Pictorial review of PET/CT guided biopsy in highly suspicious malignant lesions.

Congress:

2019 ASM

Poster Number:

R-0081

Type:

Educational Exhibit

Keywords:

Biopsy, PET-CT, Pelvis, Lymph nodes, Neoplasia

Authors:

S. N. Purchuri, R. Bain; QLD/AU

DOI:

10.26044/ranzcr2019/R-0081

DOI-Link:

https://dx.doi.org/10.26044/ranzcr2019/R-0081

Fig. 4: USS guided core biopsy of PET avid left inguinal region.

Fig. 6: PET guided biopsy with needle through the PET avid left inguinal region.

Fig. 7: PET jar showing that the lesion has been captured.

Fig. 2: CT showing soft tissue density/scar tissue post left inguinal lymph node...

Learning objectives

To highlight the efficacy and safety of an unusual procedure (PET/CT guided percutaneous biopsy) which would significantly impact patient’s diagnosis and management.

Background

Combined PET/CT imaging incorporates both physiological and anatomical information and therefore can provide effective guidance during percutaneous biopsy by helping to accurately target the metabolically active lesion.[1]With the help of advanced technology, real time confirmation of needle tip within the lesion is accurately identified and this gives the Radiologist more certainty about the biopsy sample. CT imaging alone does not demonstrate metabolic activity and therefore it fails to delineate between malignant from benign areas within the lesion. However, combining PET imaging with CT assists in...

Imaging findings OR Procedure details

69-year-old female presented following a PET scan after surgery for vulval SCC. The scan showed a small focus of FDG avidity within an area of scar tissue from left inguinal lymph node dissection. The surgery had been complicated by a postoperative fluid collection in this region, which made interpretation of the finding difficult. Multiple ultrasound-guided core biopsies had been obtained within this region, which were negative for malignancy. However there was concern that this could be a false negative result in view of the uncertainty...

Conclusion

PET/CT-guided percutaneous biopsy of FDG avid lesions targets either the metabolically active part of a lesion or can identify a lesion that is not visible on unenhanced CT imaging. It therefore yields a high diagnostic success rate with minimal false negative rates. The occupational dose to the Radiologist is also surprisingly low.

Personal information

References

1.Paparo F, E.A.Advantages of percutaneous abdominal biopsy under PET-CT/ultrasound fusion imaging guidance: a pictorial essay. - PubMed – NCBI 2.Govindarajan, M., Nagaraj, K., K. And Sridhar, P.PET/CT guidance for percutaneous fine needle aspiration cytology/biopsy 3.Ahmed, S., Zimmer, A., Mcdonald, N. and Spies, S.The effectiveness of lead aprons in reducing radiation exposures from specific radionuclide