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

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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 suspected bone metastasis of unknown primary site.

Methods

The patients with suspected bone metastasis who underwent PET-CT for evaluation of primary site were enrolled in this study. The primary sites were identified by the histopathologic or imaging studies and were classified according to the FDG uptake positivity of the primary site. To evaluate the guiding capability of PET-CT in biopsy site selection, we statistically analyzed 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 51 patients (94.1%). Forty-six patients were eligible to test the association of clinical choice of biopsy site with PET positivity of extra-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 came out 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 biopsy sites in patients with suspected bone metastasis.

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Correspondence to Seong Young Kwon.

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Conflict of Interest

Su Woong Yoo, Md. Sunny Anam Chowdhury, Subin Jeon, Sae-Ryung Kang, Changho Lee, Zeenat Jabin, Jahae Kim, Sang-Geon Cho, Ho-Chun Song, Hee-Seung Bom, Jung-Joon Min, and Seong Young Kwon declare that they have no conflict of interest.

This research was supported by a grant from KOICA, Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean government (MSIT) (No. NRF-2019M3E5D1A02067958), the National Research Foundation Korea (NRF) grants funded by the Korean government (MSIT) (No. NRF-2018R1D1A1B07050011).

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed Consent

The institutional review board of our institute approved this retrospective study, and the requirement to obtain informed consent was waived.

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Yoo, S.W., Chowdhury, M.S.A., Jeon, S. et al. Clinical Impact of F-18 FDG PET-CT on Biopsy Site Selection in Patients with Suspected Bone Metastasis of Unknown Primary Site. Nucl Med Mol Imaging 54, 192–198 (2020). https://doi.org/10.1007/s13139-020-00649-4

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  • DOI: https://doi.org/10.1007/s13139-020-00649-4

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