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¹⁸F-FDG PET for Evaluation of Bone Marrow Infiltration in Staging of Lymphoma: A Meta-Analysis

¹ Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
² Department of Nuclear Medicine, University Hospital of Ioannina, School of Medicine, Ioannina, Greece
³ Biomedical Research Institute, Foundation for Research and Technology–Hellas, Ioannina, Greece
⁴ Department of Medicine, Institute for Clinical Research and Health Policy Studies, Tufts–New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts

The ability of PET with ¹⁸F-FDG to evaluate bone marrow infiltration in patients with lymphoma has been a matter of extensive investigation with controversial results. Therefore, we aimed to evaluate systematically, with a meta-analysis, the diagnostic performance of ¹⁸F-FDG PET in this setting. Methods: Relevant studies were identified with MEDLINE and EMBASE searches (last update, August 2004). Data on the diagnostic performance of ¹⁸F-FDG PET were combined quantitatively across eligible studies. We estimated weighted summary sensitivities and specificities, summary receiver-operating-characteristic (SROC) curves, and weighted summary likelihood ratios. We also conducted separate analyses according to various subgroups. Bone marrow biopsy (BMB) was used as the reference standard. Results: Thirteen eligible nonoverlapping studies, which enrolled a total of 587 patients, were included in the meta-analysis. The independent random-effects weighted estimates of sensitivity and specificity against BMB were 51% (95% confidence interval [CI], 38%–64%) and 91% (95% CI, 85%–95%), respectively. Results were consistent in the SROC curve: a sensitivity of 51% corresponds to a specificity of 92%, whereas a specificity of 91% corresponds to a sensitivity of 55%. The weighted positive likelihood ratio (LR+) was 5.75 (95% CI, 348–9.48) and the negative likelihood ratio (LR–) was 0.67 (95% CI, 0.55–0.82). Six of 12 patients with positive ¹⁸F-FDG PET and negative initial biopsy were found to have bone marrow involvement when biopsy was performed at the sites with positive imaging signals. Subgroup analyses showed better sensitivity in patients with Hodgkin’s disease and in aggressive histologic types of non-Hodgkin’s lymphoma than in patients with less aggressive histologic types and in studies using unilateral BMB compared with those using bilateral biopsy. Conclusion: This meta-analysis showed that ¹⁸F-FDG PET has good, but not excellent, concordance with the results of BMB for the detection of bone marrow infiltration in the staging of patients with lymphoma. ¹⁸F-FDG PET may complement the results of BMB and its performance may vary according to the type of lymphoma.

Key Words: ¹⁸F-FDG PET • staging • lymphoma • bone marrow • biopsy

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