Imaging-guided biopsy of 18F-FDG-Avid extrapulmonary lesions: Do lesion location and morphologic features on CT affect the positive predictive value for malignancy?

My Linh Nguyen, Debra A. Gervais, Michael A. Blake, Peter R. Mueller, Dushyant V. Sahani, Peter F. Hahn, Raul N. Uppot

Research output: Contribution to journalArticle

Abstract

Objective. The purpose of our study was to analyze the effect of lesion location and morphologic appearance on CT on the positive predictive value (PPV) for malignancy of all extrapulmonary lesions that were 18F-FDG avid on PET/CT and that were biopsied under imaging guidance. Materials and Methods. Between January 2004 and December 2010, 227 patients underwent imaging-guided biopsy of 231 PET-positive extrapulmonary lesions with diagnostic pathologic Results. The PET PPV for malignancy was retrospectively calculated and stratified according to lesion location and morphologic appearance. Results. The overall PET PPV for malignancy was 72%. Inflammatory processes accounted for the majority of benign biopsy Results. Lesion location significantly affected the PPV (p < 0.001). Bone (96%) and liver (90%) lesions had significantly higher PPVs for malignancy compared with other locations, whereas lymph nodes (60%) had a significantly lower PPV for malignancy. Lesions that were morphologically suspicious and morphologically benign according to CT findings alone were associated with PPVs of 74% and 57%, respectively (p = 0.05). FDG-Avid subcentimeter lymph nodes (n = 8) had a PPV for malignancy of 38%. Conclusion. Over half of PET-Avid morphologically benign-Appearing lesions and one third of PET-Avid subcentimeter lymph nodes were found to be malignant at biopsy, suggesting that benign morphologic appearance alone should not preclude further workup of a PET-positive lesion. Biopsies of FDG-Avid lesions in liver and bone yielded high rates of true malignancy, whereas biopsies of lymph nodes yielded a lower rate of malignancy compared with other lesion locations.

Original languageEnglish (US)
Pages (from-to)433-438
Number of pages6
JournalAmerican Journal of Roentgenology
Volume201
Issue number2
DOIs
StatePublished - Aug 1 2013
Externally publishedYes

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Image-Guided Biopsy
Fluorodeoxyglucose F18
Neoplasms
Lymph Nodes
Biopsy
Bone and Bones
Liver

Keywords

  • 18F-fluorodeoxyglucose
  • Imaging-guided biopsy
  • Interventional radiology, nuclear medicine, PET/CT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Imaging-guided biopsy of 18F-FDG-Avid extrapulmonary lesions : Do lesion location and morphologic features on CT affect the positive predictive value for malignancy? / Nguyen, My Linh; Gervais, Debra A.; Blake, Michael A.; Mueller, Peter R.; Sahani, Dushyant V.; Hahn, Peter F.; Uppot, Raul N.

In: American Journal of Roentgenology, Vol. 201, No. 2, 01.08.2013, p. 433-438.

Research output: Contribution to journalArticle

Nguyen, My Linh ; Gervais, Debra A. ; Blake, Michael A. ; Mueller, Peter R. ; Sahani, Dushyant V. ; Hahn, Peter F. ; Uppot, Raul N. / Imaging-guided biopsy of 18F-FDG-Avid extrapulmonary lesions : Do lesion location and morphologic features on CT affect the positive predictive value for malignancy?. In: American Journal of Roentgenology. 2013 ; Vol. 201, No. 2. pp. 433-438.
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title = "Imaging-guided biopsy of 18F-FDG-Avid extrapulmonary lesions: Do lesion location and morphologic features on CT affect the positive predictive value for malignancy?",
abstract = "Objective. The purpose of our study was to analyze the effect of lesion location and morphologic appearance on CT on the positive predictive value (PPV) for malignancy of all extrapulmonary lesions that were 18F-FDG avid on PET/CT and that were biopsied under imaging guidance. Materials and Methods. Between January 2004 and December 2010, 227 patients underwent imaging-guided biopsy of 231 PET-positive extrapulmonary lesions with diagnostic pathologic Results. The PET PPV for malignancy was retrospectively calculated and stratified according to lesion location and morphologic appearance. Results. The overall PET PPV for malignancy was 72{\%}. Inflammatory processes accounted for the majority of benign biopsy Results. Lesion location significantly affected the PPV (p < 0.001). Bone (96{\%}) and liver (90{\%}) lesions had significantly higher PPVs for malignancy compared with other locations, whereas lymph nodes (60{\%}) had a significantly lower PPV for malignancy. Lesions that were morphologically suspicious and morphologically benign according to CT findings alone were associated with PPVs of 74{\%} and 57{\%}, respectively (p = 0.05). FDG-Avid subcentimeter lymph nodes (n = 8) had a PPV for malignancy of 38{\%}. Conclusion. Over half of PET-Avid morphologically benign-Appearing lesions and one third of PET-Avid subcentimeter lymph nodes were found to be malignant at biopsy, suggesting that benign morphologic appearance alone should not preclude further workup of a PET-positive lesion. Biopsies of FDG-Avid lesions in liver and bone yielded high rates of true malignancy, whereas biopsies of lymph nodes yielded a lower rate of malignancy compared with other lesion locations.",
keywords = "18F-fluorodeoxyglucose, Imaging-guided biopsy, Interventional radiology, nuclear medicine, PET/CT",
author = "Nguyen, {My Linh} and Gervais, {Debra A.} and Blake, {Michael A.} and Mueller, {Peter R.} and Sahani, {Dushyant V.} and Hahn, {Peter F.} and Uppot, {Raul N.}",
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T1 - Imaging-guided biopsy of 18F-FDG-Avid extrapulmonary lesions

