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Background: Data assessing the role of positron emission tomography (PET)/computed tomography (CT) imaging in lymphoma staging is still being accumulated and current staging is based primarily on CT. This study aims to compare the value of PET/CT over conventional CT and bone marrow biopsy (BMB) in the initial evaluation of patients with lymphoma. Methods: Data on 122 patients with PET/CT scans as part of their initial staging were prospectively collected and reviewed. All patients had complete staging, including BMB. Results: Among the 122 patients, 101 had non-Hodgkin's lymphoma (NHL) and 21 had Hodgkin's lymphoma (HL). Compared with conventional CT, PET/CT upstaged 21 (17%) cases [B-cell non-Hodgkin's lymphoma (B-NHL), 12; T-cell non-Hodgkin's lymphoma (T-NHL), 3; HL, 6]. Of significance, in 13 patients with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG)-avid splenic lesions, four had normal CT findings. A maximum FDG uptake of >10 standardized uptake value (SUV) seems to significantly correlate with an aggressive B-cell lineage (odds ratio 2.47, 95% confidence interval 2.23–2.70). Overall, PET scan was concordant with BMB results in 108 (89%) and discordant in 14 (11%) cases. In HL, our data show that PET scan and marrow results agreed in 19 of the cases (90%), being concordantly negative in 18 cases and concordantly positive in one, giving a negative predictive value (NPV) of 100%, sensitivity of 100% and specificity of 90%. Of note, all 13 with early-stage HL had negative PET/CT scan and BMB. In NHL, all 17 cases of T-NHL had concordant PET and BMB results. In patients with aggressive B-NHL, BMB and PET/CT agreed in 58 patients (92%) and disagreed in five (8%), while the corresponding rates in indolent B-cell lymphoma were 14 (67%) and seven patients (33%), respectively. All seven were falsely negative. Conclusions: PET/CT upstages 17% of cases and detects occult splenic involvement. This may have potential therapeutic and prognostic implications. SUV >10 may predict for an aggressive histology. Except for indolent B-NHL, our data show that PET scans have a good overall NPV in excluding lymphomatous bone marrow involvement. This is particularly true of early-stage HL, suggesting that BMB may be safely omitted in this group.

Background UPS represents one of the largest subsets of HG-STS but is often reported together with other STS histologic types limiting the value of such data in clinical practice. We sought to define clinical characteristics, prognostic factors and treatment outcomes in UPS. Methods Single institution retrospective study of 135 consecutive UPS pts with complete medical records representing 18% of all STS cases seen at our center from 2002-2011. Results Median age was 57 years; 73% presented with localized disease. Distribution according to primary site: 44% vs 44% vs 11% originating from extremities, axial, head and neck regions respectively. In pts with localized disease, 91% underwent curative surgery with 64% of evaluable pts achieving microscopically negative surgical margins; no correlation between margin status and primary site was noted. Notably 59% received adjuvant therapy, of whom 81% received radiotherapy (RT), 6% chemotherapy, 13% both. At a median follow-up of 20.7 months (mths), median overall survival (OS) for the entire cohort was 28.6 mths, 57.9 mths vs 5.2 mths in pts presenting with localized vs metastatic disease, respectively (p Conclusions This study reinforces the value of adjuvant RT in UPS. The survival benefit of palliative chemotherapy in advanced UPS is noteworthy. However survival in metastatic UPS appears inferior to advanced HG-STS as a whole (typically 12 mths) calling for further improvements in molecular characterization and therapy in this narrowly defined subset of STS. Disclosure All authors have declared no conflicts of interest.