Real Time F-18 FDG PET-CT-Guided Metabolic Biopsy Targeting Differential FDG Avidity in a Pulmonary Blastoma
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Real Time F-18 FDG PET-CT-Guided Metabolic Biopsy Targeting Differential FDG Avidity in a Pulmonary Blastoma Tarun Kumar Jain 1 & Harmandeep Singh 1
&
Rajender Kumar 1 & Amanjit Bal 2 & Ashwani Sood 1 & Bhagwant Rai Mittal 1
Received: 6 May 2020 / Revised: 6 July 2020 / Accepted: 14 July 2020 # Korean Society of Nuclear Medicine 2020
Abstract Pulmonary blastoma (PB) is a rare thoracic malignancy and preoperative diagnosis is challenging. A young man presented with dyspnea and chest pain for 3–4 months and chest-computed tomography (CT) revealed large mass in the left lung upper lobe and pleural effusion. Repeated CT-guided fine-needle aspiration cytology from the lesion and pleural fluid aspiration was negative for malignancy. F-18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) revealed heterogeneous tracer avidity in left lung mass with areas of necrosis. Real-time PET-CT-guided biopsy from metabolically active component of the lesion revealed biphasic PB on histopathology. Keywords Pulmonary blastoma . F-18 FDG PET-CT . PET-guided biopsy
A 30-year-old man presented with cough and dyspnea for 3– 4 months, which was slowly progressive. He had history of the pain in left side of chest, weight loss, and smoking with no past history of trauma, tuberculosis, malignancy, or asbestos exposure. Contrast-enhanced computed tomography (CT) of chest revealed a large heterogeneously enhancing soft tissue mass in the left lung upper lobe and loculated left pleural effusion, which was highly suspicious for malignancy. CTguided fine-needle aspiration (FNA) cytology revealed * Harmandeep Singh [email protected] Tarun Kumar Jain [email protected] Rajender Kumar [email protected] Amanjit Bal [email protected] Ashwani Sood [email protected] Bhagwant Rai Mittal [email protected] 1
Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
2
Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
normal respiratory epithelial cells and pleural fluid aspiration done twice was negative for malignancy. He underwent whole body F-18-fluorodeoxyglucose positron emission tomography-CT (FDG PET-CT), followed by PET-guided biopsy from the metabolically active area within the lesion on the same day. F-18 FDG PET-CT maximum intensity projection image (Fig. 1a; arrow) showed large FDG avid lesion in the left hemithorax. Trans-axial CT and PET-CT images of the thoracic region (Fig. 1b, c; arrow) show heterogeneous FDG uptake (SUVmax 6.6) in a large soft tissue mass with areas of necrosis in the left lung upper lobe. Non-FDG avid loculated left pleural effusion was also noted. Patient underwent real-time F-18 FDG PET-CT-guided percutaneous transthoracic biopsy using 18G semi-automatic biopsy needle and automatic robotic arm (ROBIO-EX, Perfint healthcare Pvt. Ltd., Chennai, India). Detailed biopsy procedure using robotic arm has been published by Radhakrishn
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