Routine bone marrow biopsy is not necessary in the staging of patients with classical Hodgkin lymphoma in the ¹⁸F-fluoro-2-deoxyglucose positron emission tomography era

Abstract

Accurate staging of classical Hodgkin lymphoma (CHL) directs treatment intensity. Functional imaging can detect marrow/bone involvement making the role of bone marrow biopsy (BMB) unclear. We assessed current UK practice in CHL staging by questionnaire and retrospectively analyzed patients staged at a single center with BMB and ¹⁸F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). From 34 questionnaire responses 50% used FDG-PET/CT routinely. BMB was employed in 97% with advanced-stage and 30% of patients with limited-stage disease (70% of those not using routine FDG-PET/CT). Ten out of 50 patients were BM+, all of which were identified by FDG-PET/CT (PET+). Conventional BMB changed management in 2% of cases. There were no clinically significant FDG-PET/CT false positives. Conventional routine BMB staging in CHL is extremely insensitive. FDG-PET/CT can rule out marrow/bone involvement in CHL. In the FDG-PET/CT staging era BMB should be targeted to a minority of patients with FDG-PET/CT + bone/marrow uptake and only when management would be altered by the result.

Key words::

• FDG-PET
• Hodgkin lymphoma
• bone marrow biopsy
• staging

Acknowledgement

We would like to thank Michael Roughton at the Cancer Research UK and University College London Cancer Trials Centre, London, UK for his review of statistical methods.

Potential conflict of interest:

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