Abstract
PurposeThis case series explores the utility of positron emission tomography (PET)/computed tomography (CT) guidance for biopsy of 18F-fludeoxyglucose (FDG)-avid osseous lesions that are inconspicuous on CT.MethodsPET/CT-guided core biopsies were performed in four patients with suspected malignancies given 18F-FDG-avid osseous lesions that were inconspicuous on CT alone. The final diagnosis for each patient was determined by histopathological and molecular testing.ResultsPET/CT-guided biopsy yielded accurate sampling via core needle biopsy (CNB) with histopathological confirmation of osseous metastases of the primary malignancy as opposed to a secondary malignancy in three patients and ruled-out metastatic spread in the fourth.ConclusionPET/CT-guided biopsy of hypermetabolic osseous lesions that are inconspicuous on CT alone is an effective and safe diagnostic tool in patients with suspected malignancy.
Highlights
18F-FDG positron emission tomography (PET)/computed tomography (CT) is a noninvasive imaging modality that can be used for staging and monitoring treatment response among a variety of oncologic diseases
18F-FDG PET/CT-guided bone biopsy All biopsies were performed under supervision of a board-certified radiologist and nuclear medicine physician in a PET/CT suite
Since O’Sullivan et al published the first study on the role of PET/CT as a diagnostic tool in musculoskeletal biopsy guidance in 2008, more studies have evaluated its efficacy in the diagnosis of a variety of metastases far beyond the scope of musculoskeletal lesions (Fei & Schuster, 2017; Cerci et al, 2016)
Summary
18F-FDG PET/CT is a noninvasive imaging modality that can be used for staging and monitoring treatment response among a variety of oncologic diseases. Studies report sensitivity and specificity for detecting most cancers between 84 and 100% and 83 and 100%, respectively (Nihayah et al, 2017). This hybrid imaging technique combines the spatial resolution of CT with the metabolic differentiation of PET. In one study, staging PET/CT discovered remote sites suspicious for a second, unrelated malignancy in 3–6% of patients with cancer, of which, one third were confirmed by biopsy as a new and separate primary malignancy (Klaeser et al, 2010). Biopsy is Farrell et al European Journal of Hybrid Imaging (2021) 5:1 critical in determining the histologic origin of a morphologically or metabolically suspicious lesion. A safe and effective methodology for biopsies is critical for guiding clinical management
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