Prognostic Importance of Bone Marrow Uptake on Baseline 18F FDG Positron Emission Tomography in Diffuse Large B Cell Lymphoma.
AIM To define the role of 18F flourodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in the detection of bone marrow (BM) involvement in patients with diffuse large B cell lymphoma (DLBCL) MATERIALS AND METHODS Fifty four (mean age: 55.5 18.3 years, 20 female and 34 male) DLBCL patients who underwent pretreatment 18F FDG PET/CT were included to the study. Focal or diffuse BM 18F FDG uptake that is higher than mediastinal blood pool uptake was accepted as positive. After staging of disease by CT and 18F FDG PET/CT, all the patients received R CHOP treatment after diagnostic blinded bone marrow biopsy (BMB) Presence of positive BM uptake in 18F FDG PET/CT and histopathological examination results of BMBs were analyzed by Chi square test. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of 18F FDG PET/CT in the detection of BM involvement were calculated. Prognostic importance of the presence of BM 18F FDG uptake was analyzed by Kaplan Meier analysis. RESULTS BM 18F FDG uptake was detected in 8 patients. Histopathological examination of BMB revealed BM involvement in 6 out of 8 patients. BMB was negative in all patients who have no 18F FDG uptake in the evaluation of PET/CT images. Sensitivity, specificity, accuracy, PPV, and NPV of 18F FDG PET/CT in the detection of BM involvement were calculated as 100% 96% 96% 75% and 100% respectively. In the Kaplan Meier analysis, we found that presence of pretreatment 18F FDG uptake in BM has a prognostic importance. Whereas mean time to progression (TTP) in patients with BM uptake was 32.25 10.9 months and mean TTP in those without was 51.69 3.6 months (p 0.013) CONCLUSIONS BM uptake in pretreatment 18F FDG PET/CT is an important prognostic factor in DLBCL patients. Moreover, in consideration of high NPV, 18F FDG PET/CT could eliminate unnecessary BMB in FDG negative patients.
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