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

View Article: PubMed Central - PubMed

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.

Methods: PET/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.

Results: A 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.

Conclusion: PET/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.

No MeSH data available.


Related in: MedlinePlus

A 58-year-old woman with suspected lung carcinoma and bone metastasis. a, b, d18F-FDG PET/CT imaging (a maximum intensity projection image, b, d axial fusion images) shows uptake (SUVmax 4.6) in a lesion in the third lumbar vertebra on the right (a, byellow arrows) which is highly suspicious of metastasis, and uptake (SUVmax 11.3) in a lung nodule in the right lower lobe (a, dwhite arrows). c Axial noncontrast CT image (using bone windows) shows the biopsy needle positioned within the lesion (yellow arrow). e Axial CT image shows the biopsy needle positioned within the lung nodule (white arrow). Histological examination confirmed the bone lesion as metastatic poorly differentiated adenocarcinoma and the lung nodule as primary adenosquamous carcinoma, and exon 19 deletion mutation in EGFR was detected in both samples
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Fig1: A 58-year-old woman with suspected lung carcinoma and bone metastasis. a, b, d18F-FDG PET/CT imaging (a maximum intensity projection image, b, d axial fusion images) shows uptake (SUVmax 4.6) in a lesion in the third lumbar vertebra on the right (a, byellow arrows) which is highly suspicious of metastasis, and uptake (SUVmax 11.3) in a lung nodule in the right lower lobe (a, dwhite arrows). c Axial noncontrast CT image (using bone windows) shows the biopsy needle positioned within the lesion (yellow arrow). e Axial CT image shows the biopsy needle positioned within the lung nodule (white arrow). Histological examination confirmed the bone lesion as metastatic poorly differentiated adenocarcinoma and the lung nodule as primary adenosquamous carcinoma, and exon 19 deletion mutation in EGFR was detected in both samples

Mentions: The needle was introduced in a stepwise manner under fused PET/CT and CT imaging guidance. The bone biopsy needle, either a 16G (Magum, Bard, AZ) or an 11G (BMN-B, SA Medical & Plastic Instruments Co., Ltd, Shanghai, China), was chosen depending on the nature of the lesion (i.e. whether it was an osteoblastic or osteolytic metastasis), and its location and depth. One sample was obtained from each patient, and histopathology and immunohistochemical or molecular diagnosis were performed on each specimen. 18F-FDG PET/CT images in representative patients undergoing bone biopsy are shown in FigsĀ 1, 2, 3 and 4.Fig. 1


PET/CT-guided percutaneous biopsy of FDG-avid metastatic bone lesions in patients with advanced lung cancer: a safe and effective technique
A 58-year-old woman with suspected lung carcinoma and bone metastasis. a, b, d18F-FDG PET/CT imaging (a maximum intensity projection image, b, d axial fusion images) shows uptake (SUVmax 4.6) in a lesion in the third lumbar vertebra on the right (a, byellow arrows) which is highly suspicious of metastasis, and uptake (SUVmax 11.3) in a lung nodule in the right lower lobe (a, dwhite arrows). c Axial noncontrast CT image (using bone windows) shows the biopsy needle positioned within the lesion (yellow arrow). e Axial CT image shows the biopsy needle positioned within the lung nodule (white arrow). Histological examination confirmed the bone lesion as metastatic poorly differentiated adenocarcinoma and the lung nodule as primary adenosquamous carcinoma, and exon 19 deletion mutation in EGFR was detected in both samples
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC5121178&req=5

Fig1: A 58-year-old woman with suspected lung carcinoma and bone metastasis. a, b, d18F-FDG PET/CT imaging (a maximum intensity projection image, b, d axial fusion images) shows uptake (SUVmax 4.6) in a lesion in the third lumbar vertebra on the right (a, byellow arrows) which is highly suspicious of metastasis, and uptake (SUVmax 11.3) in a lung nodule in the right lower lobe (a, dwhite arrows). c Axial noncontrast CT image (using bone windows) shows the biopsy needle positioned within the lesion (yellow arrow). e Axial CT image shows the biopsy needle positioned within the lung nodule (white arrow). Histological examination confirmed the bone lesion as metastatic poorly differentiated adenocarcinoma and the lung nodule as primary adenosquamous carcinoma, and exon 19 deletion mutation in EGFR was detected in both samples
Mentions: The needle was introduced in a stepwise manner under fused PET/CT and CT imaging guidance. The bone biopsy needle, either a 16G (Magum, Bard, AZ) or an 11G (BMN-B, SA Medical & Plastic Instruments Co., Ltd, Shanghai, China), was chosen depending on the nature of the lesion (i.e. whether it was an osteoblastic or osteolytic metastasis), and its location and depth. One sample was obtained from each patient, and histopathology and immunohistochemical or molecular diagnosis were performed on each specimen. 18F-FDG PET/CT images in representative patients undergoing bone biopsy are shown in FigsĀ 1, 2, 3 and 4.Fig. 1

View Article: PubMed Central - PubMed

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.

Methods: PET/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.

Results: A 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.

Conclusion: PET/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.

No MeSH data available.


Related in: MedlinePlus