Positron emission tomography/computed tomography guided percutaneous biopsies of Ga-68 avid lesions using an automated robotic arm

• Published in: Diagnostic and interventional imaging 2020-03, Vol.101 (3), p.157-167
• Main Authors: Kumar, R., Mittal, B.R., Bhattacharya, A., Vadi, S.K., Singh, H., Bal, A., Shukla, J., Sharma, V., Sood, A., Singh, S.K.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Automated robotic arm assisted biopsy; Feasibility Studies; Female; Ga-68 chemokine analogue (CXCR-4); Ga-68 DOTANOC; Ga-68 PSMA; Gallium Radioisotopes; Humans; Image-Guided Biopsy - methods; Male; Middle Aged; Neoplasms - diagnostic imaging; Neoplasms - pathology; PET/CT-guided biopsy; Positron Emission Tomography Computed Tomography - instrumentation; Positron Emission Tomography Computed Tomography - methods; Prospective Studies; Robotics; Young Adult
• ISSN: 2211-5684; 2211-5684
• DOI: 10.1016/j.diii.2019.10.006

The purpose of this prospective study was to evaluate the feasibility of positron emission tomography/computed tomography (PET/CT)-guided biopsy of Ga-68 avid lesions using an automated robotic arm and determine the diagnostic yield of this technique. Patients who underwent Ga-68 labelled tracers imaging followed by PET/CT-guided biopsies of tracer-avid lesions were prospectively included. Biopsies were performed using a dedicated automated-robotic-arm assisted PET/CT-guided biopsy device on the same-day of diagnostic PET/CT-imaging. The tissue samples were retrieved after confirming the position of needle-tip in the target lesion. Procedure-related complications and radiation exposure of the interventionist were recorded. Histopathological reports were reviewed for diagnostic yield. A total of 25 patients (19 men, six women) with a mean age of 50.8±17.3 (SD) years (range: 17-83 years) were included. The biopsies were performed after PET/CT using Ga-68 DOTANOC (n=16) or Ga-68 PSMA (n=8) and Ga-68 chemokine-analogue (n=1). The biopsy samples were obtained from the liver (n=9), bone (n=8), lymph-nodes (n=3), lung (n=1), pancreas (n=1), anterior mediastinal lesion (n=1), peritoneal-deposit (n=1) and thigh-lesion (n=1). No immediate or delayed procedure-related complications were documented in any patient. PET/CT-guided molecular sampling was technically successful in all the patients. Histopathology revealed malignancies in all the biopsied specimens without the need for repeat sampling or further invasive-diagnostic workup, with a diagnostic yield of 100%. The estimated absorbed-radiation dose was 566.7μSv/year for the interventionist. PET/CT-guided molecular biopsy using Ga-68 labelled radiotracers is feasible and can be performed safely and accurately with a high-diagnostic yield. It is helpful in accurately staging the disease when tracer-avid isolated distant lesion evident on imaging and highly practical in patients with previous inconclusive sampling.