Magnetic resonance imaging of bone marrow versus bone marrow biopsy in malignant lymphoma

25 Years Old Women With Inflammatory Low Back Pain

INTRODUCTION

Diffuse large B-cell lymphoma (DLBCL) is the most frequent histological type of malignant lymphomas (approximately 30% of cases). DLBCL is highly curable through chemotherapy. Rituximab in combination with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy as the most frequent of care for first - DLBCL therapy, improves long-term survival of patients effectively.

CASE REPORT

A young female (25 years old) complained about pain in her right back for two years. She was suffering from backache with priority in the right and contracture in mornings. Sacroiliac joint seemed normal but lytic and sclerotic lesions and also density changing of L5 and humerus head was revealed by CT scan. Biopsy was taken from the iliac bone and diffuse large B cell lymphoma was diagnosed.

CONCLUSION

Chronic pains especially in axial skeleton, pelvis area and main joints must be taken seriously and examined by CT scan and MRI. If no particular issue was reported primarily while the pain was remained, a complete diagnosis BMB associated with PET must be applied. Despite of dependency on diagnosis the treatment by CHOP in association with rituximab is the most recommended chemotherapy alternative for patients with DLBCL.

Can [18F]fluorodeoxyglucose positron emission tomography imaging complement biopsy results from the iliac crest for the detection of bone marrow involvement in patients with malignant lymphoma?

OBJECTIVES

To assess the usefulness of [18F]fluorodeoxyglucose positron emission tomography in the detection of bone marrow involvement in malignant lymphoma, and its impact in clinical management.

METHODS

One hundred and six consecutive patients with a confirmed diagnosis of lymphoma, referred for staging or restaging of Hodgkin's lymphoma (n=18) or non-Hodgkin's lymphoma (n=88), were reviewed retrospectively. A positron emission tomography scan and bone marrow biopsy of the iliac crest were performed in all patients. The assessment of bone marrow involvement by lymphoma was confirmed by histology and/or progression of bone marrow lesions in clinical follow-up.

RESULTS

In 28 of 106 patients, bone marrow involvement was found. Positron emission tomography was more sensitive (86%) than bone marrow biopsy (57%). Positron emission tomography and bone marrow biopsy were concordant by positive correlation in 12 of 28 cases (43%) and by negative correlation in 77 of 78 cases (99%). Ten cases of non-Hodgkin's lymphoma and two cases of Hodgkin's lymphoma with positive positron emission tomography results and an initial negative bone marrow biopsy showed clinical progression of the bone marrow lesions and/or subsequent positive histology. These were considered as false-negative results for bone marrow biopsy. In seven of the 12 positive cases with negative bone marrow biopsy, positron emission tomography uptake distant from the site of the biopsy was seen. In four cases of follicular lymphoma, the bone marrow biopsy was positive and the positron emission tomography scan was normal.

CONCLUSIONS

Positron emission tomography and bone marrow biopsy are complementary in assessing the presence of bone marrow involvement in patients with malignant lymphoma. In our series, positron emission tomography was more sensitive than bone marrow biopsy in Hodgkin's and non-Hodgkin's lymphoma, except in follicular lymphoma.

A Comparison of Whole-Body MRI and CT for the Staging of Lymphoma

OBJECTIVE

Our objective was to compare whole-body MRI and CT for the staging of lymphoma.

CONCLUSION

Whole-body MRI represents an alternative to CT in the staging of lymphoma, with an ability to stage disease, identify lymph nodes greater than 1.2 cm, and the additional ability to evaluate for the presence or absence of disease spread to bone marrow. CT allows detection of more nodes (< 1.2 cm) than MRI but this does not alter tumor stage.

A large-scale study of bone marrow involvement in patients with Hodgkin's lymphoma

This study was designed to identify variables that can predict bone marrow involvement (BMI) in Hodgkin's lymphoma (HL), and to analyze the benefit of bilateral over unilateral bone marrow trephine biopsy (BMB). From 1982 to 2000, BMB had been performed at diagnosis in 1161 patients with HL who had been followed from the institutions participating in the Piemonte Hodgkin's Disease Registry. Six hundred and sixteen patients (53%) had received bilateral BMB, and the remaining 545 patients (47%) received unilateral BMB. The relationships between BMB results and other clinical features were retrospectively studied with both univariate and multivariate analyses. Ninety-two patients (8%) showed BMI: 51 of them were staged with bilateral and 41 with unilateral BMB. Among the 92 patients with BMI, a second extranodal involvement was present in only 25 patients (27%). In multivariate analysis, the 5 independent factors that predicted for BMI were B symptoms, infradiaphragmatic involvement, mixed cellularity (MC) and lymphocyte depleted (LD) histology, involvement of > or = 4 lymphatic areas, and liver involvement. The probability of BMI according to the presence of these variables was distributed as follows: 0.3%, 2.5%, 7.6%, and 27% in patients positive for 0, 1, 2, and > or = 3 factors, respectively. Among 51 patients staged with bilateral BMB, BMI was shown in both specimens in 33 cases (65%), whereas the positivity was limited to only 1 of the 2 specimens in the remaining 18 cases (35%). A score based on 5 variables can predict the probability of BMI, and BMB could be avoided in patients with a score of 0 and a probability of BMI of < 0.5%. When BMB is needed, the superiority of bilateral over unilateral biopsy is suggested.