PET/CT bests gold standard bone marrow biopsy for diagnosis and prognosis of lymphoma patients

Main Category: Lymphoma / Leukemia / Myeloma
Also Included In: MRI / PET / Ultrasound
Article Date: 05 Aug 2013 - 1:00 PDT Current ratings for:
PET/CT bests gold standard bone marrow biopsy for diagnosis and prognosis of lymphoma patients

A more precise method for determining bone marrow involvement in patients with diffuse large B-cell lymphoma (DLBCL) - a key factor in tailoring patient management plans - has been identified by researchers in a study published in the August issue of The Journal of Nuclear Medicine. Imaging with 18F-FDG positron emission tomography/computed tomography (PET/CT), when compared to bone marrow biopsy, was more sensitive, showed a higher negative predictive value and was more accurate, changing treatment for 42 percent of patients with bone marrow involvement.

DLBCL is the most frequent subtype of high-grade non-Hodgkin lymphoma, accounting for nearly 30 percent of all newly diagnosed cases in the United States. In recent decades, there has been a 150 percent increase in incidence of DLBCL.

"In our study, we showed that in diffuse large B-cell lymphoma, 18F-FDG PET/CT has better diagnostic performance than bone marrow biopsy to detect bone marrow involvement and provides a better prognostic stratification. While bone marrow biopsy is considered the gold standard to evaluate bone marrow involvement by high-grade lymphomas, 18F-FDG PET/CT is in fact the best method to evaluate extension of the disease, as well as avoid invasive procedures," said Louis Berthet, MD, lead author of the study "In Newly Diagnosed Diffuse Large B-Cell Lymphoma, Determination of Bone Marrow Involvement with 18F-FDG PET/CT Provides Better Diagnostic Performance and Prognostic Stratification Than Dose Biopsy."

The retrospective study included 133 patients diagnosed with DLBCL. All patients received both a whole-body 18F-FDG PET/CT scan, as well as a bone marrow biopsy to determine bone marrow involvement. A final diagnosis of bone marrow involvement was made if the biopsy was positive, or if the positive PET/CT scan was confirmed by a guided biopsy, by targeted magnetic resonance imaging (MRI) or, after chemotherapy, by the concomitant disappearance of focal bone marrow uptake and uptake in other lymphoma lesions on 18F-FDG PET/CT reassessment. Progression-free survival and overall survival were then analyzed.

Thirty-three patients were considered to have bone marrow involvement. Of these, eight were positive according to the biopsy and 32 were positive according to the PET/CT scan.18FDG PET/CT was more sensitive (94 percent vs. 24 percent), showed a higher negative predictive value (98 percent vs. 80 percent) and was more accurate (98 percent vs. 81 percent) than bone marrow biopsy. Among the 26 patients with positive 18F-FDG PET/CT results and negative biopsy results, 11 were upstaged to stage IV by PET/CT, which changed their treatment plans.18F-FDG PET/CT was also determined to be an independent predictor of progression-free survival.

"Our findings add to the literature to prove the significance of 18F-FDG PET/CT in cancer evaluation and to democratize this imaging method," said Berthet. "Molecular imaging is the best method to adapt targeted therapies to each patient. The emergence of PET/MRI and novel radiotracers predicts an exciting new future for our field.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our lymphoma / leukemia / myeloma section for the latest news on this subject.

In Newly Diagnosed Diffuse Large B-Cell Lymphoma, Determination of Bone Marrow Involvement with 18F-FDG PET/CT Provides Better Diagnostic Performance and Prognostic Stratification Than Dose Biopsy“” Berthet L, Cochet A, Kanoun S, Berriolo-Riedinger A, Humbert O, Toubeau M, Dygai-Cochet I, Legouge C, Casasnovas O, Brunotte F, J Nucl Med. 2013 May 14. [Epub ahead of print].

