In staging Hodgkin's lymphoma, would you identify a PET+ bony focus as disease when there are no associated bone changes on CT and a biopsy was not obtained?

The staging bone marrow biopsy was negative. The staging manual simply states "bone involvement is identified using appropriate imaging studies." Is PET+ alone sufficient? Would location of site relative to nodal disease and/or extent of nodal disease change your assessment? If a biopsy of the site was NOT obtained pre-chemo and the restaging scan after initial chemo shows resolution of the bony hypermetabolic activity, would you irradiate the site as part of consolidative therapy?

Answer from: Radiation Oncologist at Academic Institution

PET is generally the most sensitive indicator for-involvement with HL, so I would not let the absence of CT findings deter one from diagnosing bone disease if the PET is convincingly positive. One should also weigh the clinical circumstances and consider how likely the pt is to have bone involvement...

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Radiation Oncologist at Coastal Radiation Oncology Medical Group
Thank you, @Leonard Prosnitz. The patient whose si...

Radiation Oncologist at Duke University Medical Center
Case = sounds good. Assuming pt is in CR, i.e. PE...

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In staging Hodgkin's lymphoma, would you identify a PET+ bony focus as disease when there are no associated bone changes on CT and a biopsy was not obtained?

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