The value of routine bone marrow biopsy in patients with diffuse large B-cell lymphoma staged with PET/CT: a Danish-Canadian study

M Alzahrani; T C El-Galaly; M Hutchings; J W Hansen; A Loft; H E Johnsen; V Iyer; D Wilson; L H Sehn; K J Savage; J M Connors; R D Gascoyne; P Johansen; E Clasen-Linde; P Brown; D Villa

doi:10.1093/annonc/mdw137

The value of routine bone marrow biopsy in patients with diffuse large B-cell lymphoma staged with PET/CT: a Danish-Canadian study

M Alzahrani, T C El-Galaly, M Hutchings, J W Hansen, A Loft, H E Johnsen, V Iyer, D Wilson, L H Sehn, K J Savage, J M Connors, R D Gascoyne, P Johansen, E Clasen-Linde, P Brown, D Villa

Department of Clinical Medicine

23 Citations (Scopus)

Abstract

BACKGROUND: The added diagnostic and prognostic value of routine bone marrow biopsy (BMB) in patients with diffuse large B-cell lymphoma (DLBCL) undergoing positron emission tomography combined with computed tomography (PET/CT) staging is controversial.

PATIENTS AND METHODS: Patients with newly diagnosed DLBCL who underwent both staging PET/CT and BMB were retrospectively identified in British Columbia, Aalborg, and Copenhagen. Original written PET/CT and pathology reports were retrospectively reviewed to determine Ann Arbor stage and outcomes, with and without the contribution of BMB.

RESULTS: A total of 530 patients were identified: 146 (28%) had focal bone marrow (BM) lesions on PET/CT and 87 (16%) had positive BMB. Fifty-two of 146 patients (36%) with positive PET/CT had a positive BMB [39 DLBCL, 13 indolent non-Hodgkin lymphoma (iNHL)], while 35 of 384 patients (9%) with negative PET/CT had positive BMB (12 DLBCL, 23 iNHL). BMB upstaged 12/209 (6%) of stage I/II patients to stage IV, although this was the case for only 3 (1%) patients with DLBCL in the BMB. PET/CT identified BM involvement by BMB with sensitivity 60%, specificity 79%, positive predictive value 36%, and negative predictive value 91%. Concordant histological involvement of the BM by DLBCL was associated with worse overall survival and progression-free survival than discordant or no involvement in univariate and multivariate analyses.

CONCLUSIONS: In patients with DLBCL, staging PET/CT can miss BM involvement with concordant DLBCL (less common) or discordant iNHL (more common). Routine BMB does not add relevant diagnostic or prognostic value over PET/CT alone in the majority of patients with DLBCL.

Original language	English
Journal	Annals of Oncology
Volume	27
Issue number	6
Pages (from-to)	1095-9
Number of pages	5
ISSN	0923-7534
DOIs	https://doi.org/10.1093/annonc/mdw137
Publication status	Published - 18 Jun 2016

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10.1093/annonc/mdw137

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Alzahrani, M., El-Galaly, T. C., Hutchings, M., Hansen, J. W., Loft, A., Johnsen, H. E., Iyer, V., Wilson, D., Sehn, L. H., Savage, K. J., Connors, J. M., Gascoyne, R. D., Johansen, P., Clasen-Linde, E., Brown, P., & Villa, D. (2016). The value of routine bone marrow biopsy in patients with diffuse large B-cell lymphoma staged with PET/CT: a Danish-Canadian study. Annals of Oncology, 27(6), 1095-9. https://doi.org/10.1093/annonc/mdw137

Alzahrani, M, El-Galaly, TC, Hutchings, M, Hansen, JW, Loft, A, Johnsen, HE, Iyer, V, Wilson, D, Sehn, LH, Savage, KJ, Connors, JM, Gascoyne, RD, Johansen, P, Clasen-Linde, E, Brown, P & Villa, D 2016, 'The value of routine bone marrow biopsy in patients with diffuse large B-cell lymphoma staged with PET/CT: a Danish-Canadian study', Annals of Oncology, vol. 27, no. 6, pp. 1095-9. https://doi.org/10.1093/annonc/mdw137

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title = "The value of routine bone marrow biopsy in patients with diffuse large B-cell lymphoma staged with PET/CT: a Danish-Canadian study",

abstract = "BACKGROUND: The added diagnostic and prognostic value of routine bone marrow biopsy (BMB) in patients with diffuse large B-cell lymphoma (DLBCL) undergoing positron emission tomography combined with computed tomography (PET/CT) staging is controversial.PATIENTS AND METHODS: Patients with newly diagnosed DLBCL who underwent both staging PET/CT and BMB were retrospectively identified in British Columbia, Aalborg, and Copenhagen. Original written PET/CT and pathology reports were retrospectively reviewed to determine Ann Arbor stage and outcomes, with and without the contribution of BMB.RESULTS: A total of 530 patients were identified: 146 (28%) had focal bone marrow (BM) lesions on PET/CT and 87 (16%) had positive BMB. Fifty-two of 146 patients (36%) with positive PET/CT had a positive BMB [39 DLBCL, 13 indolent non-Hodgkin lymphoma (iNHL)], while 35 of 384 patients (9%) with negative PET/CT had positive BMB (12 DLBCL, 23 iNHL). BMB upstaged 12/209 (6%) of stage I/II patients to stage IV, although this was the case for only 3 (1%) patients with DLBCL in the BMB. PET/CT identified BM involvement by BMB with sensitivity 60%, specificity 79%, positive predictive value 36%, and negative predictive value 91%. Concordant histological involvement of the BM by DLBCL was associated with worse overall survival and progression-free survival than discordant or no involvement in univariate and multivariate analyses.CONCLUSIONS: In patients with DLBCL, staging PET/CT can miss BM involvement with concordant DLBCL (less common) or discordant iNHL (more common). Routine BMB does not add relevant diagnostic or prognostic value over PET/CT alone in the majority of patients with DLBCL.",

