Rajender Kumar1,2,3,4, Bhagwant Rai Mittal1,2,3,4, Anish Bhattacharya1,2,3,4, Harmandeep Singh1,2,3,4, Amanjit Bal1,2,3,4, Gaurav Prakash1,2,3,4, Navneet Singh1,2,3,4. 1. 1 Department of Nuclear Medicine and PET/CT, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India. 2. 2 Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. 3. 3 Department of Hemato-Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. 4. 4 Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Abstract
OBJECTIVE: The purpose of this study is to establish the feasibility, safety, diagnostic performance, and clinical impact of real-time intraprocedural 18F-FDG PET/CT-guided automated robotic arm-assisted biopsy of hypermetabolic marrow or bone lesions. SUBJECTS AND METHODS: This prospective study included 73 patients (47 male patients and 26 female patients) who underwent PET/CT-guided biopsy of accessible hypermetabolic marrow or bone lesions. The biopsy needle was inserted into the target lesion with automated robotic arm assistance, and tissue sampling was performed at the site with the highest metabolic activity, after the needle position was confirmed using PET/CT. The results of histopathologic examination and clinical and imaging follow-up examinations were reviewed. The referring physicians were interviewed to assess the clinical impact of interventions on treatment planning. RESULTS: Of the 73 patients assessed, 34 were oncology patients with suspected metastasis or residual disease. The pathologic diagnosis was not known for 38 patients with clinically suspected benign (n = 7) or malignant (n = 31) disease. The remaining patient was suspected of having skeletal sarcoidosis. Thirty-nine marrow lesions and 34 bone lesions were targeted. All procedures were technically successful and safe, and no major complication was observed. Pathologic diagnosis was confirmed for 72 patients, for a diagnostic yield of 98.6%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the detection of malignancy (n = 54) were 98.2%, 100%, 100%, 94.7%, and 98.6%, respectively. The procedure was helpful in determining the treatment plan for 91.7% of patients. CONCLUSION: Automated robotic arm-assisted FDG PET/CT-guided real-time bone biopsy is a feasible and safe intervention with a very high diagnostic yield. It had a major clinical impact on patients with minimal residual FDG uptake on end-of-treatment PET/CT and isolated suspected metastatic lesions.
OBJECTIVE: The purpose of this study is to establish the feasibility, safety, diagnostic performance, and clinical impact of real-time intraprocedural 18F-FDG PET/CT-guided automated robotic arm-assisted biopsy of hypermetabolic marrow or bone lesions. SUBJECTS AND METHODS: This prospective study included 73 patients (47 male patients and 26 female patients) who underwent PET/CT-guided biopsy of accessible hypermetabolic marrow or bone lesions. The biopsy needle was inserted into the target lesion with automated robotic arm assistance, and tissue sampling was performed at the site with the highest metabolic activity, after the needle position was confirmed using PET/CT. The results of histopathologic examination and clinical and imaging follow-up examinations were reviewed. The referring physicians were interviewed to assess the clinical impact of interventions on treatment planning. RESULTS: Of the 73 patients assessed, 34 were oncology patients with suspected metastasis or residual disease. The pathologic diagnosis was not known for 38 patients with clinically suspected benign (n = 7) or malignant (n = 31) disease. The remaining patient was suspected of having skeletal sarcoidosis. Thirty-nine marrow lesions and 34 bone lesions were targeted. All procedures were technically successful and safe, and no major complication was observed. Pathologic diagnosis was confirmed for 72 patients, for a diagnostic yield of 98.6%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the detection of malignancy (n = 54) were 98.2%, 100%, 100%, 94.7%, and 98.6%, respectively. The procedure was helpful in determining the treatment plan for 91.7% of patients. CONCLUSION: Automated robotic arm-assisted FDG PET/CT-guided real-time bone biopsy is a feasible and safe intervention with a very high diagnostic yield. It had a major clinical impact on patients with minimal residual FDG uptake on end-of-treatment PET/CT and isolated suspected metastatic lesions.
Entities:
Keywords:
FDG PET/CT-guided bone biopsy; automated robotic arm assisted; clinical impact; diagnostic performance
Authors: Naila Loudini; Andor W J M Glaudemans; Paul C Jutte; Derya Yakar; Thomas C Kwee Journal: Skeletal Radiol Date: 2020-04-06 Impact factor: 2.199