Percutaneous biopsy based on PET/CT findings in cancer patients: technique, indications, and results

To describe a technique for CT-guided biopsy based on PET/CT findings and to evaluate the indications and results of the technique in cancer patients.

We evaluated all patients receiving CT-guided percutaneous biopsies whose indication was based on PET/CT findings at an oncology reference center from October 2009 to December 2010. The PET/CT images were evaluated side by side with noncontrast CT images to identify the lesion or area of interest to be biopsied. Biopsies were guided by CT with the needle directed at the area of metabolic activity identified in the PET/CT examination performed before the procedure.

A total of 64 cases were included in this study. The most common lesion location was pulmonary (n = 28; 43.8%). The median of the lesions' greatest diameter and maximum SUV were 44.1 ± 31.6 mm (10-186 mm) and 8.4 ± 5.9 (2.1-34.0), respectively. The histologic results of the biopsies were negative for malignancy in 15 cases (23.4%), positive in 46 cases (71.9%), and inconclusive in 3 cases (4.7%). Lesions with an SUV ≥ 4.0 were more likely to be malignant (85.4% vs. 46.2%; P = 0.006).

CT-guided biopsies should be used routinely for lesions identified or better characterized by PET/CT. The results of this study demonstrate that this method is reliable, secure, and very accurate diagnostically, revealing a high percentage of malignant lesions.