title: PET/CT-guided biopsies of metabolically active bone lesions: applications and clinical impact.
abstract: OBJECTIVE
  In a minority of cases a definite diagnosis and stage grouping in cancer patients is not possible based on the imaging information of PET/CT. We report our experience with percutaneous PET/CT-guided bone biopsies to histologically verify the aetiology of hypermetabolic bone lesions.
  
  
  METHODS
  We retrospectively reviewed the data of 20 consecutive patients who underwent multimodal image-guided bone biopsies using a dedicated PET/CT system in a step-by-step technique. Technical and clinical success rates of PET/CT-guided biopsies were evaluated. Questionnaires were sent to the referring physicians to assess the impact of biopsies on patient management and to check the clinical need for PET/CT-guided biopsies.
  
  
  RESULTS
  Clinical indications for biopsy were to histologically verify the aetiology of metabolically active bone lesions without a morphological correlate confirming the suspicion of metastases in 15 patients, to determine the origin of suspected metastases in 3 patients and to evaluate the appropriateness of targeted therapy options in 2 patients. Biopsies were technically successful in all patients. In 19 of 20 patients a definite histological diagnosis was possible. No complications or adverse effects occurred. The result of PET/CT-guided bone biopsies determined a change of the planned treatment in overall 56% of patients, with intramodality changes, e.g. chemotherapy with palliative instead of curative intent, and intermodality changes, e.g. systemic therapy instead of surgery, in 22 and 50%, respectively.
  
  
  CONCLUSIONS
  PET/CT-guided bone biopsies are a promising alternative to conventional techniques to make metabolically active bone lesions-especially without a distinctive morphological correlate-accessible for histological verification. PET/CT-guided biopsies had a major clinical impact in patients who otherwise cannot be reliably stage grouped at the time of treatment decisions.
authors.affiliation: Department of Nuclear Medicine, University of Bern, Bern, Switzerland.
authors.forename: Bernd
authors.initials: B
authors.lastname: Klaeser
authors.forename: Jakub
authors.initials: J
authors.lastname: Wiskirchen
authors.forename: Jan
authors.initials: J
authors.lastname: Wartenberg
authors.forename: Thilo
authors.initials: T
authors.lastname: Weitzel
authors.forename: Ralph A
authors.initials: RA
authors.lastname: Schmid
authors.forename: Michel D
authors.initials: MD
authors.lastname: Mueller
authors.forename: Thomas
authors.initials: T
authors.lastname: Krause
mesh_terms: D000368:Aged; D001706:Biopsy / Q000009:adverse effects / Q000379:methods*; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed