الفهرس 
Title : Assessment of PET-CT Scan As An Alternative Method To Bone Marrow Biopsy In Assessment of Bone Marrow In Lymphoma Patients
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Abstract
Bone marrow assessment is an important part in the Ann Arbor staging system in lymphoma. It is done routinely through posterior iliac crest bone marrow biopsy (BMB) which is an invasive technique with limited examination of one site. 18F-FDG PET-CT is now used for staging of lymphoma. The aim of this study was to compare the sensitivity of PET-CT and BMB in detecting BMI in Hodgkin lymphoma (HL) and Non Hodgkin lymphoma (NHL) and determine agreement between both in assessing bone marrow in lymphoma patients. This is a prospective study of 145 patients with pathologically proven lymphoma.Patients who underwent both PET-CT and iliac crest BMB before initiation of therapy within a period not exceeding 2 weeks were only included in this study. Iliac crest BMB was not used only as the gold standard for evaluating BMI, follow up, local biopsy, targeted MRI and/or CT changes were also used. We found thatPET-CT detected 24 (16.5%) cases with positive BMI that were missed by BMB. The PET CT showed a higher sensitivity 95.6% (95%CI: 89.3-100 %) than BMB 46.7% (95%CI: 31.5-61.8%) in detecting BMI in both HL and NHL. We found a moderate agreement between PET-CT and BMB results in the whole cohort using Cohen{u2019}s k computation. It was found 0.47 with p value less than 0.0001. PET-CT can detect more bone marrow involvement in HL and NHL compared with BMB. PET-CTshould precede BMB as it can replace the routine invasive BMB in most of the cases, especially those showing multifocal uptake in both HL and NHL. PET-CT can also help to guide the site of the biopsy in some cases. Iliac crest BMB is still needed in cases showing diffuse FDG uptake to differentiate malignant uptake from reactive hyperplasia, in certain types of lymphoma with known limited FDG avidity and in some cases with negative uptake to exclude early infiltration if management will differ