Nucl Med Mol Imaging.  2020 Aug;54(4):192-198. 10.1007/s13139-020-00649-4.

Clinical Impact of F-18 FDG PET-CT on Biopsy Site Selection in Patients with Suspected Bone Metastasis of Unknown Primary Site

Affiliations
  • 1Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun Jeollanam-do 58128 Republic of Korea
  • 2Institute of Nuclear Medicine and Allied Sciences, Bangladesh Atomic Energy Commission, Bogra Bangladesh
  • 3Department of Nuclear Medicine, Chonnam National University Medical School, Jeollanam-do Republic of Korea
  • 4National Institute of Nuclear Medicine and Allied Sciences, Bangladesh Atomic Energy Commission, Dhaka Bangladesh
  • 5Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju Republic of Korea

Abstract

Purpose
We investigated the clinical role of F-18 fluorodeoxyglucose (FDG) positron emission tomography-computed tomography(PET-CT) in the identification of the primary site and the selection of the optimal biopsy site in patients with suspectedbone metastasis of unknown primary site.
Methods
The patients with suspected bone metastasis who underwent PET-CT for evaluation of primary site were enrolled inthis study. The primary sites were identified by the histopathologic or imaging studies and were classified according to the FDGuptake positivity of the primary site. To evaluate the guiding capability of PET-CT in biopsy site selection, we statisticallyanalyzed whether the biopsy site could be affected according to the presence of extra-skeletal FDG uptake.
Results
Among 74 enrolled patients, 51 patients had a metastatic bone disease. The primary site was identified in 48 of 51patients (94.1%). Forty-six patients were eligible to test the association of clinical choice of biopsy site with PET positivity ofextra-skeletal lesion. The extra-skeletal biopsies were done in 42 out of 43 patients with positive extra-skeletal uptake lesions.Bone biopsies were inevitably performed in the other three patients without extra-skeletal uptake lesions. The association cameout to be significant (Fisher’s exact test, P< 0.001).
Conclusion
F-18 FDG PET-CT significantly contributed not only to identify the primary site but also to suggest optimal biopsysites in patients with suspected bone metastasis.

Keyword

Bone metastasis; Unknown primary site; PET-CT; Biopsy
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