title: Feasibility of a multimodal (18)F-FDG-directed lymph node surgical excisional biopsy approach for appropriate diagnostic tissue sampling in patients with suspected lymphoma.
abstract: BACKGROUND
  F-FDG PET/CT imaging is widely utilized in the clinical evaluation of patients with suspected or documented lymphoma. The aim was to describe our cumulative experience with a multimodal (18)F-FDG-directed lymph node surgical excisional biopsy approach in patients with suspected lymphoma.
  
  
  METHODS
  Thirteen patients (mean age 51 (± 16;22-76) years), with suspected new or suspected recurrent lymphoma suggested by (18)F-FDG-avid lesions seen on prior diagnostic whole-body PET/CT imaging, were injected IV with (18)F-FDG prior to undergoing same-day diagnostic lymph node surgical excisional biopsy in the operating room. Various (18)F-FDG detection strategies were used on the day of surgery, including, (1) same-day pre-resection patient PET/CT; (2) intraoperative gamma probe assessment; (3) clinical scanner specimen PET/CT imaging of whole surgically excised tissue specimens; (4) specimen gamma well counts; and/or (5) same-day post-resection patient PET/CT.
  
  
  RESULTS
  Same-day (18)F-FDG injection dose was 14.8 (± 2.4;12.5-20.6) millicuries or 548 (± 89;463-762) megabecquerels. Sites of (18)F-FDG-avid lesions were 4 inguinal, 3 cervical, 3 abdominal/retroperitoneal, 2 axillary, and 1 gluteal region subcutaneous tissue. Same-day pre-resection patient PET/CT was performed on 6 patients. Intraoperative gamma probe assessment was performed on 13 patients. Clinical scanner PET/CT imaging of whole surgically excised tissue specimens was performed in 10 cases. Specimen gamma well counts were performed in 6 cases. Same-day post-resection patient PET/CT imaging was performed on 8 patients. Time from (18)F-FDG injection to same-day pre-resection patient PET/CT, intraoperative gamma probe assessment, and same-day post-resection patient PET/CT were 76 (± 8;64-84), 240 (± 63;168-304), and 487 (± 104;331-599) minutes, respectively. Time from (18)F-FDG injection to clinical scanner PET/CT of whole surgically excised tissue specimens was 363 (± 60;272-446) minutes. Time from (18)F-FDG injection to specimen gamma well counts was 591 (± 96;420-689) minutes. Intraoperative gamma probe assessment successfully identified (18)F-FDG-avid lesions in 12/13 patients. Histopathologic evaluation confirmed lymphoma in 12/13 patients and benign disease in 1/13 patients.
  
  
  CONCLUSIONS
  A multimodal approach to (18)F-FDG-directed lymph node surgical excisional biopsy for suspected lymphoma is technically feasible for guiding appropriate diagnostic tissue sampling of lymph nodes seen as (18)F-FDG-avid lesions on diagnostic (18)F-FDG PET/CT imaging.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. stephen.povoski@osumc.edu.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Povoski
authors.affiliation: Division of Molecular Imaging and Nuclear Medicine, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. nathan.hall@uphs.upenn.edu.|Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA. nathan.hall@uphs.upenn.edu.
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Hall
authors.affiliation: Division of Molecular Imaging and Nuclear Medicine, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. douglas.murrey@osumc.edu.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Murrey
authors.affiliation: Division of Molecular Imaging and Nuclear Medicine, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. chadwick.wright@osumc.edu.
authors.forename: Chadwick L
authors.initials: CL
authors.lastname: Wright
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. edward.martin@osumc.edu.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Martin
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D061705:Image-Guided Biopsy; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008223:Lymphoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18