Clinical Case Reports

Biography

Biography: Ghaleb Elyamany

Abstract

Achieving a correct histological diagnosis and an accurate staging of the disease are the first and most relevant steps in the management of patients with lymphoma. Bone marrow aspirate and trephine (BMB) is the current gold standard for the assessment of BM involvement. Recently, Positron emission tomography (PET) using 18fluoro-2-deoxyglucose (FDG) has become a standard clinical tool for staging and response assessment in aggressive lymphomas. Several studies and consensus conclude that if a PET/CT is performed, a BMB is no longer indicated for HL, DLBCL and FL. BMB is only needed for DLBCL if the PET is negative and identifying a discordant histology is important for patient management. In the other hand, several studies and the consensus is that, at present, FDG-PET has a complementary role to play in the assessment of BM involvement in patients with lymphoma but cannot replace a BMB. A meta-analysis published in 2004 examined the role of FDG-PET in the assessment of BM involvement in both HL and NHL; it included data from 13 clinical studies and a total of 587 patients; the authors concluded that FDG-PET could complement a BMB in the staging of lymphoma, but it cannot replace it. Similarly, most studies report a significant rate of false-negative FDG-PET in patients with ‘indolent’ NHL with a positive BMB, resulting in a low sensitivity for FDG-PET to detect BM involvement. In summary, the consensus is that, at present, FDG-PET has a complementary role to play in the assessment of BM involvement in patients with NHL but cannot replace a BMB whereas the current evidence suggests that FDG-PET/CT may be an appropriate method to replace BMB in newly diagnosed HL. Prospective studies of larger numbers of patients and in multiple centers are needed before conclusions derived from these results can be adopted into clinical practice