title: Image-guided biopsy: what the interventional radiologist needs to know about PET/CT.
abstract: Positron emission tomography (PET)/computed tomography (CT) with fluorine 18 fluorodeoxyglucose (FDG) is increasingly used in evaluation of oncology patients. Because PET/CT can demonstrate malignancy before morphologic changes are evident, application of PET/CT information to image-guided biopsy can facilitate early histologic diagnosis and staging. However, because FDG uptake is not specific to cancer, PET/CT findings may raise questions about whether uptake in a lesion is an indication for biopsy. To properly select patients for image-guided biopsy, interventional radiologists should be familiar with the biologic significance of FDG uptake and various causes of false-positive uptake. PET/CT images may also become a source of confusion in the interpretation of biopsy results. Various causes of false-positive and false-negative FDG uptake need to be considered, especially when there is a discrepancy between biopsy results and PET/CT findings. False-negative FDG uptake can result from cancers that are too small to be observed or not FDG avid. False-positive FDG uptake can be due to underlying inflammation from recent treatment. Conversely, complete resolution of FDG uptake in a treated lesion does not necessarily indicate absence of viable cells. When questions about PET/CT findings arise in the context of image-guided biopsy, discussion with experienced nuclear imaging physicians is essential.
authors.affiliation: Diagnostic and Therapeutic Care Line, Section of Radiology, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX 77030, USA. Katsuhiro.Kobayashi@va.gov
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Peeyush
authors.initials: P
authors.lastname: Bhargava
authors.forename: Shanker
authors.initials: S
authors.lastname: Raja
authors.forename: Farbod
authors.initials: F
authors.lastname: Nasseri
authors.forename: Hassan A
authors.initials: HA
authors.lastname: Al-Balas
authors.forename: Darryl D
authors.initials: DD
authors.lastname: Smith
authors.forename: Sharad P
authors.initials: SP
authors.lastname: George
authors.forename: Meena S
authors.initials: MS
authors.lastname: Vij
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D061705:Image-Guided Biopsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009369:Neoplasms / Q000175:diagnosis*; D049268:Positron-Emission Tomography; D015641:Radiography, Interventional / Q000379:methods*; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18