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. 2014 Dec;41(12):2265-72.
doi: 10.1007/s00259-014-2852-1. Epub 2014 Aug 9.

Performance of intra-procedural 18-fluorodeoxyglucose PET/CT-guided biopsies for lesions suspected of malignancy but poorly visualized with other modalities

F Cornelis  1 , M Silk, H Schoder, H Takaki, J C Durack, J P Erinjeri, C T Sofocleous, R H Siegelbaum, M Maybody, S B Solomon
Affiliations

Performance of intra-procedural 18-fluorodeoxyglucose PET/CT-guided biopsies for lesions suspected of malignancy but poorly visualized with other modalities

F Cornelis et al. Eur J Nucl Med Mol Imaging. 2014 Dec.

Abstract

Purpose: We sought to evaluate the safety and the diagnostic success rate of percutaneous biopsies performed under intra-procedural (18)F-deoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) guidance for lesions difficult to see with conventional cross-sectional imaging.

Methods: From 2011 to 2013, consecutive clinically indicated percutaneous PET/CT-guided biopsies of 106 masses (mean size, 3.3 cm; range, 0.7-15.9 cm; SD, 2.9 cm) in bones (n = 33), liver (n = 26), soft tissues (n = 18), lung (n = 15) and abdomen (n = 14) were reviewed. The biopsy procedures were performed following injection of a mean of 255 MBq (SD, 74) FDG. Mean maximal standardized uptake value (SUV) of lesions was 8.8 (SD, 6.3). A systematic review of the histopathological results and outcomes was performed.

Results: Biopsies were positive for malignancy in 76 cases (71.7%, 76/106) and for benign tissue in 30 cases (28.3%, 30/106). Immediate results were considered adequate for 100 PET/CT biopsies (94.3%, 100/106) requiring no further exploration, and for the six others (5.7%, 6/106) benign diagnoses were confirmed after surgery (n = 4) or follow-up (n = 2). The consequent overall sensitivity and the diagnostic success of biopsy were therefore 100%. No significant differences in terms of detection of malignancy were observed between the different locations. Lesions > 2 cm or with SUV > 4 were not significantly more likely to be malignant. Complications occurred after four biopsies (3.7%, 4/106).

Conclusion: Intra-procedural PET/CT guidance appears as a safe and effective method and allows high diagnostic success of percutaneous biopsies for metabolically active lesions.

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Conflict of interest statement

Conflicts of interest The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
PET/CT-guided bone biopsy in a 60-year-old man with history of oropharyngeal carcinoma. a Axial FDG PET/CT image showed uptake (10.2) on the left iliac bone (arrow) with high suspicion of metastasis. b Axial non-contrast CT scan showed no imaging correlate in the corresponding region (discontinuous arrow). c CT image showing the needle into the lesion. The pathologist concluded to a carcinoma metastasis
Fig. 2
Fig. 2
PET/CT-guided soft-tissue biopsy in a 73-year-old man with history of lymphoma and back pain. a Axial non−contrast CT-scan showed no imaging correlate (arrow). b FDG PET image showed uptake in the left paraspinal muscle (SUV 10.4) (discontinuous arrow). c Axial PET/CT fusion image with needle. The 10.8 cm lesion corresponded to a recurrence of a B-cell lymphoma
Fig. 3
Fig. 3
PET/CT-guided splenic biopsy in a 70-year-old woman with history of follicular lymphoma. a Axial FDG PET/CT fusion image showed a 2 cm uptake (SUV 8.2) in the spleen (arrow) with high suspicion of new localization. b Axial non-contrast CT-scan showed nothing suspicious in the corresponding region. c Corresponding PET/CT image showing the needle into the lesion. The pathologist concluded to granulomatous reaction and normal spleen tissue. A splenectomy performed subsequently confirmed this result without lymphoma recurrence
See this image and copyright information in PMC

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