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PET/CT-guided biopsies of metabolically active bone lesions: applications and clinical impact

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

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.

Conclusion

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.

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Acknowledgements

B.K., J.W. and T.K. were supported by a local quality assurance project.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland

    Bernd Klaeser, Jakub Wiskirchen, Jan Wartenberg, Thilo Weitzel & Thomas Krause

  2. Department of Radiology, Neuroradiology, and Nuclear Medicine, University Hospital Tübingen, Tübingen, Germany

    Jakub Wiskirchen

  3. Department of Thoracic Surgery, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland

    Ralph A. Schmid

  4. Department of Obstetrics and Gynaecology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland

    Michel D. Mueller

Authors
  1. Bernd Klaeser
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  2. Jakub Wiskirchen
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  4. Thilo Weitzel
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  5. Ralph A. Schmid
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  6. Michel D. Mueller
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  7. Thomas Krause
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Correspondence to Jakub Wiskirchen.

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Klaeser, B., Wiskirchen, J., Wartenberg, J. et al. PET/CT-guided biopsies of metabolically active bone lesions: applications and clinical impact. Eur J Nucl Med Mol Imaging 37, 2027–2036 (2010). https://doi.org/10.1007/s00259-010-1524-z

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  • DOI: https://doi.org/10.1007/s00259-010-1524-z

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