Feasibility of a multimodal 18F-FDG-directed lymph node surgical excisional biopsy approach for appropriate diagnostic tissue sampling in patients with suspected lymphoma

Abstract

Background18F-FDG PET/CT imaging is widely utilized in the clinical evaluation of patients with suspected or documented lymphoma. The aim was to describe our cumulative experience with a multimodal 18F-FDG-directed lymph node surgical excisional biopsy approach in patients with suspected lymphoma.MethodsThirteen patients (mean age 51 (±16;22–76) years), with suspected new or suspected recurrent lymphoma suggested by 18F-FDG-avid lesions seen on prior diagnostic whole-body PET/CT imaging, were injected IV with 18F-FDG prior to undergoing same-day diagnostic lymph node surgical excisional biopsy in the operating room. Various 18F-FDG detection strategies were used on the day of surgery, including, (1) same-day pre-resection patient PET/CT; (2) intraoperative gamma probe assessment; (3) clinical scanner specimen PET/CT imaging of whole surgically excised tissue specimens; (4) specimen gamma well counts; and/or (5) same-day post-resection patient PET/CT.ResultsSame-day 18F-FDG injection dose was 14.8 (±2.4;12.5-20.6) millicuries or 548 (±89;463–762) megabecquerels. Sites of 18F-FDG-avid lesions were 4 inguinal, 3 cervical, 3 abdominal/retroperitoneal, 2 axillary, and 1 gluteal region subcutaneous tissue. Same-day pre-resection patient PET/CT was performed on 6 patients. Intraoperative gamma probe assessment was performed on 13 patients. Clinical scanner PET/CT imaging of whole surgically excised tissue specimens was performed in 10 cases. Specimen gamma well counts were performed in 6 cases. Same-day post-resection patient PET/CT imaging was performed on 8 patients. Time from 18F-FDG injection to same-day pre-resection patient PET/CT, intraoperative gamma probe assessment, and same-day post-resection patient PET/CT were 76 (±8;64–84), 240 (±63;168–304), and 487 (±104;331–599) minutes, respectively. Time from 18F-FDG injection to clinical scanner PET/CT of whole surgically excised tissue specimens was 363 (±60;272–446) minutes. Time from 18F-FDG injection to specimen gamma well counts was 591 (±96;420–689) minutes. Intraoperative gamma probe assessment successfully identified 18F-FDG-avid lesions in 12/13 patients. Histopathologic evaluation confirmed lymphoma in 12/13 patients and benign disease in 1/13 patients.ConclusionsA multimodal approach to 18F-FDG-directed lymph node surgical excisional biopsy for suspected lymphoma is technically feasible for guiding appropriate diagnostic tissue sampling of lymph nodes seen as 18F-FDG-avid lesions on diagnostic 18F-FDG PET/CT imaging.

One-by-One Comparison of Lymph Nodes Between 18F-FDG Uptake and Pathological Diagnosis in Esophageal Cancer

“…The following steps to implement FDG-guided surgery have been proposed: (1) preoperative diagnostic PET imaging, (2) intraoperative imaging, (3) ex vivo imaging, and (4) postoperative clinical PET imaging. 6 , 7 , 25 Ex vivo imaging indicates imaging of the specimen after resection, which can be measured by several methods using clinical PET, micro-PET, or a well-type counter. Our study concerns the stage of ex vivo imaging using a well-type counter.…”

Image-Guided Biopsy in the Era of Personalized Cancer Care: Proceedings from the Society of Interventional Radiology Research Consensus Panel

“…However, real-time fusion imaging platforms are often bulky and used more frequently at specialized centers, rendering them less generalizable to allow for molecular imaging guidance during biopsy. Another approach is to develop biopsy devices capable of detecting molecular tracers in the tumor tissue, allowing for more accurate intra-procedural tissue sampling [22,23]. For example, a biopsy device that incorporates a needle gamma detector allows for real-time intra-procedural detection of a molecular tracer (F18) during the biopsy [22].…”

“…Another approach is to develop biopsy devices capable of detecting molecular tracers in the tumor tissue, allowing for more accurate intra-procedural tissue sampling [22,23]. For example, a biopsy device that incorporates a needle gamma detector allows for real-time intra-procedural detection of a molecular tracer (F18) during the biopsy [22]. These tools can be applied to existing molecular tracers that can detect key molecular events such as metabolism (FDG), neovascularity (arginine-glycineaspartic RGD peptides) and proliferation (deoxy-fluoro-thymidine FLT).…”

Contemporary use of sentinel lymph node biopsy in the head and neck

“… 59 Although PET-based agents may not be easily imaged within the surgical suite, new operative room approaches have been described for the targeted excision of radiolabeled lymph nodes containing the PET radiotracer fluorine-18 fluorodeoxyglucose ( 18 F-FDG) using existing hand-held surgical probes and ex vivo specimen PET/CT imaging. 60 Additionally real-time optical imaging of PET-radiolabeled lymph nodes called Cerenkov Luminescence Imaging (CLI) is now available as well. Cerenkov luminescence refers to the visible light produced when a positron is emitted and then passes through the aqueous medium of cells and tissues.…”