. Results: Of the 104 patients, 44 (42.3%) and 17 (16.3%) had BMI in PET/CT and BMB respectively. All patients who had BMI in BMB also had involvement in PET/CT. BMB did not detect BMI in 27 patients who had BMI in PET/CT. All 27 patients had partial or complete remission on PET/CT performed at the end of treatment. This finding was regarded as a relative indicator for BMI. PET/CT had a sensitivity and negative predictive value of 100%, specificity of 68.9% and accuracy rate of 74% to determine BMI. Conclusion: We observed that PET/CT and BMB were compatible to determine BMI in patients diagnosed with HL. Unilateral BMB may result false negative especially in cases with focal involvement. Therefore, PET/CT should be considered as a complimentary technique to determine BMI. Staging should be reevaluated in patients who have BMI in PET/CT and a negative BMB treatment should be planned accordingly.

Hodgkin Lenfomalı Hastalarda Kemik İliği Tutulumunun Tespitinde PET/BT

Amaç: Hodgkin Lenfoma’da (HL) tedavi planının çizilmesi için en önemli ilk adım evrelemedir ve kemik iliği tutulumu (KİT) evrelemenin önemli bir bileşenidir. Dorsal iliyak kemikten yapılan tek taraflı kemik iliği biyopsisi (KİB) bugün için KİT’nin gösterilmesi için standart yöntemdir. Pozitron emisyon tomografisi (PET/ BT), HL’de tedavi yanıtının değerlendirilmesinin yanı sıra KİT’nin gösterilmesi için de tamamlayıcı bir tetkik olarak önerilmektedir. Çalışmamızda HL’li hastalarda KİT’nin tespit edilmesi için PET/BT, KİB’nin yerini alabilir mi sorusunun cevaplanması amaçlanmıştır. Yöntemler: Merkezimizde Ocak 2007 ile Haziran 2015 tarihleri arasında yeni tanı almış toplam 159 erişkin hastanın dosyası incelendi. Dahil edilme kriterlerine uyan 104 hasta analizlere dahil edildi. Tüm hastalarda PET/BT ve KİB ilk evreleme sürecinde yapılmıştı. Bulgular: Analizler sonunda toplam 104 hastadan, 44 (%42,3) hastada PET/BT ve 17 (%16,3) hastada KİB ile KİT saptanmış olduğu görüldü. KİB’de tutulum olan hastaların tamamında PET/BT’de tutulum mevcutken, PET/BT ile tutulum tespit edilen hastalardan 27’sinde KİB’nin negatif raporlanmış olduğu tespit edildi. Bunlardan 19’unda tutulum şekli fokal iken 8 hastanın yaygın KİT’si vardı. KİB negatifken PET/BT KİT açısından pozitif bulunan 27 hastanın tümünde tedavi sonrası kontrol PET/BT görüntülemelerinde parsiyel ya da tam yanıt elde edilmiş olduğu kaydedildi. Verilerin istatistiksel analizi sonunda PET/BT’nin KİT’nin saptanması için sensitivitesi %100, spesifitesi %68,9 ve doğruluk oranı %74 olarak bulundu. Sonuç: HL’li hastalarda KİT’nin tespiti için PET/BT sonuçlarının KİB ile uyumlu olduğu, ancak özellikle fokal tutulumu olan olgularda tek taraflı KİB’nin yanlış negatif sonuçlanabileceği tespit edilmiştir. Bu nedenle HL evrelemesinde KİT’nin değerlendirilmesi için KİB’ye ek olarak PET/BT bulguları da mutlaka dikkate alınmalıdır.

Kaynakça

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