Diagnostic and prognostic value of bone marrow biopsy in patients with extranodal NK/T-cell lymphoma based on PET-CT staging
Zheng Hao1, Yang Yong1, Qiu Yanyan2, Liao Siqin3, Huang Cheng1, Shi Guiqing1, Zhao Ruizhi1, Tang Tianlan1, Wang Shunyuan1, Chen Silin1, Liu Tingbo2, Xu Benhua1
1Department of Radiation Oncology, Fujian Medical University Union Hospital, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou 350001, China; 2Department of Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, China; 3Center of PET-CT, Fujian Medical University Union Hospital, Fuzhou 350001, China
Abstract：Objective To analyze the diagnostic and prognostic value of routine bone marrow examination in patients with extranodal NK/T-cell lymphoma (ENKTCL) based on PET-CT staging. Methods Clinical data of 186 patients who received bone marrow biopsy and bone marrow aspiration in Fujian Medical University Union Hospital from 2013 to 2021 were retrospectively analyzed. All patients were divided into bone marrow biopsy + bone marrow aspiration group (n=186) and PET-CT + bone marrow biopsy group (n=139). The sensitivity, specificity, positive and negative predictive values were compared between two groups. The data were analyzed and plotted. Survival analysis was performed using Kaplan-Meier method and log-rank test. Results In the whole cohort, 45 patients were positive for bone marrow biopsy, and 30 of them were positive for bone marrow aspiration. A total of 141 patients who were negative for bone marrow biopsy also achieved negative results for bone marrow aspiration. A total of 139 patients completed PET-CT staging and bone marrow biopsy. And 30 patients were diagnosed with positive bone marrow by PET-CT, in which 22 of them were confirmed positive by bone marrow biopsy. Among 109 patients diagnosed with negative bone marrow by PET-CT, 5 of them were confirmed positive by bone marrow biopsy. All these cases were classified as stage Ⅳ due to distant metastases. PET-CT had a diagnostic sensitivity of 81.5%, a specificity of 92.9%, a positive predictive value of 73.3%, and a negative predictive value of 95.4%. Among early stage (Ⅰ-Ⅱ stage) patients diagnosed with PET-CT, all of them were negative for bone marrow biopsy (the negative predictive value was 100%). In stage Ⅳ patients (n=55), the 1-year overall survival of patients with bone marrow involvement by bone marrow biopsy or PET-CT (n=35) compared with their counterparts with the involvement of other organs (n=20) was 28.7% vs.42.0% (P=0.13), and 1-year progression free survival rates was 23.2% vs. 23.3% in (P=0.94). Conclusions Routine bone marrow biopsy does not change the original staging of patients with early stage ENKTCL based on PET-CT staging. Advanced stage patients with positive bone marrow biopsy tend to obtain worse prognosis, indicating that bone marrow biopsy still has certain value.
Zheng Hao,Yang Yong,Qiu Yanyan et al. Diagnostic and prognostic value of bone marrow biopsy in patients with extranodal NK/T-cell lymphoma based on PET-CT staging[J]. Chinese Journal of Radiation Oncology, 2023, 32(4): 313-318.
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2023, Vol. 32 
