Comparison of CT and PET/CT for biopsy guidance in oncological patients

Abstract

PET/CT-guided biopsy is already known to be a feasible and accurate method in the diagnostic work-up of suspected malignant lesions. This prospective analysis of a large number of patients demonstrated the feasibility and advantages of using PET/CT as the imaging method of choice for biopsy guidance, especially where FDG-avid foci do not show corresponding lesions on the CT scan. There were no significant differences in the ability to obtain a diagnostic specimen or in the complication rates between PET/CT and CT guidance.

Diagnostic accuracy of positron emission tomography/computed tomography-driven biopsy for the diagnosis of lymphoma

“…The low rate of complications described in our experience makes this method extremely safe and easily affordable on an outpatient basis and also in patients with comorbidities, for whom general anesthesia and invasive surgery can be definitely contraindicated. These data favorably compare with previous experiences reported in literature with oncological patients [ 13 , 14 , 16 , 17 , 20 – 22 ].…”

“…As far as patients with a clinical suspect of lymphoma are concerned, CT- and ultrasound-guided biopsies have a relatively lower capacity of sampling nodal or extranodal tissue clearly representative of lymphoma. This can be stated by taking into account the few prospective series described in literature [ 9 , 14 , 23 – 25 ], though data are generally hard to be compared: some studies are retrospective and only report outcomes in patients with a known diagnosis of lymphoma, thus with the limitation of a selection bias [ 8 , 26 ]; other trials are only limited to superficial nodal lesions, in this sense excluding both deep nodes and extranodal sites which are the major indication for a needle biopsy approach [ 6 , 7 , 11 ].…”

“…Despite these advantages, the accuracy of CT- and US-guided core needle biopsies for a specific diagnosis of lymphoma approximates 85–90% for nodal localizations, and it is not clearly established—although markedly reduced—for extranodal sites [ 3 , 5 , 7 – 11 ]. In most extranodal areas, in fact, and with particular regard to the skeleton [ 12 ], lymphoma-related morphological changes are hard to be recognized on CT images only, whereas they appear more clearly if a functional imaging technique such as 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is applied [ 13 , 14 ]. FDG-PET is able to highlight areas of active lymphoma both in lymph nodes and other tissues (including the bone and most of the parenchymas) with a very high sensitivity in comparison with conventional imaging, given the documented—although variable—avidity of the lymphoma tissue for FDG [ 15 ].…”

Detection of additional primary malignancies: the role of CT and PET/CT combined with multiple percutaneous biopsy

“…CT-guided biopsy has been widely used as an effective, safe procedure for diagnostic confirmation in various clinical contexts. A biopsy guided by PET/CT, which combines anatomical information obtained from CT and metabolic information from PET with 18 F-FDG, is a procedure that can optimize the diagnostic yield of image-guided interventions, given that lesions presenting uptake of 18 F-FDG, without a corresponding anatomical anomaly, may be accessible to percutaneous interventions ( 31 ) . Although there have been no studies demonstrating any significant differences between PET/CT and CT in terms of their ability to obtain a viable biopsy sample or their complication rates, we believe that PET/CT is a particularly important method, given that CT has been shown to fail to detect lesions that later appear as foci of avid 18 F-FDG uptake ( 31 ) .…”

Percutaneous biopsy of abdominal lesions: what is currently the best diagnostic strategy?

“…CT-guided percutaneous biopsies of omental and mesenteric lesions have high rates of technical success and diagnostic yield, regardless of lesion size or skin depth ( 10 ) . Some authors have also demonstrated the benefit of techniques guided by PET/CT scans ( 11 ) , in comparison with conventional CT, for cases in which the lesions have extensive necrotic content, with the object of directing the material collection to the regions with high FDG uptake; however, the disadvantages of that technique, such as cost and logistics, often make it unfeasible.…”