Rajender Kumar1, Bhagwant Rai Mittal2, Anish Bhattacharya1, Harmandeep Singh1, Amanjit Bal3, Shelvin Kumar Vadi1, Ashwani Sood1, Gaurav Prakash4, Harjeet Singh5, Aman Sharma6. 1. Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India. 2. Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India. brmittal@yahoo.com. 3. Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. 4. Department of Hemato-Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. 5. Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India. 6. Department of Rheumatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Abstract
PURPOSE: To evaluate the feasibility and diagnostic performance of 18F-FDG PET/CT-guided biopsy of abdominal and pelvic lesions with automated robotic arm (ARA) assistance. METHODS: This prospective study included 114 patients (75 men, 39 women; mean age 51.3 ± 14.7 years, range: 18-90 years) who underwent PET/CT-guided biopsy of FDG-avid abdominal and pelvic lesions from October 2014 to December 2017. Of these patients, 54 had a prior inconclusive CT-guided biopsy. The biopsies were done with ARA assistance, and a real-time sample was obtained after confirming the position of the needle tip within the target lesion on PET/CT. Histopathology reports were reviewed to evaluate the diagnostic performance of the procedure. Clinical or imaging follow-up was done to confirm negative results. RESULTS: The lesions were successfully targeted in 110 of the 114 patients (96.5%) and yielded a pathological diagnosis. Pathological diagnoses were confirmed in 50 of the 54 patients with a prior inconclusive biopsy. Of the 110 lesions, 82 were malignant, 20 were benign, and 8 showed minimal residual FDG uptake at the end of treatment and had no active disease even on clinical and imaging follow-up of at least 3 months. Findings were true-positive in 102 lesions, false-positive in none, true-negative in eight and false-negative in four. The procedure showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 96.2%, 100%, 100%, 66.7 and 96.5%, respectively. No immediate complications or delayed life-threatening events were observed. CONCLUSION: Percutaneous biopsy of metabolically active abdominal and pelvic lesions with ARA assistance is a technically feasible, safe and accurate method for pathological diagnosis with high diagnostic performance. PET-guided biopsy is highly practical and useful in patients, especially in those with a previous inconclusive biopsy.
PURPOSE: To evaluate the feasibility and diagnostic performance of 18F-FDG PET/CT-guided biopsy of abdominal and pelvic lesions with automated robotic arm (ARA) assistance. METHODS: This prospective study included 114 patients (75 men, 39 women; mean age 51.3 ± 14.7 years, range: 18-90 years) who underwent PET/CT-guided biopsy of FDG-avid abdominal and pelvic lesions from October 2014 to December 2017. Of these patients, 54 had a prior inconclusive CT-guided biopsy. The biopsies were done with ARA assistance, and a real-time sample was obtained after confirming the position of the needle tip within the target lesion on PET/CT. Histopathology reports were reviewed to evaluate the diagnostic performance of the procedure. Clinical or imaging follow-up was done to confirm negative results. RESULTS: The lesions were successfully targeted in 110 of the 114 patients (96.5%) and yielded a pathological diagnosis. Pathological diagnoses were confirmed in 50 of the 54 patients with a prior inconclusive biopsy. Of the 110 lesions, 82 were malignant, 20 were benign, and 8 showed minimal residual FDG uptake at the end of treatment and had no active disease even on clinical and imaging follow-up of at least 3 months. Findings were true-positive in 102 lesions, false-positive in none, true-negative in eight and false-negative in four. The procedure showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 96.2%, 100%, 100%, 66.7 and 96.5%, respectively. No immediate complications or delayed life-threatening events were observed. CONCLUSION: Percutaneous biopsy of metabolically active abdominal and pelvic lesions with ARA assistance is a technically feasible, safe and accurate method for pathological diagnosis with high diagnostic performance. PET-guided biopsy is highly practical and useful in patients, especially in those with a previous inconclusive biopsy.
Entities:
Keywords:
18F-FDG PET/CT-guided biopsy; Abdominal and pelvic lesions; Automated robotic arm (ARA) assistance; Diagnostic performance
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