Can FDG-PET/CT replace blind bone marrow biopsy of the posterior iliac crest in Ewing sarcoma?

Skeletal Radiol. 2018 Mar;47(3):363-367. doi: 10.1007/s00256-017-2807-2. Epub 2017 Nov 9.

Abstract

Objective: To determine and compare the value of 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) to blind bone marrow biopsy (BMB) of the posterior iliac crest in detecting metastatic bone marrow involvement in newly diagnosed Ewing sarcoma.

Materials and methods: This retrospective study included 20 patients with newly diagnosed Ewing sarcoma who underwent pretreatment FDG-PET/CT and a total of 38 blind BMBs (two unilateral and 18 bilateral) of the posterior iliac crest. FDG-PET/CT scans were evaluated for bone marrow involvement, both in the posterior iliac crest and other sites, and compared to blind BMB results.

Results: FDG-PET/CT was positive for bone marrow involvement in 7/38 posterior iliac crests, whereas BMB was positive in 5/38 posterior iliac crests. FDG-PET/CT and BMB results in the posterior iliac crest agreed in 36/38 cases (94.7%, 95% confidence interval [CI]: 82.7-98.5%). On a patient level, FDG-PET/CT was positive for bone marrow involvement in 4/20 patients, whereas BMB of the posterior iliac crest was positive in 3/20 patients. On a patient level, FDG-PET/CT and BMB results agreed in 19/20 patients (95.0%, 95% CI: 76.4-99.1%). The only discrepancies between FDG-PET/CT and BMB were observed in two BMBs of one patient. Both BMBs in this patient were negative, whereas FDG-PET/CT indicated bilateral posterior iliac crest involvement and also extensive bone marrow involvement elsewhere.

Conclusions: FDG-PET/CT appears to be a valuable method for metastatic bone marrow assessment in newly diagnosed Ewing sarcoma. The routine use of blind BMB of the posterior iliac crest should be reconsidered when FDG-PET/CT is available.

Keywords: Biopsy; Bone; Ewing sarcoma; Pet-Ct; Tumor staging.

MeSH terms

  • Adolescent
  • Adult
  • Bone Marrow / diagnostic imaging
  • Bone Marrow / pathology
  • Bone Neoplasms / diagnostic imaging*
  • Bone Neoplasms / pathology
  • Child
  • Child, Preschool
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Ilium / diagnostic imaging*
  • Ilium / pathology
  • Male
  • Middle Aged
  • Positron Emission Tomography Computed Tomography* / methods
  • Radiopharmaceuticals
  • Retrospective Studies
  • Sarcoma, Ewing / diagnostic imaging*
  • Sarcoma, Ewing / pathology

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18