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Year : 2009  |  Volume : 19  |  Issue : 3  |  Page : 208-209
PET/CT guidance for percutaneous fine needle aspiration cytology/biopsy

1 Consulting Radiologist, Bangalore Institute of Oncology - Health Care Global, Bangalore, India
2 Consulting Nuclear Medicine Specialist, Bangalore Institute of Oncology - Health Care Global, Bangalore, India
3 Consulting Radiation oncologist, Bangalore Institute of Oncology - Health Care Global, Bangalore, India

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Date of Web Publication4-Aug-2009


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.

Keywords: PET/CT, tumor, FNAC/biopsy

How to cite this article:
Govindarajan M J, Nagaraj K R, Kallur K G, Sridhar P S. PET/CT guidance for percutaneous fine needle aspiration cytology/biopsy. Indian J Radiol Imaging 2009;19:208-9

How to cite this URL:
Govindarajan M J, Nagaraj K R, Kallur K G, Sridhar P S. PET/CT guidance for percutaneous fine needle aspiration cytology/biopsy. Indian J Radiol Imaging [serial online] 2009 [cited 2021 Jan 26];19:208-9. Available from:

   Introduction Top

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],[2],[3],[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.

   Technical Note Top

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 [5] 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 [Figure 2] and [Figure 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:

  1. real-time confirmation that the needle tip is correctly positioned;
  2. the radiologist is more confident about biopsying the most metabolically active part of the lesion
The disadvantages of this technique are:

  1. it takes more time than traditional techniques, since fusion is necessary, which takes a few more seconds per image;
  2. we use a lead shield to reduce radiation dose to the operator, which limits the movements of the radiologist, and
  3. radiation exposure to the operator and supporting staff is more.
Anecdotally, we believe that the results of this technique are superior to traditional techniques and larger studies are required to confirm this.

   Conclusions Top

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.

   References Top

1.Takalkar AM, El-Haddad G, Lilien DL. FDG-PET and PET/CT - Part I. Indian J Radiol Imaging 2007;17:169-80.   Back to cited text no. 1    Medknow Journal
2.Tillisch J, Brunken R, Marshall R, Schwaiger M, Mandelkern M, Phelps M, et al . Reversibility of cardiac wall-motion abnormalities predicted by positron tomography. N Engl J Med 1986;314:884-8.   Back to cited text no. 2  [PUBMED]  
3.Warburg O, Wind F, Negelein E. The metabolism of tumors in body. J Gen Physiol 1927;8:519-30.  Back to cited text no. 3    
4.Takalkar AM, El-Haddad G, Lilien DL. FDG-PET and PET/CT - Part II. Indian J Radiol Imaging 2008;18:17-36.  Back to cited text no. 4    Medknow Journal
5.Govindarajan MJ, Kalyanpur A, Nagaraj KR, Ravikumar H, Kallur KG, Sridhar PS. Technical note: Preprocedural PET/CT guidance for FNAC of a lung mass. Indian J Radiol Imaging 2008;18:90-1.  Back to cited text no. 5    Medknow Journal

Correspondence Address:
M J Govindarajan
No.6, Shrinivasnilaya, 3rd Cross, Vimajyoti, LIC colony, Basaveshwar nagar, Bangalore - 560 079
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0971-3026.54885

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  [Figure 1], [Figure 2], [Figure 3]

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