Biopsy of suspect tissues is required to reach a diagnosis and to plan adequate treatment. Open incisional biopsy (OIB) is traditionally the method of choice, providing an accuracy of approximately 100%. OIB is very expensive and is associated with several drawbacks [1]. The development of imaging-guided biopsies (US, CT) has almost overcome these disadvantages. However recent literature shows that imaging-guided biopsies have an accuracy between 70-90%, with several non-diagnostic procedures [2]. FDG PET/CT is a functional imaging technique that highlights, with a very high sensitivity,...

Between November2014 and September2015, 10 patients with suspect hypermetabolic findings were enrolledat our institution. Among them,8/10 had a suspect malignancy relapse and 2/10 had suspect findings without a previous significant clinical history; 5/10 (50%) had a previous non-diagnostic CT-guided biopsy. All patientsfullfilled the criteria to undergo a real-time FDG PET/CT guided biopsyandhad a prior whole body PET/CT scan showing the abnormal focal uptake area. Five out of tenpatients underwent also contrast media injection to depict vessels surrounding the suspect lesion. After informed consent had been...

Ten out of ten (100%) PET/CT positive lesions were successfully biopsied without the need for repeating the procedure.A pathological diagnosis after real-time PET/CT guided biopsy was achieved in all patients. The results of the histology reports were as follows: 1 tubercolosis, 1 sacral chordoma (Fig. 1), 2 rectal cancer relapse (Fig. 2), 1 serous papillary ovarian cancer, 2 intermediate lymphoma, 1 Langerhans cell histiocytosis, 1 node metastasis of uterine neoplasm (Fig. 3), 1 scar tissue post-radiotherapy. No patients had complications.

Ourpreliminary results showthat real-time FDG PET/CT guided biopsy is feasible in the clinical practice and could optimize the diagnostic yield of biopsies.PET/CT images allow to identify the most active lesion (if more than one is detected) and to sample the most active tissue within the target lesion (large masses such as chordomas may include dedifferentiated areas) [6]. Of note, real-time FDG PET/CT guided biopsyallowed to obtain a definite histology diagnosis even in those patients with aprevious non-diagnostic biopsy, thus starting atreatment.

1. Issakov J, Flusser G, Kollender Y, et al. Computed tomography-guided core needle biopsy for bone and soft tissue tumors. Isr Med Assoc J 2003;5:28-30. 2. Kiatisevi P, Thanakit V, Sukunthanak B, et al. Computed tomography-guided core needle biopsy versus incisional biopsy in diagnosing muscoloskeletal lesions. J Orthop Surg 2013;21:204-208. 3. Bomanji JB, Costa DC, Ell PJ. Clinical role of positron emission tomography in oncology. Lancet Oncol 2001;2:157–164. 4.Hustinx R, Bénard F, Alavi A. Whole-body FDG-PET imaging in the management of patients with cancer. Semin...