PET/CT Scanner and Bone Marrow Biopsy in Detection of Bone Marrow Involvement in Diffuse Large B-Cell Lymphoma

Fadi El Karak 1Ibrahim R Bou-Orm 1Marwan Ghosn 1Joseph Kattan 1Fadi Farhat 1Toni Ibrahim 1Mario Jreige 2Jean El Cheikh 3Mohamad Haidar 4


1School of Medicine, Saint Joseph University (USJ), Beirut, Lebanon.

2Nuclear Medicine Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.

3Hematology Department, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon.

4Radiology Department, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon & Nuclear Medicine Department, Mount Lebanon hospital, Beirut, Lebanon.PMID: 28099514

 PMCID: PMC5242511

 DOI: 10.1371/journal.pone.0170299

Free PMC article


Evaluation of bone marrow involvement (BMI) is paramount in diffuse large B-cell lymphoma (DLBCL) for prognostic and therapeutic reasons. PET/CT scanner (PET) is now a routine examination for the staging of DLBCL with prognostic and therapeutic implications. This study evaluates the role of PET for detecting marrow involvement compared to bone marrow biopsy (BMB). This monocentric study included 54 patients diagnosed with DLBCL between 2009 and 2013 and who had FDG PET/CT in a pre-treatment setting. A correlation analysis of the detection of BMI by PET and BMB was performed. A prognostic evaluation of BMI by BMB and/or PET/CT and correlation with an overall 2-year survival were analyzed. PET was more sensitive for the detection of BMI than BMB (92.3% vs. 38.5%). It can be considered a discriminatory Pre-BMB test with a negative predictive value of 97.6%. In addition, BMI by PET had a prognostic value with strong correlation with progression-free survival (PFS) (HR = 3.81; p = 0.013) and overall survival (OS) (HR = 4.12; p = 0.03) while the BMB had not. PET shows superior performance to the BMB for the detection of marrow involvement in DLBCL. It may be considered as the first line examination of bone marrow instead of the biopsy.

Conflict of interest statement

The authors have declared that no competing interests exist.