• Sandra Purz, Christine Mauz-Körholz, Dieter Körholz, Dirk Hasenclever, Antje Krausse, Ina Sorge, Kathrin Ruschke, Martina Stiefel, Holger Amthauer, Otmar Schober, W Tilman Kranert, Wolfgang A Weber, Uwe Haberkorn, Patrick Hundsdörfer, Karoline Ehlert, Martina Becker, Jochen Rössler, Andreas E Kulozik, Osama Sabri, and Regine Kluge.
• Department of Nuclear Medicine, University of Leipzig, Liebigstrasse 18, 04103 Leipzig, Germany. sandra.purz@medizin.uni-leipzig.de
• J. Clin. Oncol. 2011 Sep 10; 29 (26): 3523-8.

PurposeCurrently, a routine bone marrow biopsy (BMB) is performed to detect bone marrow (BM) involvement in pediatric Hodgkin's lymphoma (HL) stage greater than IIA. [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET) is increasingly used for the initial staging of HL. The value of using FDG-PET to detect BM involvement has not been sufficiently defined. We compared the results of BMBs and FDG-PET for the diagnosis of BM involvement in a large pediatric group with HL.Patients And MethodsThe initial staging of 175 pediatric patients with newly diagnosed classical HL stage greater than IIA was determined by using BMB, FDG-PET, chest computed tomography (CT), and magnetic resonance imaging (MRI) or CT of the neck, abdomen, and pelvis. Staging images were prospectively evaluated by a central review board. Skeletal regions that were suggestive of BM involvement by either method were re-evaluated by using different imaging modalities. In suspicious cases, bone scintigraphy was performed. If follow-up FDG-PET scans were available, the remission of skeletal lesions during treatment was evaluated.ResultsBMB results were positive in seven of 175 patients and were identified by FDG-PET. FDG-PET scans showed BM involvement in 45 patients. In addition, the lesions of 32 of these 45 patients had a typical multifocal pattern. In 38 of 39 follow-up positron emission tomography scans, most of the skeletal lesions disappeared after chemotherapy. There was no patient with skeletal findings suggestive of BM involvement by MRI or CT with a negative FDG-PET.ConclusionFDG-PET is a sensitive and specific method for the detection of BM involvement in pediatric HL. The sensitivity of a BMB appears compromised by the focal pattern of BM involvement. Thus, FDG-PET may safely be substituted for a BMB in routine staging procedures.

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