PET/CT-guided percutaneous biopsy of FDG-avid metastatic bone lesions in patients with advanced lung cancer: a safe and effective technique

Abstract

Purpose 18F-FDG PET/CT should be performed before a diagnostic biopsy site is chosen in patients with a high clinical suspicion of aggressive, advanced tumour. The aim of this study was to evaluate the safety and efficacy of 18F-FDG PET/CT in guiding biopsy of bone metastases in patients with advanced lung cancer.MethodsPET/CT-guided percutaneous core biopsies were performed in 51 consecutive patients with suspected lung cancer and 18F-FDG-avid bone lesions after whole-body 18F-FDG PET/CT scans. Generally, one tissue sample was obtained from each patient. The final diagnoses were established on the basis of the histology results. The histopathological and molecular testing results were systematically evaluated.ResultsA total of 53 samples were obtained for histological examination or molecular testing as a second biopsy was required in two patients in whom the pathological diagnosis was unclear following the first biopsy. The pathological diagnosis and lung cancer classification were confirmed in 48 patients. The epidermal growth factor receptor mutation status was determined in 23 biopsies, and the mutation rate was 30.4 % (7/23). The anaplastic lymphoma kinase mutation status was determined in 19 biopsies, and the mutation rate was 31.6 % (6/19). Two of the 51 biopsies were positive for non-Hodgkin’s lymphoma and one was positive for metastatic renal cell carcinoma. The first-time diagnostic success rate of biopsy was 96.1 % (49/51) and the overall diagnostic success rate and sensitivity were 100 %. All 51 patients were eventually confirmed as having stage IV disease. No serious complications were encountered and the average biopsy time was 30 min.ConclusionPET/CT-guided percutaneous biopsy of 18F-FDG-avid bone metastases is an effective and safe method that yields a high diagnostic success rate in the evaluation of hypermetabolic bone lesions in patients with suspected advanced lung cancer.

PET Molecular Imaging–Directed Biopsy: A Review

“…Guo et al [30] evaluated the safety and efficacy of FDG PET/CT for guiding biopsy of bone metastases in patients with advanced lung cancer. PET/CT-guided percutaneous core biopsies were performed for patients with suspected lung cancer and FDG-avid bone lesions after whole-body FDG PET/CT.…”

Imaging for biopsies

“…They also founded the sensitivity of PET/CT guided biopsies was 100%, with an accuracy that reached 96%. 3 Cerci et al also conducted a prospective study where they evaluated 181 patients who will undergo biopsies guided by PET/CT and compared them with other 142 patients who will undergo biopsies guided by standard CT techniques. They found no significant differences between the two groups regarding safety and complications rates.…”

“…2 This last technique is not as widely available as the previous ones, and it usually can only be done in specialized PET/CT interventional suites. 3 In this review, we will thoroughly discuss the indications, uses, and advantages of guiding biopsies with PET/CT techniques, with main focus on the field of oncology.…”

How Can New Imaging Modalities Help in the Practice of Radiology?

“…Warfarin should be stopped 5-7 days prior to the procedure and may be resumed the day following biopsy. Heparin should be withheld 6-12 h prior to biopsy [62][63][64][65][66][67].…”