PET/CT-based bone-marrow assessment shows potential in replacing routine bone-marrow biopsy in part of patients newly diagnosed with extranodal natural killer/T-cell lymphoma
This study aimed to determine the potential of positron emission tomography/computed tomography (PET/CT) in replacing routine bone-marrow biopsies (BMB) in newly diagnosed extranodal natural killer/T-cell lymphoma (ENKTCL).
Newly diagnosed patients underwent PET/CT imaging and routine BMB to assess bone/bone marrow involvement (BMI). Clinical stage and treatment plan were determined, and survival was compared.
In a total of 101 patients, 78 were diagnosed as stage I/II and 23 as stage III/IV without using the BMB results. No BMB-positive patients were identified in stages I/II, and therefore, the BMB results did not alter the stage and treatment choice in any patients. The sensitivity and specificity of focal skeletal PET/CT lesion(s) in assessing BMI was 100% and 92.8%, respectively, taking routine BMB as the reference standard. The overall survival (OS) and progression-free survival (PFS) of BMB-positive patients was significantly inferior (P = 0.0011 and 0.0465, respectively, in advanced-stage patients; both P < 0.0001 in all patients), and this was corroborated by the PET/CT findings (P = 0.0006 and 0.0116, respectively, in advanced-stage patients; both P < 0.0001 in all patients).
Based on the results, PET/CT demonstrated satisfactory predictive performance in terms of staging and prognosis in ENKTCL. BMB did not influence staging and treatment in newly diagnosed ENKTCL, and routine non-targeted BMB is not obligatory for early stage patients undergoing PET/CT. Targeted BMB is recommended to confirm BMI in advanced-stage patients.
KeywordsExtranodal natural killer/T-cell lymphoma (ENKTCL) PET/CT Bone-marrow biopsy Bone/bone-marrow involvement Prognosis
This study has no specific funding. We are grateful to the patients in this trial and clinical staff from the pathology and nuclear medicine departments of West China Hospital for their assistance.
YW and MJ performed the research. MJ designed the research study. Other authors analyzed the data; YW and MJ wrote the paper.
Compliance with ethical standards
Conflict of interest
The authors declared no conflict of interest to this work.
We abided by ethical standards of the institutional and/or national research committee, the Helsinki Declaration in 1964 and its later amendments or comparable ethical standards in all procedures performed in this study and all human participants involved.
Informed consent was obtained from all individual participants included in the study.
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