Society of Nuclear Medicine

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PET/CT bests gold standard bone marrow biopsy for diagnosis and prognosis of lymphoma patients

Main Category: Lymphoma / Leukemia / Myeloma
Also Included In: MRI / PET / Ultrasound
Article Date: 05 Aug 2013 - 1:00 PDT Current ratings for:
PET/CT bests gold standard bone marrow biopsy for diagnosis and prognosis of lymphoma patients

A more precise method for determining bone marrow involvement in patients with diffuse large B-cell lymphoma (DLBCL) - a key factor in tailoring patient management plans - has been identified by researchers in a study published in the August issue of The Journal of Nuclear Medicine. Imaging with 18F-FDG positron emission tomography/computed tomography (PET/CT), when compared to bone marrow biopsy, was more sensitive, showed a higher negative predictive value and was more accurate, changing treatment for 42 percent of patients with bone marrow involvement.

DLBCL is the most frequent subtype of high-grade non-Hodgkin lymphoma, accounting for nearly 30 percent of all newly diagnosed cases in the United States. In recent decades, there has been a 150 percent increase in incidence of DLBCL.

"In our study, we showed that in diffuse large B-cell lymphoma, 18F-FDG PET/CT has better diagnostic performance than bone marrow biopsy to detect bone marrow involvement and provides a better prognostic stratification. While bone marrow biopsy is considered the gold standard to evaluate bone marrow involvement by high-grade lymphomas, 18F-FDG PET/CT is in fact the best method to evaluate extension of the disease, as well as avoid invasive procedures," said Louis Berthet, MD, lead author of the study "In Newly Diagnosed Diffuse Large B-Cell Lymphoma, Determination of Bone Marrow Involvement with 18F-FDG PET/CT Provides Better Diagnostic Performance and Prognostic Stratification Than Dose Biopsy."

The retrospective study included 133 patients diagnosed with DLBCL. All patients received both a whole-body 18F-FDG PET/CT scan, as well as a bone marrow biopsy to determine bone marrow involvement. A final diagnosis of bone marrow involvement was made if the biopsy was positive, or if the positive PET/CT scan was confirmed by a guided biopsy, by targeted magnetic resonance imaging (MRI) or, after chemotherapy, by the concomitant disappearance of focal bone marrow uptake and uptake in other lymphoma lesions on 18F-FDG PET/CT reassessment. Progression-free survival and overall survival were then analyzed.

Thirty-three patients were considered to have bone marrow involvement. Of these, eight were positive according to the biopsy and 32 were positive according to the PET/CT scan.18FDG PET/CT was more sensitive (94 percent vs. 24 percent), showed a higher negative predictive value (98 percent vs. 80 percent) and was more accurate (98 percent vs. 81 percent) than bone marrow biopsy. Among the 26 patients with positive 18F-FDG PET/CT results and negative biopsy results, 11 were upstaged to stage IV by PET/CT, which changed their treatment plans.18F-FDG PET/CT was also determined to be an independent predictor of progression-free survival.

"Our findings add to the literature to prove the significance of 18F-FDG PET/CT in cancer evaluation and to democratize this imaging method," said Berthet. "Molecular imaging is the best method to adapt targeted therapies to each patient. The emergence of PET/MRI and novel radiotracers predicts an exciting new future for our field.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our lymphoma / leukemia / myeloma section for the latest news on this subject.

In Newly Diagnosed Diffuse Large B-Cell Lymphoma, Determination of Bone Marrow Involvement with 18F-FDG PET/CT Provides Better Diagnostic Performance and Prognostic Stratification Than Dose Biopsy“” Berthet L, Cochet A, Kanoun S, Berriolo-Riedinger A, Humbert O, Toubeau M, Dygai-Cochet I, Legouge C, Casasnovas O, Brunotte F, J Nucl Med. 2013 May 14. [Epub ahead of print].