keywords = "Journal Article",

author = "M Alzahrani and El-Galaly, {T C} and M Hutchings and Hansen, {J W} and A Loft and Johnsen, {H E} and V Iyer and D Wilson and Sehn, {L H} and Savage, {K J} and Connors, {J M} and Gascoyne, {R D} and P Johansen and E Clasen-Linde and P Brown and D Villa",

note = "{\textcopyright} The Author 2016. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: [email protected].",

year = "2016",

month = jun,

day = "18",

doi = "10.1093/annonc/mdw137",

language = "English",

volume = "27",

pages = "1095--9",

journal = "Annals of Oncology",

issn = "0923-7534",

publisher = "Oxford University Press",

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TY - JOUR

T1 - The value of routine bone marrow biopsy in patients with diffuse large B-cell lymphoma staged with PET/CT

T2 - a Danish-Canadian study

AU - Alzahrani, M

AU - El-Galaly, T C

AU - Hutchings, M

AU - Hansen, J W

AU - Loft, A

AU - Johnsen, H E

AU - Iyer, V

AU - Wilson, D

AU - Sehn, L H

AU - Savage, K J

AU - Connors, J M

AU - Gascoyne, R D

AU - Johansen, P

AU - Clasen-Linde, E

AU - Brown, P

AU - Villa, D

PY - 2016/6/18

Y1 - 2016/6/18

N2 - BACKGROUND: The added diagnostic and prognostic value of routine bone marrow biopsy (BMB) in patients with diffuse large B-cell lymphoma (DLBCL) undergoing positron emission tomography combined with computed tomography (PET/CT) staging is controversial.PATIENTS AND METHODS: Patients with newly diagnosed DLBCL who underwent both staging PET/CT and BMB were retrospectively identified in British Columbia, Aalborg, and Copenhagen. Original written PET/CT and pathology reports were retrospectively reviewed to determine Ann Arbor stage and outcomes, with and without the contribution of BMB.RESULTS: A total of 530 patients were identified: 146 (28%) had focal bone marrow (BM) lesions on PET/CT and 87 (16%) had positive BMB. Fifty-two of 146 patients (36%) with positive PET/CT had a positive BMB [39 DLBCL, 13 indolent non-Hodgkin lymphoma (iNHL)], while 35 of 384 patients (9%) with negative PET/CT had positive BMB (12 DLBCL, 23 iNHL). BMB upstaged 12/209 (6%) of stage I/II patients to stage IV, although this was the case for only 3 (1%) patients with DLBCL in the BMB. PET/CT identified BM involvement by BMB with sensitivity 60%, specificity 79%, positive predictive value 36%, and negative predictive value 91%. Concordant histological involvement of the BM by DLBCL was associated with worse overall survival and progression-free survival than discordant or no involvement in univariate and multivariate analyses.CONCLUSIONS: In patients with DLBCL, staging PET/CT can miss BM involvement with concordant DLBCL (less common) or discordant iNHL (more common). Routine BMB does not add relevant diagnostic or prognostic value over PET/CT alone in the majority of patients with DLBCL.

AB - BACKGROUND: The added diagnostic and prognostic value of routine bone marrow biopsy (BMB) in patients with diffuse large B-cell lymphoma (DLBCL) undergoing positron emission tomography combined with computed tomography (PET/CT) staging is controversial.PATIENTS AND METHODS: Patients with newly diagnosed DLBCL who underwent both staging PET/CT and BMB were retrospectively identified in British Columbia, Aalborg, and Copenhagen. Original written PET/CT and pathology reports were retrospectively reviewed to determine Ann Arbor stage and outcomes, with and without the contribution of BMB.RESULTS: A total of 530 patients were identified: 146 (28%) had focal bone marrow (BM) lesions on PET/CT and 87 (16%) had positive BMB. Fifty-two of 146 patients (36%) with positive PET/CT had a positive BMB [39 DLBCL, 13 indolent non-Hodgkin lymphoma (iNHL)], while 35 of 384 patients (9%) with negative PET/CT had positive BMB (12 DLBCL, 23 iNHL). BMB upstaged 12/209 (6%) of stage I/II patients to stage IV, although this was the case for only 3 (1%) patients with DLBCL in the BMB. PET/CT identified BM involvement by BMB with sensitivity 60%, specificity 79%, positive predictive value 36%, and negative predictive value 91%. Concordant histological involvement of the BM by DLBCL was associated with worse overall survival and progression-free survival than discordant or no involvement in univariate and multivariate analyses.CONCLUSIONS: In patients with DLBCL, staging PET/CT can miss BM involvement with concordant DLBCL (less common) or discordant iNHL (more common). Routine BMB does not add relevant diagnostic or prognostic value over PET/CT alone in the majority of patients with DLBCL.

KW - Journal Article

U2 - 10.1093/annonc/mdw137

DO - 10.1093/annonc/mdw137

M3 - Journal article

C2 - 27002106

SN - 0923-7534

VL - 27

SP - 1095

EP - 1099

JO - Annals of Oncology

JF - Annals of Oncology

IS - 6

ER -

The value of routine bone marrow biopsy in patients with diffuse large B-cell lymphoma staged with PET/CT: a Danish-Canadian study

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