Routine bone marrow biopsy (BMB) did not contribute relevant diagnostic or prognostic value over positron emission tomography (PET)/computed tomography (CT) alone in most patients with diffuse large B-cell lymphoma (DLBCL), according to a study published in the Annals of Oncology.1

Investigators sought to determine if routine bone marrow biopsy added diagnostic and prognostic value in patients with diffuse large B-cell lymphoma undergoing PET/CT staging.

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Investigators retrospectively identified 530 patients with newly diagnosed DLBCL who underwent staging PET/CT and BMB. Original PET/CT pathology reports were reviewed to determine Ann Arbor stage and outcomes, with and without the contribution of BMB.

A total of 28% of patients had focal bone marrow lesions on PET/CT; 16% had positive BMB. A total of 36% of patients with positive PET/CT had a positive BMB (39 DLBCL and 13 indolent non-Hodgkin lymphoma [iNHL] and 9% with negative PET/CT had positive BMB [12 DLBCL; 23 iNHL).

For 6% of stage 1/2 patients, BMB upstaged them to stage 4, even though that was only true for 3 patients with DLBLC in the BMB. PET/CT identified bone marrow involvement by BMB with a sensitivity of 60%, specificity of 79%, positive predictive value 36%, and negative predictive value 91%.

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In univariate and multivariate analyses, concordant histological involvement of the bone marrow by DLBCL was associated with worse overall survival and progression-free survival than discordant or no involvement.

“In patients with DLBCL, staging PET/CT can miss BM involvement with concordant DLBCL (less common) or discordant iNHL (more common),” the authors concluded.


  1. Alzahrani M, El-Galaly TC, Hutchings M, et al. The value of routing bone marrow biopsy in patients with diffuse large B-cell lymphoma staged with PET/CT: a Danish-Canadian study [published online ahead of print March 21, 2016]. Ann Oncol. doi: 10.1093/annonc/mdw137.