Society of Nuclear Medicine

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Society of Nuclear Medicine. "PET/CT bests gold standard bone marrow biopsy for diagnosis and prognosis of lymphoma patients." Medical News Today. MediLexicon, Intl., 5 Aug. 2013. Web.
5 Aug. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'PET/CT bests gold standard bone marrow biopsy for diagnosis and prognosis of lymphoma patients'

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'Motion sensor' may aid autism diagnosis and treatment

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Academic Journal
Main Category: Autism
Article Date: 27 Jul 2013 - 0:00 PDT Current ratings for:
'Motion sensor' may aid autism diagnosis and treatment

Scientists have developed a new screening tool that could use an individual's movement to diagnose and treat autism, according to a series of studies published in the journal Frontiers in Integrative Neuroscience.

Researchers from Indiana University School of Medicine and Rutgers University have developed the method, which presents individuals with various images while a sensitive tracker monitors their movements.

The researchers say that this method, which can be used in children over the age of three, could provide an earlier, more objective and more accurate diagnosis of autism.

The method was tested on 78 children and adults with autism, including non-verbal autistic children and those with mild forms of the disorder.

The researchers say that the tool correctly diagnosed all of the participants, and even diagnosed autism subtypes, identified gender differences and tracked individual progress in treatment and development.

A movement tracker is attached to the individual, which senses "systemic signatures," measuring each person's movement as they respond to various screen images from an advanced computer program, showing 240 images a second.

The researchers say that this tool analyzes the importance of changes in movement and movement sensing, enabling the identification of stable capabilities in each individual, as well as highlighting the impairments of a person's movement system.

They add that the screening tool can measure tiny fluctuations, determining exactly how an individual's movement differs to that of a more typically developing child or adult. Dr Jorge José, vice president of research at Indiana University, says:

"We can estimate the cognitive abilities of people just from the variability of how they move. This may lead to a complementary way to develop therapies for autistic children at an early age."

The researchers say this tool can change the way autistic children learn and communicate by helping them to develop self-motivation, as opposed to being told or conditioned in what to do.

As part of the screening method, 25 autistic children were presented with a variety of media visuals, including videos of themselves, cartoons and music videos, and were given games to play. The children communicated which visuals they liked in a single motion.

Dr Elizabeth Torres, assistant professor in psychology at the School of Arts and Sciences, Rutgers University, explains:

"Every time the children cross a certain region in space, the media they like best goes on. They start out randomly exploring their surroundings. They seek where in space that interesting spot is which causes the media to play, and then they do so more systematically.

"Once they see a cause-and-effect connection, they move deliberately. The action becomes an intentional behavior."

She adds that through this method, the children independently learned that they could control their own bodies in order to communicate what they wanted to watch.

At present, there is no medical test to diagnose autism, and the disorder is diagnosed through specialists' opinions on an individual's behavior and communication.

The researchers say it is too early to see whether this research will lead to methods of therapy and diagnosis that are publicly available.

But Torres says she is confident that parents of autistic children would find it easy to adapt to her computer-aided technique and help their children.

Dr Jorge José adds:

"This research may open doors for the autistic community by offering the option of a dynamic diagnosis at a much earlier age and possibly enabling the start of therapy sooner in the child's development."

Written by Honor Whiteman

Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today Visit our autism section for the latest news on this subject.

Autism: the micro movement perspective, published in the journal Frontiers in Integrative Neuroscience, July 24, 2013

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Potential for a faster, simpler diagnosis for fibromyalgia using a finger-stick blood sample

Main Category: Fibromyalgia
Also Included In: Medical Devices / Diagnostics;  Arthritis / Rheumatology
Article Date: 25 Jul 2013 - 3:00 PDT Current ratings for:
Potential for a faster, simpler diagnosis for fibromyalgia using a finger-stick blood sample

Researchers have developed a reliable way to use a finger-stick blood sample to detect fibromyalgia syndrome, a complicated pain disorder that often is difficult to diagnose.

If it were someday made available to primary care physicians, the test could knock up to five years off of the wait for a diagnosis, researchers predict.

In a pilot study, the scientists used a high-powered and specialized microscope to detect the presence of small molecules in blood-spot samples from patients known to have fibromyalgia.

