Francois Cornelis MD, Presenter: Nothing to Disclose

Haruyuki Takaki MD, Abstract Co-Author: Nothing to Disclose

Jeremy C. Durack MD, Abstract Co-Author: Scientific Advisory Board, Investor - Adient Medical Research Grants - Society of Interventional Radiology Foundation, Prostate Cancer Foundation

Joseph Patrick Erinjeri MD, PhD, Abstract Co-Author: Nothing to Disclose

Constantinos Thasos Sofocleous MD, PhD, Abstract Co-Author: Consultant, Sirtex Medical Ltd

Robert H. Siegelbaum MD, Abstract Co-Author: Nothing to Disclose

Heiko Schoder MD, Abstract Co-Author: Nothing to Disclose

Stephen Barnett Solomon MD, Abstract Co-Author: Research Grant, General Electric Company Research Grant, AngioDynamics, Inc Consultant, Johnson & Johnson Consultant, Covidien AG Director, Devicor Medical Products, Inc Director, Aspire Bariatrics, Inc

To report the accuracy of percutaneous biopsies performed under intra-procedural 18-Fluoro-deoxyglucose (FDG) positron emission computed tomography (PET-CT) guidance.

The IRB approved this retrospective study with a waiver of written informed consent. We reviewed 105 consecutive patients from 2011 to 2013 who had 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). Recommendation for PET-CT guidance was based on existing image review and challenges anticipated using CT, MR or ultrasound modalities for procedural guidance. The biopsy procedures were performed following injection of 6.9mCi in mean (range, 3.9-13.2; SD, 2) of FDG. Maximal standardized uptake value (SUV) of lesions was 8.8 in mean (range, 1.9-44.4; SD, 6.3). A systematic review of the histopathological results and outcomes was performed. Descriptive statistics were used to summarize the results.

Biopsies were positive for malignancy in 76 (71.7%, 76/106) cases and for benign tissue in 30 cases (19.8%, 30/106). Immediate results were considered as adequate for 100 PET-CT biopsies (94.3%, 100/106), and for the 6 others (5.7%, 6/106) benign diagnoses were confirmed after surgery (n=4) or follow-up (n=2). Accuracy, sensitivity and positive predictive value (PPV) of biopsies were all 100%, with a 95% confidence interval of [95.2-100] for PPV. Complications occurred after 4 biopsies (3.7%, 4/106).

Intra-procedural PET-CT guidance appears is a safe and effective method and allows high accuracy of percutaneous biopsies for metabolically active lesions. For purposes of biopsy guidance, half of the typical FDG activity is sufficient for target visualization.

PET-CT imaging guidance can be used to biopsy metabolically active lesions not well visualized on other modalities with an excellent specificity and positive predictive value.  

Cornelis, F, Takaki, H, Durack, J, Erinjeri, J, Sofocleous, C, Siegelbaum, R, Schoder, H, Solomon, S, Intra-procedural Low-dose 18-Fluoro-deoxyglucose PET/CT-guided Biopsy Leads to Increased Accuracy in Poorly Visualized Lesions.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14001789.html