Role of PET/computed tomography and biopsy guidance in characterization of malignant biliary obstruction

Abstract

Objective This prospective study was conducted to evaluate the diagnostic effect of PET/computed tomography (PET/CT) in patients with malignant biliary obstruction and if the metabolic information provided by PET/CT scan adds an incremental benefit while performing image-guided biopsies. Background Malignant biliary tract obstruction is a frequent cause of jaundice. PET/CT is used to evaluate such patients, and information delivered by PET images is used to guide biopsy procedure. Patients and methods This study was carried out from March 2016 to March 2018 on 52 patients diagnosed/suspected to have MTBO. They all were investigated by PET/CT. Results were compared with the results of contrast-enhanced CT in ∼42 cases and with magnetic resonance cholangiopancreatography (MRCP) in ∼15 cases. A group of patients had undergone PET/CT-guided biopsy (15 patients). Results This study revealed that sensitivity, specificity, positive predictive value, and negative predictive value for PET/CT were 92, 75, 96, and 60%, respectively, whereas for CT and for MRCP were 68, 60, 85, and 20% and 60, 50, 85, and 20%, respectively. PET/CT has sensitivity of 90% for detection of lymph nodal metastases compared with 37% for CT and 20% for MRCP. PET/CT is more sensitive than CT and MRCP for distant metastases detection. Conclusion PET/CT is more sensitive and specific than CT and MRCP in primary detection and staging of tumors causing malignant biliary tract obstruction. PET/CT-guided biopsy increases the chance of obtaining a definitive diagnostic result.