Omitting Bone Marrow Sampling in FDG-Avid Rhabdomyosarcoma With 2-[ 18 F]FDG PET-Negative Marrow: Results From an International Retrospective Study

PURPOSE Detection of bone marrow disease has been a major component of rhabdomyosarcoma (RMS) staging with bilateral bone marrow aspirates/biopsies (BMAB) from the iliac crests considered the diagnostic gold standard. This study's goal was to determine if 2- 18 F-labeled fluorodeoxyglucose positron emission tomography/computed tomography ([ 18 F]FDG PET/CT) or PET/magnetic resonance imaging (MRI) may replace BMAB in RMS staging. METHODS Patients were recruited in Europe and North America. Medical records, FDG PET/CT or FDG PET/MRI (PET), and BMAB reports were collected retrospectively. Images were re-reviewed by nuclear medicine physicians at the patients' home institutions if PET reports indicated increased FDG uptake at bone/bone marrow sites or if tumor cells were detected in bone marrow samples. RESULTS PET imaging and BMAB were performed before chemotherapy and tumor resection in 301 patients with FDG-avid RMS. Bone marrow metastases were detected by PET and BMAB in 54, by PET only in 24, and by BMAB only in one of 301 patients with FDG-avid primary tumors. Absence of bone marrow metastases was confirmed by PET and BMAB in 222 of 301 patients. These observations translated into 98% sensitivity and 90% specificity for PET in detecting bone marrow metastases when BMAB was considered as gold standard. FDG-avid marrow disease was patchy (1-5 foci) in one third of cases. Patients with marrow disease indicated by PET and BMAB had more FDG-avid bone marrow foci, more metastatic sites, and lower survival than those with marrow disease indicated by PET only, suggesting more advanced disease stages. CONCLUSION Bone marrow sampling may be omitted in patients without evidence of FDG-avid bone marrow disease by PET. If there are FDG-avid bone marrow lesions, further investigation by MRI and/or biopsy should be considered.

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Journal
Journal of Clinical Oncology
Published
2026-08-24
DOI
https://doi.org/10.1200/jco-25-03080
Primary Topic
Hematological disorders and diagnostics
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article
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article

Omitting Bone Marrow Sampling in FDG-Avid Rhabdomyosarcoma With 2-[ 18 F]FDG PET-Negative Marrow: Results From an International Retrospective Study

Maria Rosaria Cuomo, Bart de Keizer, Aaron R. Weiss, Stefan Rutkowski et al.
Journal of Clinical Oncology
Hematological disorders and diagnostics
article

Omitting Bone Marrow Sampling in FDG-Avid Rhabdomyosarcoma With 2-[ 18 F]FDG PET-Negative Marrow: Results From an International Retrospective Study

Maria Rosaria Cuomo, Bart de Keizer, Aaron R. Weiss, Stefan Rutkowski, Martin Ebinger, Johannes H. M. Merks, Ajaykumar C. Morani, Claudia Rössig, Christian Lohrmann, Reineke A. Schoot, Livia Ruffini, Justin Sims, Alexander Heinzel, Giorgio Baldari, Irene von Luettichau, Federico Mercolini, Carmen Degitz, Stephan D. Voss, Sonja Chen, Simone Hettmer, Marguerite T. Parisi, Pia Kröning, Pietro Zucchetta, Christine Mauz‐Körholz, Alessandra Alessi, Natalie B. Collins, Corinne M. Linardic, Stefano Chiaravalli, Ayami Yoshimi, Sebastian Jacob, Sebastian Dorin Asaftei, Barry L. Shulkin, Maura Scarlattei, Stefano Fanti, I. Borrego-Dorado, Guido Rovera, Monika Sparber‐Sauer, Katia Perruccio, Carmelo Caldarella, Michael Arnold, Gianni Bisogno, Forrest G. FitzGerald, Martin T. Freitag, Edmund Cheesman, Josef J. Fox, Suzi Birz, Bernhard Haller, Nicodemo Baffa, Marissa Just, C. Ramos Font, Giuseppe Arturo Fuso, Douglas Harrison, Laura Hiemcke-Jiwa, Wendy Allen-Rhoades, Hein J. Verberne, Jacquelyn Crane, Raya Saab, Michael DiGianvittorio, Alexandra Fischer, Maria C. Affinita, Markus Uhl, Jürgen Schäfer, Michele Sternberg, for the INSTRuCT Imaging/Pathology/Biology Network, Martina Pugliano, Jessica L. Iftner, Kristina Schachtrup, Hedieh Khalatbari, Helen Nadel, Martha Kleinwechter
article en

