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?

• Published in: Annals of oncology Vol. 25; no. 5; pp. 921 - 927
• Main Authors: Adams, H.J.A., Kwee, T.C., de Keizer, B., Fijnheer, R., de Klerk, J.M.H., Littooij, A.S., Nievelstein, R.A.J.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.05.2014; Oxford University Press
• Subjects: Antineoplastic agents; Biological and medical sciences; Biopsy; bone marrow; Bone Marrow - diagnostic imaging; Bone Marrow - pathology; Bone Marrow Neoplasms - diagnostic imaging; Bone Marrow Neoplasms - secondary; FDG-PET/CT; Fluorodeoxyglucose F18; Hematologic and hematopoietic diseases; Hodgkin; Hodgkin Disease - diagnostic imaging; Hodgkin Disease - pathology; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Medical sciences; meta-analysis; Pharmacology. Drug treatments; Positron-Emission Tomography; Radiopharmaceuticals; ROC Curve; systematic review; Tomography, X-Ray Computed; FDG-PET/CT; biopsy; meta-analysis; Hodgkin; systematic review; bone marrow; Radionuclide study; Performance evaluation; 2-deoxy-2-fluoroglucose; Radiodiagnosis; Hodgkin disease; Systematic review; Early stage; Malignant hemopathy; Review; Lymphoma; Metaanalysis; Anatomic pathology; Biopsy; Lymphoproliferative syndrome; Bone marrow; Medical imagery; Computerized axial tomography; Diagnosis; Positron emission tomography; Cancer; Emission tomography
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1093/annonc/mdt533

This study aimed to systematically review and meta-analyze published data on the diagnostic performance of 18F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting bone marrow involvement in newly diagnosed Hodgkin lymphoma, and to determine whether FDG-PET/CT can replace blind bone marrow biopsy (BMB) in these patients. The PubMed/Medline and Embase databases were systematically searched for relevant studies. Methodological quality of each study was assessed. Sensitivities and specificities of FDG-PET/CT in individual studies were calculated and underwent meta-analysis with a random effects model. A summary receiver operating characteristic curve (sROC) was constructed with the Moses–Shapiro–Littenberg method. The weighted summary proportion of FDG-PET/CT-negative patients with a positive BMB among all cases was calculated under the fixed effects model. Nine eligible studies, comprising a total of 955 patients with newly diagnosed Hodgkin lymphoma, were included. Overall, the studies were of moderate methodological quality. The sensitivity and specificity of FDG-PET/CT for the detection of bone marrow involvement ranged from 87.5% to 100% and from 86.7% to 100%, respectively, with pooled estimates of 96.9% [95% confidence interval (CI) 93.0% to 99.0%] and 99.7% (95% CI 98.9% to 100%), respectively. The area under the sROC curve was 0.9860. The weighted summary proportion of FDG-PET/CT-negative patients with a positive BMB among all cases was 1.1% (95% CI 0.6% to 2.0%). Although the methodological quality of studies that were included in this systematic review and meta-analysis was moderate, the current evidence suggests that FDG-PET/CT may be an appropriate method to replace BMB in newly diagnosed Hodgkin lymphoma.