Bone marrow biopsy versus PET/CT scan for staging classical Hodgkin lymphoma

This study examined whether bone marrow biopsies are necessary if PET scans are used to stage classical Hodgkin lymphoma. The study concluded that patients can safely be staged with PET/CT scans without bone marrow biopsy.

Hodgkin lymphoma (HL) is widely considered a curable disease. Between 4 and 11% of patients with classical HL will experience bone marrow involvement. Disease treatment is determined by disease stage and presence of bone marrow involvement (BMI).

Bone marrow biopsies (BMB) have been used to stage HL and determine BMI. A bone marrow biopsy is an invasive procedure that can have serious complications. Positron emission tomography/computed tomography (PET/CT) scans are now recommended for staging and for determining treatment response. PET/CT scans may be able to replace biopsies for staging HL and determining BMI. More research is needed to determine if PET/CT scans are as accurate as a BMB. 

This study examined patients who had received both a bone marrow biopsy and PET/CT scan when they were first diagnosed. The medical records of 1,085 patients with classical HL were reviewed. All patients received both a PET/CT scan and BMB when they were first diagnosed. All patients were followed for a minimum of 3 months.

According to the PET/CT scans, 55 patients were in Stage I (5%), 532 patients were in Stage II (49%), 258 patients were in Stage III (23.7%), and 240 were in stage IV (22.1%). The bone marrow biopsy changed the staging of 9 patients (0.8%). 1 patient was moved from Stage II to III, and 8 patients were moved from Stage III to IV.

55 (5.1%) of patients tested positive for bone marrow involvement with a bone marrow biopsy. 54 out of the 55 who tested positive for BMI would have been correctly identified as advanced stage by a PET/CT scan alone. 

The authors concluded that PET/CT scans can safely replace bone marrow biopsies for HL disease staging and determining bone marrow involvement.