Abstract

PURPOSE Detection of bone marrow disease has been a major component of rhabdomyosarcoma (RMS) staging with bilateral bone marrow aspirates/biopsies (BMAB) from the iliac crests considered the diagnostic gold standard. This study's goal was to determine if 2- 18 F-labeled fluorodeoxyglucose positron emission tomography/computed tomography ([ 18 F]FDG PET/CT) or PET/magnetic resonance imaging (MRI) may replace BMAB in RMS staging. METHODS Patients were recruited in Europe and North America. Medical records, FDG PET/CT or FDG PET/MRI (PET), and BMAB reports were collected retrospectively. Images were re-reviewed by nuclear medicine physicians at the patients' home institutions if PET reports indicated increased FDG uptake at bone/bone marrow sites or if tumor cells were detected in bone marrow samples. RESULTS PET imaging and BMAB were performed before chemotherapy and tumor resection in 301 patients with FDG-avid RMS. Bone marrow metastases were detected by PET and BMAB in 54, by PET only in 24, and by BMAB only in one of 301 patients with FDG-avid primary tumors. Absence of bone marrow metastases was confirmed by PET and BMAB in 222 of 301 patients. These observations translated into 98% sensitivity and 90% specificity for PET in detecting bone marrow metastases when BMAB was considered as gold standard. FDG-avid marrow disease was patchy (1-5 foci) in one third of cases. Patients with marrow disease indicated by PET and BMAB had more FDG-avid bone marrow foci, more metastatic sites, and lower survival than those with marrow disease indicated by PET only, suggesting more advanced disease stages. CONCLUSION Bone marrow sampling may be omitted in patients without evidence of FDG-avid bone marrow disease by PET. If there are FDG-avid bone marrow lesions, further investigation by MRI and/or biopsy should be considered.

Journal of Clinical Oncology
Indiana University Health (US), Boston Children's Hospital (US), St. Jude Children's Research Hospital (US), Nationwide Children's Hospital (US), Mayo Clinic (US), Children's Hospital of Philadelphia (US), The University of Texas MD Anderson Cancer Center (US), Harvard University (US), University of Padua (IT), Thomas Jefferson University (US), Universität Hamburg (DE), University of Freiburg (DE), Duke University (US), Utrecht University (NL), Justus-Liebig-Universität Gießen (DE), University Medical Center Freiburg (DE), Texas Scottish Rite Hospital for Children (US), University Medical Center Utrecht (NL), University of Chicago (US), Institute for Stem Cell Biology and Regenerative Medicine (IN), München Klinik Schwabing (DE), Children's Hospital Colorado (US), MaineHealth (US), University Hospital Münster (DE), University Medical Center Hamburg-Eppendorf (DE), Azienda USL di Bologna (IT), University Children's Hospital Tübingen (DE), Princess Máxima Center (NL), Ospedale Regina Margherita (IT), Stanford Medicine (US), Fondazione IRCCS Istituto Nazionale dei Tumori (IT), Klinikum Stuttgart (DE), Dana-Farber/Boston Children's Cancer and Blood Disorders Center (US), University of Colorado Anschutz Medical Campus (US), The Ohio State University (US), University of Turin (IT), Indiana University – Purdue University Indianapolis (US), Technical University of Munich (DE), Massachusetts Institute of Technology (US), Martin Luther University Halle-Wittenberg (DE), University of Colorado Denver (US)
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Hematological disorders and diagnostics
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