We carried out a meta-analysis to evaluate the performance of 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) PET and PET/CT against bone marrow biopsy (BMB) in the initial diagnosis of bone marrow infiltration (BMI) in patients with Hodgkin’s disease (HD).
Materials and methods
Retrospective and prospective studies with direct comparison of 18F-FDG PET with BMB in the initial evaluation of BMI in HD were included. Seven eligible studies were included in the meta-analysis comprising a total of 687 patients.
Both 18F-FDG PET and BMB had excellent specificity in detecting BMI. However, 18F-FDG PET had excellent pooled sensitivity (94.5%; 95% confidence interval: 89.0–97.8%) in detecting BMI in the initial staging of HD patients, whereas the pooled sensitivity of iliac BMB was very poor (39.4%; 95% confidence interval: 30.8–48.4%). The diagnostic odds ratio, a measure of the overall diagnostic power of the test, was much higher for PET (pooled value of 1591) than for iliac BMB (pooled value of 137).
18F-FDG PET significantly outperforms iliac BMB in the detection of BMI in the initial staging of HD patients and therefore should be used as a first-line study. Iliac BMB has low sensitivity and a high rate of false-negative findings. Thus, a negative BMB finding cannot rule out marrow involvement in HD patients on initial staging.