Original Research

The relationship between bone marrow involvement on 18F-FDG PET/CT and bone marrow biopsy in patients with multiple myeloma and other plasma cell neoplasms

Kiflom S. Gebreslassie, Fatima C. Bassa, Zivanai C. Chapanduka, James M. Warwick
South African Journal of Oncology | Vol 6 | a197 | DOI: https://doi.org/10.4102/sajo.v6i0.197 | © 2022 Kiflom Seyoum Gebreslassie, Fatima Bassa, Zivanai Chapanduka, James Warwick | This work is licensed under CC Attribution 4.0
Submitted: 18 September 2021 | Published: 10 January 2022

About the author(s)

Kiflom S. Gebreslassie, Nuclear Medicine Division, Department of Clinical Oncology and Medical Imaging, Faculty of Health Sciences, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
Fatima C. Bassa, Clinical Hematology Division, Department of Internal Medicine, Faculty of Health Sciences, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
Zivanai C. Chapanduka, Haematological Pathology and National Health Laboratory Service Division, Faculty of Health Sciences, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
James M. Warwick, Nuclear Medicine Division, Department of Clinical Oncology and Medical Imaging, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa., South Africa


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Abstract

Background: Bone marrow biopsy (BMB) plays a crucial role in the diagnosis and assessment of treatment response in patients with multiple myeloma (MM). 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has been shown to be a complimentary measure of marrow involvement in patients with Hodgkin and diffuse large B cell lymphomas. However, only limited information is available on its relationship with BMB in MM.

Aim: To assess the association between bone marrow involvement on 18F-FDG PET/CT, and BMB in patients with MM and other plasma cell neoplasms.

Setting: Cape Town, South Africa.

Methods: Hundred and three patients undergoing 18F-FDG PET/CT and BMB were included. Plasma cell infiltration (PCI) on BMB was compared for three visual patterns of 18F-FDG bone marrow uptake (irregular, diffuse less than or equal to the liver and diffuse greater than liver).

Results: Eighty-four patients had diffuse bone marrow uptake. Of these, 25/84 had uptake greater than liver, all having PCI ≥ 60% and a median value of 85%. Of the 84 patients, the 59 patients with uptake less than or equal to liver had PCI < 10% in 57.6% (34/59), and ≥ 10% in 42.4% (25/59) with a median value of 8%. Nineteen patients had irregular bone marrow uptake. Of these, 4/19 (21.1%) had PCI of < 10% and 15/19 (78.9%) had PCI ≥ 10%, with the median value of 23%. The median percentage of PCI across the three described patterns of FDG uptake was significantly different (p = 0.0001).

Conclusion: 18F-fluorodeoxyglucose positron emission tomography/computed tomography might avoid the need of repeat BMB in most of the patients with diffuse and irregular patterns of 18F-FDG uptake.


Keywords

multiple myeloma; 18F-FDG PET/CT; bone marrow biopsy; patterns of 18F-FDG uptake; plasma cell neoplasms

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