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18F-FDG PET/CT bone/bone marrow findings in Hodgkin’s lymphoma may circumvent the use of bone marrow trephine biopsy at diagnosis staging

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Abstract

Purpose

Accurate staging of Hodgkin’s lymphoma (HL) is necessary in selecting appropriate treatment. Bone marrow trephine biopsy (BMB) is the standard procedure for depicting bone marrow involvement. BMB is invasive and explores a limited part of the bone marrow. 18F-FDG PET/CT is now widely used for assessing response to therapy in HL and a baseline study is obtained to improve accuracy. The aim of this retrospective analysis was to assess whether routine BMB remains necessary with concomitant 18F-FDG PET/CT.

Methods

Data from 83 patients (newly diagnosed HL) were reviewed. All patients had received contrast-enhanced CT, BMB and 18F-FDG PET/CT. Results of BMB were not available at the time of 18F-FDG PET/CT imaging.

Results

Seven patients had lymphomatous involvement on BMB. Four patients had bone involvement on conventional CT (two with negative BMB). All patients with bone marrow and/or bone lesions at conventional staging were also diagnosed on 18F-FDG PET/CT scan. PET/CT depicted FDG-avid bone/bone marrow foci in nine additional patients. Four of them had only one or two foci, while the other had multiple foci. However, the iliac crest, site of the BMB, was not involved on 18F-FDG PET/CT. Osteolytic/sclerotic lesions matching FDG-avid foci were visible on the CT part of PET/CT in three patients. MRI ordered in three other patients suggested bone marrow involvement. Interim and/or end-therapy 18F-FDG PET/CT documented response of FDG-avid bone/bone marrow foci to chemotherapy in every patient.

Conclusion

18F-FDG PET/CT highly improves sensitivity for diagnosis of bone/bone marrow lesions in HL compared to conventional staging.

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Acknowledgments

The authors are grateful to Drs. Christian Gisselbrecht, Catherine Thieblemont, Patricia Franchi-Rezgui, Véronique Edline, Anne Vincent-Salomon, Jean Michon and all physicians and staff who participated in patient management at St-Louis Hospital and Institut Curie.

Conflicts of interest

None.

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Authors and Affiliations

  1. Service de Médicine Nucléaire, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris 7, 1, avenue Claude Vellefaux, 75475, Paris cedex 10, France

    Gerard Moulin-Romsee, Elif Hindié, Jean-Emmanuel Filmont & Jean-Luc Moretti

  2. Nuclear Medicine, Institut Curie, Paris, France

    Gerard Moulin-Romsee & Myriam Bénamor

  3. Haemato-Oncology, Hôpital Saint-Louis, Paris, France

    Xavier Cuenca, Pauline Brice & David Sibon

  4. Haematology, Institut Curie, Paris, France

    Didier Decaudin & Marcela Anitei

  5. Pathology, Hôpital Saint-Louis, Paris, France

    Josette Brière

  6. Radiology, Hôpital Saint-Louis, Paris, France

    Eric de Kerviler

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  1. Gerard Moulin-Romsee
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  2. Elif Hindié
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Correspondence to Elif Hindié.

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Gerard Moulin-Romsee and Elif Hindié contributed equally to this work.

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Moulin-Romsee, G., Hindié, E., Cuenca, X. et al. 18F-FDG PET/CT bone/bone marrow findings in Hodgkin’s lymphoma may circumvent the use of bone marrow trephine biopsy at diagnosis staging. Eur J Nucl Med Mol Imaging 37, 1095–1105 (2010). https://doi.org/10.1007/s00259-009-1377-5

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