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PET/CT, used as a guiding tool, can improve the accuracy of percutaneous fine needle aspiration cytology (FNAC)/biopsy due to its ability to incorporate both physiological and anatomical information.
One of the uses of PET/CT fusion imaging, apart from cancer detection, staging and restaging and non-neoplastic applications in cardiac and neurological diseases, [1–4] is in providing guidance during percutaneous biopsy; this application of PET/CT has not been exhaustively studied. We would like to describe our limited experience in performing PET/CT-guided biopsies.
Although there are no definite described methods in the literature, we believe, there can be, for all practical purposes, at least two ways of using PET/CT for percutaneous biopsy guidance.
The first is where information from a PET scan done previously is used to target a metabolically active lesion or lesion-part so that the diagnostic yield improves [Figure 1]. The second is where the biopsy is done immediately after a PET/CT study, without changing the patient's position [Figures [Figures22 and and3].3]. We have now performed nine biopsies using the second method. In this method, the PET/CT is first performed in the usual manner. Using this information, the appropriate site to be biopsied is selected and the procedure is started with CT guidance. The CT scan image acquired during and after the needle insertion is fused with PET images acquired before needle insertion to confirm that the needle tip is in the right place. The advantages of this technique are:
The disadvantages of this technique are:
Anecdotally, we believe that the results of this technique are superior to traditional techniques and larger studies are required to confirm this.
PET/CT-guided biopsies may help in difficult situations, especially when it is important to know which part of the tumor is active or which lesion is active in patients with multiple, widespread lesions.
Source of Support: Nil
Conflict of Interest: None declared.