DIAGNOSTIC ACCURACY OF 18F-FDG PET/CT IN DETECTING BONE MARROW LESIONS IN CHILDREN WITH HODGKIN'S LYMPHOMA

 

Dunaykin M.M.¹, Shestopalov G.I.^1,2, Yadgarov M.Ya.^1,3, Kailash Ch.¹,

Kireeva E.D.¹, Myakova N.V.¹, Likar Yu.N.¹

 

1 - Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology.

2 - Russian Children's Clinical Hospital, N.I. Pirogov Russian National Research Medical University.

3 - Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology. Moscow, Russia.

To assess the diagnostic accuracy of 18F-FDG PET/CT for detecting bone marrow lesions in children with Hodgkin's lymphoma (HL), using bone marrow biopsy (BMB) as the "gold standard."

Materials and Methods. Сhildren with newly diagnosed HL and who underwent both BMB and PET/CT imaging as part of pre-treatment staging were included in this retrospective analysis. We evaluated sensitivity, specificity, prognostic values and overall diagnostic accuracy.

Results. A total of 118 children with HL were included based on the selection criteria, with a median age of 14.3 years (IQR 11.1-16.2) and an age range of 0 to 17 years. The cohort comprised 55.9% males. Among the participants, 1 patient had stage I, 40 had stage II, 39 had stage III, and 38 had stage IV disease. The median follow-up period was 29 months (IQR 14-47 months), revealing 13 cases of recurrence/progression (11.0%) and one mortality (0.8%). Bone marrow involvement was confirmed in 5 (4.2%) out of the 118 patients based on BMB results. Initial PET/CT scans indicated pathological bone marrow lesions in 28 (23.7%) patients. Notably, all patients who tested positive in BMB also showed positive findings on PET/CT. There were no statistically significant differences in event-free survival based on the presence of focal lesions (p=0.19).

Discussion. The results of our study confirmed the previously obtained data that PET/CT has high sensitivity, specificity, negative predictive value and is an effective method for determining bone marrow involvement when compared with ВМВ, which is accepted as the "gold standard". In cases where the initial PET/CT demonstrate physiological distribution of 18F-FDG in bone marrow, there is no need to perform BMB. In addition, given the fact that bone marrow lesions in HL are often discrete and BMB is generally not performed from the lesion, but from the iliac crest (the standard area for BMB), which can give a false-negative result. Thus, in our work, PET/CT allowed us to identify bone marrow involvement in the form of single or multiple discrete foci in 23 patients, and in all 23 patients the BMB results were negative. Our findings confirm the results of previously published studies and indicate that if the initial PET/CT demonstrate bone marrow involvement, BMB should be avoided.

Conclusion. 18F-FDG PET/CT can be a perfect alternative to BMB as a noninvasive diagnostic method with high sensitivity and specificity for assessing bone marrow lesions in children with HL. Based on our findings, BMB should not be performed in HL patients when initial PET/CT shows no evidence of bone marrow lesions or when clear signs of bone marrow involvement are present.

 

Keywords: PET/CT scan, Hodgkin's lymphoma, children, bone marrow biopsy, 18F-FDG.

 

Corresponding author: Dunaykin M.M., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript .

 

For citation: Dunaykin M.M., Shestopalov G.I., Yadgarov M.Ya., Kailash Ch., Kireeva E.D., Myakova N.V., Likar Yu.N. Diagnostic accuracy of 18F-FGD PET/CT in detecting bone marrow lesions in children with hodgkin's lymphoma. REJR 2025; 15(2):97-108. DOI: 10.21569/2222-7415-2025-15-2-97-108.

Received:        03.12.24 Accepted:       26.03.25