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FDG PET for Evaluation of Bone Marrow Status in T-Cell Lymphoma

Koh, Youngil, MD*†; Lee, Jung Min, MD; Woo, Go-Un, MD*; Paeng, Jin Chul, MD; Youk, Jeonghwan, MD*; Yoon, Sung-Soo, MD; Kim, Inho, MD; Kang, Keon Wook, MD

doi: 10.1097/RLU.0000000000002320
Original Articles

Purpose In T-cell lymphoma, the role of FDG PET for bone marrow (BM) evaluation is not established yet. We investigated diagnostic performance and prognostic implication of FDG PET for BM evaluation in peripheral T-cell lymphoma (PTCL) and extranodal NK/T-cell lymphoma (NKTCL).

Patients and Methods Patients with PTCL or NKTCL, who underwent initial staging with FDG PET and BM biopsy, were retrospectively enrolled and analyzed. PET BM finding was evaluated using visual analysis and a quantitative index (marrow-to-liver ratio [MLR]). Diagnostic performance of PET for BM involvement was assessed with biopsy as the gold standard. Prognostic value of PET findings was also assessed regarding progression-free survival (PFS) and overall survival (OS).

Results A total of 109 (63 PTCL and 46 NKTCL) patients were analyzed. Biopsy revealed BM involvement in 35.8% of cases. Sensitivity and specificity of PET for diagnosing positive BM biopsy were 61.5% and 75.7% by visual analysis and 64.1% and 72.9% by MLR. Diagnostic performance of PET was not different across lymphoma types. Survival analysis revealed that MLR and BM biopsy result is significant for both PFS and OS. In multivariate analysis, MLR was an independent prognostic factor for both PFS and OS. Marrow-to-liver ratio was also a significant prognostic factor in BM biopsy-negative patients.

Conclusions Despite fair correlation with BM biopsy result, PET may not replace BM biopsy in PTCL and NKTCL. However, the BM finding on PET is an independent prognostic factor, suggesting additional biological implication of PET findings.

From the *Department of Internal Medicine,

Biomedical Research Institute, and

Department of Nuclear Medicine, Seoul National University Hospital; and

§Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.

Received for publication June 28, 2018; revision accepted September 6, 2018.

Conflicts of interest and source of funding: This study was supported by the National Research Foundation of Korea (NRF) grant for the Global Core Research Center (No. 2011–0030001) and NRF grant for Research Center for Cellular Heterogeneity and Adaptation (No. NRF-2016R1A5A1011974) funded by the Korean government (Ministry of Science, ICT, and Future Planning). None declared to all authors.

Correspondence to: Jin Chul Paeng, MD, PhD, Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. E-mail:

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