The Role of FDG- PET/CT in Detecting Bone Marrow Involvement in Childhood Solid Tumors

Abstract

Purpose To compare the results of 18F-Fluorodeoxy positron emission tomography/computed tomography (18 F-FDG-PET/CT) and bone marrow biopsy (BMB) procedures in the initial evaluation of bone marrow involvement (BMI) in pediatric solid tumors.

Methods We conducted a retrospective analysis of newly diagnosed pediatric cases with lymphoma, neuroblastoma, Ewing sarcoma, rhabdomyosarcoma. Each case underwent both PET-CT imaging and BMB. Presence of tumor infiltration in BMB specimens and/or positive FDG-PET/CT findings indicate as BMI were regarded as true positive results.

Results Sixty-four patients were included in the study. BMI was detected in 23/64 (36%) patients, FDG-PET/CT imaging and BMB results were concordant in 54/64 patients. In 9/64 patients the finding was FDG-PET/CT (+), BMB (-) indicating a false negative BMB result. In only 1/64 patients FDG- PET/CT (-), BMB (+), indicating a false negative FDG-PET/CT result. In the whole patient group, the sensitivity, specificity, positive predictive value and negative predictive value of PET/CT and BMB in detecting bone marrow involvement were 95.6%, 100%, 100% and 97.6% and 60.8 %, 100%, 100% and 82%, respectively.

Conclusion PET/CT has a high sensitivity and specificity for the assessing marrow involvement in pediatric solid tumors. We believe that PET/CT imaging should be performed as the first step in diagnostic staging, and BMB may not be necessary in every patient, only in patients with suspicious PET/CT results for bone marrow involvement. Additionally, for a more precise determination of bone marrow involvement, it is reasonable to perform BMB from FDG-retaining areas, using PET/CT as a guide tool.

Keywords

bone marrow involvement - children - solid tumors - staging - PET/CT - bone marrow biopsy

Publication History

Received: 14 July 2023

Accepted after revision: 07 December 2023

Article published online:
08 January 2024

• References

• 1 Yağci-Küpeli B, Koçyiğit-Deveci E, Adamhasan F. et al. The Value of 18F-FDG PET/CT in Detecting Bone Marrow Involvement in Childhood Cancers. J Pediatr Hematol Oncol 2019; 41 (06) 438-441
• 2 Yue ZX, Xing TY, Zhao W. et al. MYCN amplification plus 1p36 loss of heterozygosity predicts ultra high risk in bone marrow metastatic neuroblastoma. Cancer Med 2022; 11 (08) 1837-1849
• 3 Cohn SL, Pearson AD, London WB. et al. The International Neuroblastoma Risk Group (INRG) classification system: an INRG Task Force report. J Clin Oncol 2009; 27 (02) 289-297
• 4 Monclair T, Brodeur GM, Ambros PF. et al. The International Neuroblastoma Risk Group (INRG) staging system: an INRG Task Force report. J Clin Oncol 2009; 27 (02) 298-303
• 5 Sharp SE, Shulkin BL, Gelfand MJ. et al. 123I-MIBG scintigraphy and 18F-FDG PET in neuroblastoma. J Nucl Med 2009; 50 (08) 1237-1243
• 6 Cheson BD, Fisher RI, Barrington SF. et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol 2014; 32 (27) 3059-3068
• 7 Ziai P, Hayeri MR, Salei A. et al. Role of Optimal Quantification of FDG PET Imaging in the Clinical Practice of Radiology. Radiographics 2016; 36 (02) 481-496
• 8 Samuel AM. PET/CT in pediatric oncology. Indian J Cancer 2010; 47 (04) 360-370
• 9 Li Z, Li C, Chen B. et al. FDG-PET/CT versus bone marrow biopsy in bone marrow involvement in newly diagnosed paediatric lymphoma: a systematic review and meta-analysis. J Orthop Surg Res 2021; 16 (01) 482
• 10 Arslantaş E, Ayçiçek A, Akıcı F. et al. Comparison of bone marrow biopsy and fluorodeoxyglucose-positron emission tomography for the assessment of bone marrow infiltration in children with Hodgkin's lymphoma. Nuklearmedizin 2023; 62 (01) 20-26
• 11 Cistaro A, Cassalia L, Ferrara C. et al. Italian Multicenter Study on Accuracy of 18F-FDG PET/CT in Assessing Bone Marrow Involvement in Pediatric Hodgkin Lymphoma. Clin Lymphoma Myeloma Leuk 2018; 18 (06) e267-e273
• 12 Hassan A, Siddique M, Bashir H. et al. 18F-FDG PET-CT 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 (07) 1198-1206
• 13 Feng L, Yang X, Lu X. et al. 18F-FDG PET/CT-based radiomics nomogram could predict bone marrow involvement in pediatric neuroblastoma. Insights Imaging 2022; 13 (01) 144
• 14 Tezol Ö, Sağcan F, Özcan PP. et al. Bone marrow involvement in pediatric malignancies: a comparison study of Positron emission tomographycomputed tomography and bone marrow biopsy. Turk J Pediatr 2020; 62 (02) 182-190
• 15 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 (02)
• 16 Guinot A, Tabone-Eglinger S, Isnardi V. et al. Staging of newly diagnosed Ewing sarcoma: Results of bone marrow aspiration and biopsy versus (18)FDG-PET/CT imaging for bone marrow involvement. Eur J Cancer 2023; 179: 56-64
• 17 Adams HJ, Kwee TC, de Keizer B. et al. Systematic review and meta-analysis on the diagnostic performance of FDG-PET/CT in detecting bone marrow involvement in newly diagnosed Hodgkin lymphoma: is bone marrow biopsy still necessary?. Ann Oncol 2014; 25 (05) 921-927
• 18 Campbell KM, Shulman DS, Grier HE. et al. Role of bone marrow biopsy for staging new patients with Ewing sarcoma: A systematic review. Pediatr Blood Cancer 2021; 68 (02) e28807
• 19 Shah S, Purandare N, Kembhavi S. et al. FDG PETCT for assessing marrow involvement at staging pediatric nonhematological round cell malignancies. Nucl Med Commun 2022; 43 (01) 56-63
• 20 Esiashvili N, Goodman M, Marcus Jr RB. Changes in incidence and survival of Ewing sarcoma patients over the past 3 decades: Surveillance Epidemiology and End Results data. J Pediatr Hematol Oncol 2008; 30 (06) 425-430