Özlem TEZOL, Fatih SAĞCAN, Pelin ÖZCAN KARA, Elvan Çaglar ÇITAK

Bone marrow involvement in pediatric malignancies: a comparison study of Positron emission tomographycomputed tomography and bone marrow biopsy

Background and objectives. The comparison of Positron emission tomography- computed tomography (PETCT) and bone marrow biopsy (BMB) modalities in detecting bone marrow disease is an up to date research topic. In this study, we aimed to compare the results of PET-CT and BMB procedures in detecting bone marrow involvement in pediatric malignancies. Method. At the time of diagnosis, PET-CT imaging and BMB performed patients’ data were evaluated, retrospectively. Malign diagnoses were Hodgkin's lymphoma in 23 (30.7%), non-Hodgkin's lymphoma in 20 (26.7%), neuroblastoma in 11 (14.7%), Ewing sarcoma in 10 (13.7%), Langerhans cell histiocytosis in 6 (8%), and rhabdomyosarcoma in 5 (6.6%) patients. Results. Bone marrow involvement was detected in 39 (52%) of 75 patients. Bone marrow involvement was identified by both PET-CT and BMB in 18 (46.1%) patients, by only PET-CT in 12 (30.7%) patients, by only BMB in 9 (23%) patients. The sensitivity of PET-CT was 66%, specificity was 75%, positive predictive value was 60%, and negative predictive value was 80%. Sensitivity, spesificity, positive and negative predictive values of PETCT were different in before mentioned malignancy groups. Conclusion. PET-CT may not have high sensitivity and specificity to identify bone marrow involvement for each type of cancer. The approach of using bone marrow biopsy and PET-CT as complementary modalities seems reliable.

PDF

___

1. Paulino AC, Margolin J, Dreyer Z, Bin S Teh, Stephen Chiang. Impact of PET-CT on involved field radiotherapy design for pediatric Hodgkin lymphoma. Pediatr Blood Cancer 2012; 58: 860-864.

2. Faizan M, Anwar S, Khan S. Demographics and outome in paediatric non-Hodgkin lymphoma: single centre experience at The Children Hospital Lahore, Pakistan. J Coll Physicians Surg Pak 2018; 28: 48-51.

3. Budiongo AN, Ngiyulu RM, Lebwaze BM, et al. Pediatric non-Hodgkin lymphomas: first report from Central Africa. Pediatr Hematol Oncol 2015; 32: 239-249.

4. Khan SJ, Ishaq I, Saeed H, Fayyaz MB, Baqari SAS, Mohammad Wali R. Bone marrow involvement in metastatic pediatric ewing sarcoma. J CollPhysicians Surg Pak 2017; 27: 502-504.

5. Rastogi P, Naseem S, Varma N, et al. Bone marrow involvement in neuroblastoma: a study of hematomorphological features. Indian J Hematol Blood Transfus 2015; 31: 57-60.

6. Zapata CP, Cuglievan B, Zapata CM, et al. PET/CT versus bone marrow biopsy in the initial evaluation of bone marrow infiltration in various pediatric malignancies. Pediatr Blood Cancer 2018; 65: e26814.

7. Hassan A, Siddique M, Bashir H, et al. 18F-FDG PETCT imaging versus bone marrow biopsy in pediatric Hodgkin's lymphoma: a quantitative assessment of marrow uptake and novel insights into clinical implications of marrow involvement. Eur J Nucl Med Mol Imaging 2017; 44: 1198-1206.

8. Ozcan Kara P. Pediatrik lenfomalarda PET/BT görüntüleme. Turkiye Klinikleri J Nucl Med-Special Topics 2017; 3: 93-99.

9. Chambers G, Frood R, Patel C, Scarsbrook A. 18F-FDG PET-CT in paediatric oncology: established and emerging applications. Br J Radiol 2019; 91: 20180584.

10. Tatsumi M, Miller JH, Wahl RL. 18F-FDG PET/CT in evaluating non-CNS pediatric malignancies. J Nucl Med 2007; 48: 1923-1931.

11. Odalovi´c S, Sobic-Saranovic D, Pavlovic S, et al. Preliminary experience with 18f-fluoro-deoxyglucose positron emission tomography/computed tomography in pediatric oncology patients. Acta Chir lugosl 2011; 58: 67-73.

12. Wegner EA, Barrington SF, Kingston JE, et al. The impact of PET scanning on management of paediatric oncology patients. Eur J Nucl Med Mol Imaging 2005; 32: 23-30.

13. Cheng G, Chen W, Chamroonrat W, Drew A Torigian, Hongming Zhuang, Abass Alavi.Biopsy versus FDG PET/CT in the initial evaluation of bone marrow involvement in pediatric lymphoma patients. Eur J Nucl Med Mol Imaging 2011; 38: 1469-1476.

14. Purz S, Mauz-Korholz C, Korholz D, et al. [18F] fluorodeoxyglucose positron emission tomography for detection of bone marrow involvement in children and adolescents with Hodgkin’s lymphoma. J Clin Oncol 2011; 29: 3523-3528.

15. Chen S, Wang S, He K, Ma C , Fu H , Wang H. PET/ CT predicts bone marrow involvement in paediatric non-Hodgkin lymphoma and may preclude the need for bone marrow biopsy in selected patients. Eur Radiol 2018; 28: 2942-2950.

16. Li C, Zhang J, Chen S, et al. Prognostic value of metabolic indices and bone marrow uptake pattern on preoperative 18F–FDG PET/CT in pediatric patients with neuroblastoma. Eur J Nucl Med Mol Imaging 2018; 45: 306-315.

17. Harrison DJ, Parisi MT, Shulkin BL. The role of 18F-FDG-PET/CT in pediatric sarcoma. Semin Nucl Med 2017; 47: 229-241.

18. Kasalak O, Glaudemans AWJM, Overbosch J, Jutte PC , Kwee TC . Can FDG-PET/CTreplace blind bone marrow biopsy of the posterior iliac crest in Ewing sarcoma? Skeletal Radiol 2018; 47: 363-367.

19. Federico SM, Spunt SL, Krasin MJ, et al. Comparison of PET-CT and conventional imaging in staging pediatric rhabdomyosarcoma. Pediatr Blood Cancer 2013; 60: 1128-1134.

20. Norman G, Fayter D, Lewis-Light K, et al. An emerging evidence base for PET-CT in the management of childhood rhabdomyosarcoma: systematic review. BMJ Open 2015; 5: e006030.

21. Kumar M, Singh Sachdeva MU, Naseem S, et al. Bone marrow infiltration in Langerhan’s cell histiocytosis - An unusual but important determinant for staging and treatment. Int J Hematol Oncol Stem Cell Res 2015; 9: 193-197.

22. Goyal A, Rani S, Singh T, Choudhury P, Dubey A. Childhood histiocytoses: a review of twenty two cases. Indian Pediatr 1998; 35: 151-156.