T2 - Do lesion location and morphologic features on CT affect the positive predictive value for malignancy?

AU - Nguyen, My Linh

AU - Gervais, Debra A.

AU - Blake, Michael A.

AU - Mueller, Peter R.

AU - Sahani, Dushyant V.

AU - Hahn, Peter F.

AU - Uppot, Raul N.

PY - 2013/8/1

Y1 - 2013/8/1

N2 - Objective. The purpose of our study was to analyze the effect of lesion location and morphologic appearance on CT on the positive predictive value (PPV) for malignancy of all extrapulmonary lesions that were 18F-FDG avid on PET/CT and that were biopsied under imaging guidance. Materials and Methods. Between January 2004 and December 2010, 227 patients underwent imaging-guided biopsy of 231 PET-positive extrapulmonary lesions with diagnostic pathologic Results. The PET PPV for malignancy was retrospectively calculated and stratified according to lesion location and morphologic appearance. Results. The overall PET PPV for malignancy was 72%. Inflammatory processes accounted for the majority of benign biopsy Results. Lesion location significantly affected the PPV (p < 0.001). Bone (96%) and liver (90%) lesions had significantly higher PPVs for malignancy compared with other locations, whereas lymph nodes (60%) had a significantly lower PPV for malignancy. Lesions that were morphologically suspicious and morphologically benign according to CT findings alone were associated with PPVs of 74% and 57%, respectively (p = 0.05). FDG-Avid subcentimeter lymph nodes (n = 8) had a PPV for malignancy of 38%. Conclusion. Over half of PET-Avid morphologically benign-Appearing lesions and one third of PET-Avid subcentimeter lymph nodes were found to be malignant at biopsy, suggesting that benign morphologic appearance alone should not preclude further workup of a PET-positive lesion. Biopsies of FDG-Avid lesions in liver and bone yielded high rates of true malignancy, whereas biopsies of lymph nodes yielded a lower rate of malignancy compared with other lesion locations.

AB - Objective. The purpose of our study was to analyze the effect of lesion location and morphologic appearance on CT on the positive predictive value (PPV) for malignancy of all extrapulmonary lesions that were 18F-FDG avid on PET/CT and that were biopsied under imaging guidance. Materials and Methods. Between January 2004 and December 2010, 227 patients underwent imaging-guided biopsy of 231 PET-positive extrapulmonary lesions with diagnostic pathologic Results. The PET PPV for malignancy was retrospectively calculated and stratified according to lesion location and morphologic appearance. Results. The overall PET PPV for malignancy was 72%. Inflammatory processes accounted for the majority of benign biopsy Results. Lesion location significantly affected the PPV (p < 0.001). Bone (96%) and liver (90%) lesions had significantly higher PPVs for malignancy compared with other locations, whereas lymph nodes (60%) had a significantly lower PPV for malignancy. Lesions that were morphologically suspicious and morphologically benign according to CT findings alone were associated with PPVs of 74% and 57%, respectively (p = 0.05). FDG-Avid subcentimeter lymph nodes (n = 8) had a PPV for malignancy of 38%. Conclusion. Over half of PET-Avid morphologically benign-Appearing lesions and one third of PET-Avid subcentimeter lymph nodes were found to be malignant at biopsy, suggesting that benign morphologic appearance alone should not preclude further workup of a PET-positive lesion. Biopsies of FDG-Avid lesions in liver and bone yielded high rates of true malignancy, whereas biopsies of lymph nodes yielded a lower rate of malignancy compared with other lesion locations.

KW - 18F-fluorodeoxyglucose

KW - Imaging-guided biopsy

KW - Interventional radiology, nuclear medicine, PET/CT

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