Nuclear Medicine & Radiation Therapy

The clinical management of lesions suspicious for malignancy relies not only on diagnosis of benign versus malignant potential but also tumor grading, immunohistochemical and genetic information. Pathological analysis remains the gold standard for definite diagnosis. Hence, a carefully performed biopsy with low risk of complication is crucial. Compared to open biopsy, image guided biopsies are minimally invasive and confer several advantages including low morbidity, low complication rate and cost savings. FDG-PET/CT has shown higher diagnostic accuracy than conventional imaging CT in characterizing tumor in initial staging, treatment response evaluation and follow-up. PET/CT guided biopsies may allow early histologic diagnosis and staging before morphologic changes are evident. PET/CT biopsy can therefore rule out/in malignancy in early stage of disease and re-stage different types of cancer. Non-real-time PET/CT biopsies have used the image co-registration of a prior PET with a intraprocedural CT. However, this method is inaccurate in time and space, takes long time and requires special software. The aim of this study is to report the initial experience of utilizing the real-time intraprocedural PET/CT guided biopsies, including feasibility and technical requirements.