Bent Talitha, Yakar Derya, Kwee Thomas C
Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9713 Groningen, The Netherlands.
Diagnostics (Basel). 2021 Mar 20;11(3):559. doi: 10.3390/diagnostics11030559.
Biopsy of F-fluoro-2-deoxy-D-glucose (FDG)-avid lesions suspected for malignancy remains an invasive procedure associated with a variety of risks. It is still unclear if the positive predictive value (PPV) of positron emission tomography (PET)/computed tomography (CT) is sufficiently high to avoid tissue sampling. Therefore, the purpose of this study was to determine the PPV of F-FDG-PET/CT for malignancy in patients with a clinical suspicion of active malignant disease.
This single-center retrospective study included 83 patients who had undergone FDG-PET/CT within 60 days before CT- or ultrasonography-guided tissue sampling and whose request form for CT- or US-guided tissue sampling requested mutation analyses. The latter implies a high clinical suspicion of active malignant disease. The nature of each biopsied lesion was determined based on the results of the pathological analysis and/or clinical and imaging follow-up of at least 12 months.
In total, eighty-eight FDG-avid lesions were biopsied. The PPV of FDG-PET/CT for malignancy was 98.9% (95% CI: 93.8-99.8%). For patients with an oncological history, the PPV was 98.7% (95% CI: 92.9-99.8%), and for patients with no oncological history, the PPV was 100% (95% CI: 74.1-100.0%). There was no significant difference between the PPV of the group with and without an oncological history ( = 0.71). In two cases, an unsuspected malignancy was diagnosed.
Although the PPV of FDG-PET/CT for malignancy in patients with a clinical suspicion of active malignant disease is high, biopsy remains recommended to avoid inappropriate patient management due the non-negligible chance of dealing with FDG-avid benign disease or unexpected malignancies.
对疑似恶性肿瘤的氟代脱氧葡萄糖（FDG）摄取阳性病变进行活检仍是一种有多种风险的侵入性操作。正电子发射断层扫描（PET）/计算机断层扫描（CT）的阳性预测值（PPV）是否足够高以避免组织采样仍不清楚。因此，本研究的目的是确定临床怀疑患有活动性恶性疾病的患者中，F-FDG-PET/CT对恶性肿瘤的PPV。
这项单中心回顾性研究纳入了83例患者，这些患者在CT或超声引导下组织采样前60天内接受了FDG-PET/CT检查，且其CT或超声引导下组织采样申请表要求进行突变分析。后者意味着对活动性恶性疾病的高度临床怀疑。根据病理分析结果和/或至少12个月的临床及影像学随访确定每个活检病变的性质。
总共对88个FDG摄取阳性病变进行了活检。FDG-PET/CT对恶性肿瘤的PPV为98.9%（95%CI：93.8-99.8%）。有肿瘤病史的患者，PPV为98.7%（95%CI：92.9-99.8），无肿瘤病史的患者，PPV为100%（95%CI：74.1-100.0%）。有肿瘤病史组和无肿瘤病史组的PPV之间无显著差异（P=0.71）。在两例病例中，诊断出了意外的恶性肿瘤。
尽管临床怀疑患有活动性恶性疾病的患者中，FDG-PET/CT对恶性肿瘤的PPV较高，但仍建议进行活检，以避免因处理FDG摄取阳性良性疾病或意外恶性肿瘤的不可忽略的可能性而导致对患者的不当管理。
