Real-time FDG PET/CT-guided bone biopsy in a patient with two primary malignancies

Excerpt

Solid dysphagia in an elderly man with gastroesophageal reflux disease is suspicious for esophageal cancer [1]. Our patient was an 83-year-old Asian American male with Barrett’s esophagus and solid dysphagia. He also had prostate cancer and a recently determined high prostate-specific antigen raised the concern for metastasis. The common metastatic sites for esophageal cancer are the liver and lungs [1]. FDG can accumulate in 92 % to 100 % of esophageal cancers [1]. This is the first report of the intraprocedural real-time use of PET/CT in the biopsy of bone metastasis from esophageal cancer. FDG PET/CT biopsy has been utilized for soft-tissue tumors and mucormycosis [2, 3]. It is feasible and may optimize the diagnostic yield of image-guided interventions [4]. Bone biopsy was performed guided by limited real-time PET/CT with the administration of 5 mCi FDG. The CT scan showed the pelvic bone with no abnormalities (a). The FDG PET scan showed focal metabolic activity in the right iliac bone (b). Hybrid PET/CT guided the tip of the needle to the exact location of the hypermetabolic bone lesion (c). The pathology report revealed metastatic esophageal adenocarcinoma with signet ring features. Metabolic information provided by FDG PET/CT allows visualization of a metabolically active mass while targeting the tumor during biopsy.

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