By "training" the equipment to recognize that molecular pattern, the researchers then showed that the microscope could tell the difference between fibromyalgia and two types of arthritis that share some of the same symptoms.

Though more analysis is needed to identify exactly which molecules are related to development of the disorder itself, the researchers say their pilot data are promising.

"We've got really good evidence of a test that could be an important aid in the diagnosis of fibromyalgia patients," said Tony Buffington, professor of veterinary clinical sciences at The Ohio State University and senior author of the study. "We would like this to lead to an objective test for primary care doctors to use, which could produce a diagnosis as much as five years before it usually occurs."

Patients with fibromyalgia are often desperate by the time they receive treatment because of the lengthy process required to make a diagnosis. The main symptoms, persistent pain and fatigue, mimic many other conditions, so physicians tend to rule out other potential causes before diagnosing fibromyalgia. Additional symptoms include disrupted sleep and memory or thought problems. An estimated 5 million American adults have the disorder, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

"The importance of producing a faster diagnosis cannot be overstated, because patients experience tremendous stress during the diagnostic process. Just getting the diagnosis actually makes patients feel better and lowers costs because of reductions in anxiety," said Kevin Hackshaw, associate professor of medicine, division of rheumatology and immunology, at Ohio State's Wexner Medical Center and lead author of the study.

The study is published in the Aug. 21, 2013, issue of the journal Analyst.

The technology used in this work is infrared microspectroscopy, which identifies the biochemical content of a blood sample based on where peaks of molecules appear in the infrared spectrum. The technology offers hints at the molecules present in the samples based on how molecular bonds vibrate when they are struck by light.

The spectroscopy works on dried blood, so just a few drops from a finger stick produce enough blood to run this test.

Researchers first obtained blood samples from patients diagnosed with fibromyalgia (14), rheumatoid arthritis (15) and osteoarthritis (12). These other conditions were chosen for comparison because they produce similar symptoms as fibromyalgia, but are easier to diagnose.

The scientists analyzed each sample with the infrared microspectroscopy to identify the molecular patterns associated with each disease. This functioned as a "training" phase of the study.

When the researchers then entered blinded blood samples into the same machinery, each condition was accurately identified based on its molecular patterns.

"It separated them completely, with no misclassifications," Buffington said. "That's very important. It never mistook a patient with fibromyalgia for a patient with arthritis. Clearly we need more numbers, but this showed the technique is quite effective."

The researchers also analyzed some of the potential chemicals that could someday function as biomarkers in the fibromyalgia blood samples, but further studies are needed to identify the molecules responsible for the spectral patterns, he said.

Though an infrared microscope can be expensive, Buffington said the testing could be affordable if a central lab existed to run the samples. That the method can use dried blood samples makes this concept feasible because dried blood can be legally sent via U.S. mail, he noted.

Why is a veterinarian pursuing this type of research? Buffington is a renowned expert on domestic cats, including a painful bladder disorder they suffer called interstitial cystitis (IC). This syndrome also occurs in humans.

It turns out that the origins of IC, like such human disorders as irritable bowel syndrome and fibromyalgia, cannot be traced to the specific area of the anatomy most affected by the syndrome. These disorders are categorized as medically unexplained or functional syndromes, and Buffington has explored the possibility that a common link exists among these types of diseases, and that they might have origins in the central nervous system.

Buffington has filed two invention disclosures with the university, and Ohio State has filed multiple patent applications for the testing method, in the United States and internationally. In November, Ohio State was issued U.S. Patent 8,309,931 on a rapid diagnostic method for functional syndromes in humans and cats.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our fibromyalgia section for the latest news on this subject.

Written by Emily Caldwell

Additional co-authors include Luis Rodriguez-Saona and Marçal Plans of the Department of Food Science and Technology at Ohio State, and Lauren Bell of Metabolon Inc., based in Durham, N.C.

Ohio State University

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'Potential for a faster, simpler diagnosis for fibromyalgia using a finger-stick blood sample'

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