Abstract
Background18F-FDG PET/CT imaging is widely utilized in the clinical evaluation of patients with suspected or documented lymphoma. The aim was to describe our cumulative experience with a multimodal 18F-FDG-directed lymph node surgical excisional biopsy approach in patients with suspected lymphoma.MethodsThirteen patients (mean age 51 (±16;22–76) years), with suspected new or suspected recurrent lymphoma suggested by 18F-FDG-avid lesions seen on prior diagnostic whole-body PET/CT imaging, were injected IV with 18F-FDG prior to undergoing same-day diagnostic lymph node surgical excisional biopsy in the operating room. Various 18F-FDG detection strategies were used on the day of surgery, including, (1) same-day pre-resection patient PET/CT; (2) intraoperative gamma probe assessment; (3) clinical scanner specimen PET/CT imaging of whole surgically excised tissue specimens; (4) specimen gamma well counts; and/or (5) same-day post-resection patient PET/CT.ResultsSame-day 18F-FDG injection dose was 14.8 (±2.4;12.5-20.6) millicuries or 548 (±89;463–762) megabecquerels. Sites of 18F-FDG-avid lesions were 4 inguinal, 3 cervical, 3 abdominal/retroperitoneal, 2 axillary, and 1 gluteal region subcutaneous tissue. Same-day pre-resection patient PET/CT was performed on 6 patients. Intraoperative gamma probe assessment was performed on 13 patients. Clinical scanner PET/CT imaging of whole surgically excised tissue specimens was performed in 10 cases. Specimen gamma well counts were performed in 6 cases. Same-day post-resection patient PET/CT imaging was performed on 8 patients. Time from 18F-FDG injection to same-day pre-resection patient PET/CT, intraoperative gamma probe assessment, and same-day post-resection patient PET/CT were 76 (±8;64–84), 240 (±63;168–304), and 487 (±104;331–599) minutes, respectively. Time from 18F-FDG injection to clinical scanner PET/CT of whole surgically excised tissue specimens was 363 (±60;272–446) minutes. Time from 18F-FDG injection to specimen gamma well counts was 591 (±96;420–689) minutes. Intraoperative gamma probe assessment successfully identified 18F-FDG-avid lesions in 12/13 patients. Histopathologic evaluation confirmed lymphoma in 12/13 patients and benign disease in 1/13 patients.ConclusionsA multimodal approach to 18F-FDG-directed lymph node surgical excisional biopsy for suspected lymphoma is technically feasible for guiding appropriate diagnostic tissue sampling of lymph nodes seen as 18F-FDG-avid lesions on diagnostic 18F-FDG PET/CT imaging.
Highlights
18F-FDG positron emission tomography/computed tomography (PET/CT) imaging is widely utilized in the clinical evaluation of patients with suspected or documented lymphoma
The surgeon has continued to play an important role in facilitating the diagnostic pathway for patients with suspected new or suspected recurrent lymphoma, as the findings noted on diagnostic 18F-FDG PET/CT imaging that are considered suspicious for lymphoma frequently require the subsequent performance of a lymph node surgical excisional biopsy procedure for confirmation of a definitive diagnosis [14], as well as for histopathologic, immunophenotypic, flow cytometry, and molecular subtype analyses [15]
The aim of this study was to describe our cumulative experience in patients with suspected new or suspected recurrent lymphoma with a multimodal approach to 18F-FDG-directed lymph node surgical excisional biopsy for guiding appropriate diagnostic tissue sampling of lymph nodes that are seen as 18F-FDG-avid lesions on prior diagnostic wholebody 18F-FDG PET/CT imaging
Summary
18F-FDG PET/CT imaging is widely utilized in the clinical evaluation of patients with suspected or documented lymphoma. Related to our collaborative efforts at The Ohio State University, we have previously investigated the use of a novel, multimodal imaging and detection approach involving perioperative patient and ex vivo surgical specimen 18F-FDG PET/CT imaging in combination with intraoperative 18F-FDG gamma probe detection [61]. In this regard, the aim of this study was to describe our cumulative experience in patients with suspected new or suspected recurrent lymphoma with a multimodal approach to 18F-FDG-directed lymph node surgical excisional biopsy for guiding appropriate diagnostic tissue sampling of lymph nodes that are seen as 18F-FDG-avid lesions on prior diagnostic wholebody 18F-FDG PET/CT imaging
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