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Utility of bone marrow aspirate and biopsy in staging of patients with T-cell lymphoma in the PET-Era - tissue remains the issue.

ABSTRACT: The role of 18F-fluoro-2-deoxy-D-glucose positron emission tomography combined with computerized tomography (PET-CT) in evaluation of bone marrow involvement (BMI) in patients with T-cell lymphoma (TCL) is poorly understood. We investigated whether PET-CT could replace bone marrow aspiration and biopsy (BMAB) in TCL. Sixty patients with newly diagnosed TCL who underwent both diagnostic PET-CT and BMAB were identified. BMI was tissue-confirmed in 15 (25%) cases, however only 8 of these 15 showed BMI on PET-CT (sensitivity of 53.3%, specificity of 100%). BMI by BMAB was associated with lower progression-free survival (PFS) (p = 0.038) and overall survival (OS) (p = 0.003) while PET-CT BMI was associated only with OS (p = 0.02). BMI detected by BMAB in the setting of a negative PET-CT had similar inferior prognosis as BMI identified on PET-CT. Thus, PET-CT in TCL misses BMI in almost half of the cases detected by BMAB and hence cannot substitute BMAB in evaluation of TCL.

SUBMITTER: Sundaram S

PROVIDER: S-EPMC8935337 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Utility of bone marrow aspirate and biopsy in staging of patients with T-cell lymphoma in the PET-Era - tissue remains the issue.

Sundaram Suchitra S Jizzini Mazen M Lamonica Dominick D Attwood Kristopher K Gravina Matthew M Hernandez-Ilizaliturri Francisco F Torka Pallawi P

Leukemia & lymphoma 20200804 13

The role of 18F-fluoro-2-deoxy-D-glucose positron emission tomography combined with computerized tomography (PET-CT) in evaluation of bone marrow involvement (BMI) in patients with T-cell lymphoma (TCL) is poorly understood. We investigated whether PET-CT could replace bone marrow aspiration and biopsy (BMAB) in TCL. Sixty patients with newly diagnosed TCL who underwent both diagnostic PET-CT and BMAB were identified. BMI was tissue-confirmed in 15 (25%) cases, however only 8 of these 15 showed ...[more]

PMID: 32749169

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Project description:BackgroundPositron emission tomography (PET) is the standard of care for non-small cell lung cancer (NSCLC) clinical staging, but it may have limited utility in evaluating subsolid lung adenocarcinomas that can have relatively indolent behavior without hypermetabolic activity.MethodsThe sensitivity and specificity of PET for determining pathologic lymph node status and disease-free survival were assessed in patients operated on for cT1 N0 subsolid lung adenocarcinoma from January 2006 to June 2022 (at Stanford University School of Medicine, Stanford, CA). Patients with clinical or pathologic tumor size >30 mm, hilar or mediastinal lymph node size >1cm, and purely solid tumors were excluded.ResultsPET was available in 498 of 534 (93.2%) patients and more often was used in older patients with larger and more solid tumors. The overall pathologic lymph node-positive rate was 8.4% (45 of 534). PET specificity was 95.1%, but sensitivity was only 20.0%. A tumor diameter of 18.5 mm and a solid component percentage of 62.5% had the maximum predictive accuracy for pathologic lymph node positivity, with a 0% and 1.5% rate of pathologic and PET lymph node positivity, respectively, for tumors with values lower than those thresholds. There was no significant difference in 5-year disease-free survival between individuals who did and did not undergo PET scanning (76.6% vs 96.8%; P = .07). Conversely, 134 (26.9%) patients who underwent PET scanning had 171 incidentally detected hypermetabolic lesions unrelated to lung cancer, with only 13 of 134 (9.7%) patients identified as having non-NSCLC premalignant or malignant conditions requiring further therapy.ConclusionsPET scan use for subsolid lung adenocarcinoma has high specificity but limited sensitivity for predicting pathologic lymph node positivity. PET also has no association with disease-free survival and often detects clinically unimportant findings rather than changing lung cancer management, particularly for patients with smaller and less solid tumors.

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Utility of bone marrow aspirate and biopsy in staging of patients with T-cell lymphoma in the PET-Era - tissue remains the issue.

Publications

Utility of bone marrow aspirate and biopsy in staging of patients with T-cell lymphoma in the PET-Era - tissue remains the issue.

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