title: Comparison of CT and PET/CT for biopsy guidance in oncological patients.
abstract: OBJECTIVE
  To compare FDG PET/CT and CT for the guidance of percutaneous biopsies with histological confirmation of lesions.
  
  
  METHODS
  We prospectively evaluated 323 patients of whom 181 underwent FDG PET/CT-guided biopsy (total 188 biopsies) and 142 underwent CT-guided biopsy (total 146 biopsies). Biopsies were performed using the same PET/CT scanner with a fluoroscopic imaging system. Technical feasibility, clinical success and complication rates in the two groups were evaluated.
  
  
  RESULTS
  Of the 188 biopsies with PET/CT guidance, 182 (96.8%) were successful with conclusive tissue samples obtained and of the 146 biopsies with CT guidance, 137 (93.8%) were successful. Therefore, 6 of 188 biopsies (3.1%) with PET/CT guidance and 9 of 146 (6.1%) with CT guidance were inconclusive (p = 0.19). Due to inconclusive histological results, 4 of the 188 lesions (2.1%) were rebiopsied with PET/CT guidance and 3 of 146 lesions (2.0%) were rebiopsied with CT guidance. Histology demonstrated that 142 of 188 lesions (75.5%) were malignant, and 40 (21.2%) were benign in the PET/CT-guided group, while 89 of 146 lesions (60.9%) were malignant and 48 (32.8%) were benign in the CT-guided group (p = 0.004 and 0.01, respectively). Patients with a histological diagnosis of benign lesion had no recurrence of disease with a minimum of 6 months follow-up. Of the 188 PET/CT-guided biopsies, 6 (3.1%) were repeat biopsies due to a previous nondiagnostic CT-guided biopsy performed in a different diagnostic centre. The interval between the two biopsies was less than a month in all cases. Histology revealed five malignant lesions and one benign lesion among these. The complication rate in the PET/CT-guided biopsy group was 12.7% (24 of 188), while in the CT-guided group, was 9.5% (14 of 146, p = 0.26). Therefore, there was no significant difference in complication rates between PET/CT and CT guidance.
  
  
  CONCLUSIONS
  PET/CT-guided biopsy is already known to be a feasible and accurate method in the diagnostic work-up of suspected malignant lesions. This prospective analysis of a large number of patients demonstrated the feasibility and advantages of using PET/CT as the imaging method of choice for biopsy guidance, especially where FDG-avid foci do not show corresponding lesions on the CT scan. There were no significant differences in the ability to obtain a diagnostic specimen or in the complication rates between PET/CT and CT guidance.
authors.affiliation: Quanta - Diagnóstico e Terapia, Rua Almirante Tamadaré, 1000, CEP 80045-170, Curitiba, PR, Brazil. cercijuliano@hotmail.com.
authors.forename: Juliano J
authors.initials: JJ
authors.lastname: Cerci
authors.affiliation: Nuclear Medicine Department, University Hospital S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Tabacchi
authors.affiliation: Quanta - Diagnóstico e Terapia, Rua Almirante Tamadaré, 1000, CEP 80045-170, Curitiba, PR, Brazil.
authors.forename: Mateos
authors.initials: M
authors.lastname: Bogoni
authors.affiliation: Vanderbilt University, Nashville, TN, USA.
authors.forename: Dominique
authors.initials: D
authors.lastname: Delbeke
authors.affiliation: Quanta - Diagnóstico e Terapia, Rua Almirante Tamadaré, 1000, CEP 80045-170, Curitiba, PR, Brazil.
authors.forename: Carlos Cunha
authors.initials: CC
authors.lastname: Pereira
authors.affiliation: Quanta - Diagnóstico e Terapia, Rua Almirante Tamadaré, 1000, CEP 80045-170, Curitiba, PR, Brazil.
authors.forename: Rodrigo J
authors.initials: RJ
authors.lastname: Cerci
authors.affiliation: Quanta - Diagnóstico e Terapia, Rua Almirante Tamadaré, 1000, CEP 80045-170, Curitiba, PR, Brazil.
authors.forename: Cassiano
authors.initials: C
authors.lastname: Krauzer
authors.affiliation: Byori - Laboratório de Patologia, Curitiba, Brazil.
authors.forename: Danielle Giacometti
authors.initials: DG
authors.lastname: Sakamoto
authors.affiliation: Nuclear Medicine Department, University Hospital S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Fanti
authors.affiliation: Quanta - Diagnóstico e Terapia, Rua Almirante Tamadaré, 1000, CEP 80045-170, Curitiba, PR, Brazil.
authors.forename: João Vicente
authors.initials: JV
authors.lastname: Vitola
mesh_terms: D000368:Aged; D001692:Biological Transport; D005240:Feasibility Studies; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology*; D000072078:Positron Emission Tomography Computed Tomography
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: CT-guided biopsy; Cancer; FDG PET/CT; PET/CT-guided biopsy