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Detection of Lymphoma in Bone Marrow by Whole-Body Positron
Emission Tomography
Robert Carr,
Sally F. Barrington,
Bella Madan,
Michael J. O'Doherty, Catherine A.B. Saunders,
Jon van der Walt, and
Adrian
R. Timothy
From the Departments of Haematology, Histopathology, Clinical
Oncology and The Clinical PET Centre, United Medical and Dental Schools
of Guy's and St Thomas's, London, UK.
Positron emission tomography (PET) is a whole-body imaging technique
using 18 fluorine-fluorodeoxyglucose (FDG), whose uptake is increased
in tumor cells. Published studies have shown PET to be an effective
method of staging lymphoma and to be more sensitive than CT at
detecting extranodal disease. The purpose of this study was to
determine whether the increased marrow uptake of FDG observed in some
lymphoma patients during routine staging PET scans represented marrow
involvement by disease. PET scans of 50 patients with Hodgkin's (12)
and non-Hodgkin's (38) lymphoma were analyzed by three independent observers and the marrow graded as normal or abnormal using a visual
grading system. Unilateral iliac crest marrow aspirates and biopsies
were performed on all patients. The PET scan and marrow histology
agreed in 39 patients (78%), being concordant positive in 13 and
concordant negative in 26 patients. In 8 patients the PET scan showed
increased FDG uptake but staging biopsy was negative; in 4 of these 8 patients the PET scan showed a normal marrow background with focal FDG
"hot spots" distant from the site biopsied. In 3 patients the
marrow biopsy specimen was positive but the PET scan normal; 2 of these
3 patients had non-Hodgkin's lymphoma whose malignant cells did not
take up FDG at lymph node or marrow disease sites. Therefore, there
were only 5 patients (10%) in whom there was a difference between the
PET scan and biopsy result which could not be fully explained. Visual
interpretation of marrow FDG uptake during whole-body staging PET scans
can correctly assess marrow disease status in a high proportion of
lymphoma patients. PET has the potential to reduce the need for staging marrow biopsy.
Blood, Vol. 91 No. 9 (May 1), 1998:
pp. 3340-3346
© 1998 by The American Society of Hematology.

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