title: FDG-PET/CT-guided biopsy of bone metastases sets a new course in patient management after extensive imaging and multiple futile biopsies.
abstract: A 73-year-old man with a history of prostate and bladder carcinoma and persistent back pain was diagnosed by MRI with multiple vertebral metastases including a compression fracture of T7. He received radiotherapy for pain relief and for vertebral instability with incipient spinal stenosis, but additional targeted systemic therapy was intended. Therefore, multiple attempts at minimally invasive and open biopsies for histological characterisation of the bone metastases were performed, but failed to provide a conclusive specimen, although CT, MRI and bone scintigraphy were used for biopsy planning. Only histopathological analysis of an (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT-guided additional biopsy at a site with high metabolic activity yielded the final diagnosis of bone metastases of a neuroendocrine small cell cancer of unknown origin; hence, the patient had a third malignancy requiring a different therapy regimen and diagnostic work-up.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Medical Center, Tübingen, Germany. Matthias.Werner@med.uni-tuebingen.de
authors.forename: M K
authors.initials: MK
authors.lastname: Werner
authors.forename: P
authors.initials: P
authors.lastname: Aschoff
authors.forename: M
authors.initials: M
authors.lastname: Reimold
authors.forename: C
authors.initials: C
authors.lastname: Pfannenberg
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology; D000368:Aged; D001706:Biopsy / Q000379:methods; D018288:Carcinoma, Small Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary*; D002295:Carcinoma, Transitional Cell / Q000473:pathology; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D009382:Neoplasms, Unknown Primary / Q000473:pathology*; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary*; D049268:Positron-Emission Tomography / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology; D019275:Radiopharmaceuticals; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary*; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000379:methods; D001749:Urinary Bladder Neoplasms / Q000473:pathology
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18