Diagnostic Value of 18F-FDG PET/CT for Detecting Bone Marrow Tumor Lesions in Patients with Newly Diagnosed Diffuse Large B-Cell Lymphoma

AIM. To study the value of PET/CT for detecting tumor lesions in bone marrow (BM) of patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) as well as to compare the data with the results of bone marrow core biopsies and immunophenotyping (IPT) of BM lymphoid elements by flow cytometry.

MATERIALS & METHODS. This prospective study enrolled 80 patients with newly diagnosed DLBCL treated at the AF Tsyb Medical Radiological Research Center from 2021 to 2024. The mean age was 53.3 years (range 26–77 years). In most patients (65 %), stage IV was reported. The median follow-up was 19.5 months (range 4.97–45.53 months). All patients received R-CHOP (66.25 %) and R-CHOP-like (33.75 %) therapy regimens. At disease onset, BM lesions were diagnosed on the basis of PET/CT, bone marrow core biopsy with morphological and immunohistochemical (morpho-IHC) analysis and aspiration biopsy as well as subsequent IPT of lymphoid elements.

RESULTS. BM involvements were reported by the results of at least one of the above methods in 32 (40 %) patients. In 27 (84.4 %) out of 32 patients, BM tumor lesions were diagnosed by PET/CT: 13 (48.2 %) of them showed diffuse, 12 (44.4 %) had focal, and 2 (7.4 %) patients showed combined type of radiopharmaceutical (RP) uptake. By morpho-IHC analysis, BM tumor lesions were diagnosed in 14 (43.7 %) out of 32 patients, in 6 of them diffuse and in 8 focal RP uptake was reported by PET/CT. By IPT, BM involvements were identified in 24 (75 %) out of 32 patients, 10 of them with diffuse, 8 with focal, 2 with combined type, and 4 without any RP hyperfixation. Compared to laboratory methods, sensitivity and specificity of PET/CT in detecting BM involvements in DLBCL patients were 83.3 % (95% CI 0.64–0.93 %) and 87.5 % (95% CI 0.76–0.93 %), respectively. The least degree of PET/CT data consistency with BM biopsies was observed with diffuse BM lesions (k = 0.284), while the maximum degree was reported for the focal type (k = 0.481). IPT results better correlated with diffuse lesions by PET/CT (k = 0.5) than with the focal ones (k = 0.392). Without regard to the type of BM lesions, PET/CT correlated with the results of morpho-IHC analysis not so well (k = 0.588) as with the IPT data (k = 0.684).

CONCLUSION. Integration of radiology (PET/CT) and laboratory methods provides the basis to most accurately assess tumor spread and confirm BM lesions in patients with newly diagnosed DLBCL.

• Artem Andreevich Vovchenko AF Tsyb Medical Radiological Research Center, branch of the NMRC of Radiology, 4 Koroleva ul., Obninsk, Kaluga Region, Russian Federation, 249036 https://orcid.org/0009-0009-6911-3322 (unauthenticated)
• A.B. Galitsyna AF Tsyb Medical Radiological Research Center, branch of the NMRC of Radiology, 4 Koroleva ul., Obninsk, Kaluga Region, Russian Federation, 249036 ; Obninsk Institute for Nuclear Power Engineering, branch of the MIFI National Research Nuclear University, 1 Studgorodok ter., Obninsk, Kaluga Region, Russian Federation, 249039 https://orcid.org/0009-0009-0188-8420 (unauthenticated)
• N.A. Falaleeva AF Tsyb Medical Radiological Research Center, branch of the NMRC of Radiology, 4 Koroleva ul., Obninsk, Kaluga Region, Russian Federation, 249036 ; Obninsk Institute for Nuclear Power Engineering, branch of the MIFI National Research Nuclear University, 1 Studgorodok ter., Obninsk, Kaluga Region, Russian Federation, 249039 https://orcid.org/0000-0002-0023-4216 (unauthenticated)
• M.M. Khodzhibekova PA Gertsen Moscow Oncology Research Institute, branch of the NMRC of Radiology, 3 2-i Botkinskii pr-d, Moscow, Russian Federation, 125284 https://orcid.org/0000-0002-2172-5778 (unauthenticated)
• V.A. Shuvaev AF Tsyb Medical Radiological Research Center, branch of the NMRC of Radiology, 4 Koroleva ul., Obninsk, Kaluga Region, Russian Federation, 249036 ; Obninsk Institute for Nuclear Power Engineering, branch of the MIFI National Research Nuclear University, 1 Studgorodok ter., Obninsk, Kaluga Region, Russian Federation, 249039 ; Russian Medical Academy of Postgraduate Education, 2/1 Barrikadnaya ul., Moscow, Russian Federation, 125993 https://orcid.org/0000-0003-3536-0770 (unauthenticated)
• L.Yu. Grivtsova AF Tsyb Medical Radiological Research Center, branch of the NMRC of Radiology, 4 Koroleva ul., Obninsk, Kaluga Region, Russian Federation, 249036 https://orcid.org/0000-0001-9103-9688 (unauthenticated)
• A.A. Danilenko AF Tsyb Medical Radiological Research Center, branch of the NMRC of Radiology, 4 Koroleva ul., Obninsk, Kaluga Region, Russian Federation, 249036 https://orcid.org/0000-0002-6798-6076 (unauthenticated)
• A.Yu. Terekhova AF Tsyb Medical Radiological Research Center, branch of the NMRC of Radiology, 4 Koroleva ul., Obninsk, Kaluga Region, Russian Federation, 249036 ; Obninsk Institute for Nuclear Power Engineering, branch of the MIFI National Research Nuclear University, 1 Studgorodok ter., Obninsk, Kaluga Region, Russian Federation, 249039 https://orcid.org/0000-0002-7458-0269 (unauthenticated)
• D.A. Manaenkov AF Tsyb Medical Radiological Research Center, branch of the NMRC of Radiology, 4 Koroleva ul., Obninsk, Kaluga Region, Russian Federation, 249036 https://orcid.org/0009-0007-9269-7405 (unauthenticated)
• S.A. Ivanov AF Tsyb Medical Radiological Research Center, branch of the NMRC of Radiology, 4 Koroleva ul., Obninsk, Kaluga Region, Russian Federation, 249036 ; Obninsk Institute for Nuclear Power Engineering, branch of the MIFI National Research Nuclear University, 1 Studgorodok ter., Obninsk, Kaluga Region, Russian Federation, 249039 https://orcid.org/0000-0001-7689-6032 (unauthenticated)

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