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Functional and metabolic imaging in transthoracic biopsies guided by computed tomography

  • Chest
  • Published:
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Abstract

Objectives

CT-guided biopsy of indeterminate lung lesions sometimes provides insufficient histological results due to tumor necrosis. Functional and metabolic methods such as DWI-MR and PET-CT may help by directing sample collection to a lesion area of greater biological representativeness. The objective is to evaluate the histopathological results based on findings on ADC and SUV levels in lung lesions suspected for primary cancer.

Methods

Tissue samples were evaluated after undergoing biopsies guided by either DWI-MR or PET-CT findings. In each patient, sample collection from two lesion areas was guided by local ADC and SUV. Values were used to define areas of low vs. high suspicion for cancer.

Results

Patients who underwent DWI-MR had median lesion size of 78.0 mm. Areas of higher suspicion (HSA) had a median ADC of 1.1 × 10-3 mm2/s, while areas of lower suspicion (LSA) had median ADC of 1.8 × 10-3 mm2/s (p = 0.0001). All HSA samples and 71.43% of LSA samples were positive for cancer (p = 0.0184). Patients who performed PET-CT had median lesion size of 61.0 mm. Median SUV was 7.1 for HSA and 3.9 for LSA (p = 0.0002). Positivity for cancer was observed in 76.9% of samples for both HSA and LSA (p = 0.0522).

Conclusion

Use of DWI-MR and PET-CT showed that tumors are functional and metabolically heterogeneous and that this heterogeneity has implications for histopathological diagnosis.

Key Points

• Lung cancer is heterogeneous regarding functional and metabolic imaging.

• Tumor heterogeneity may have implications in histopathological diagnosis.

• Intralesional lower levels of ADC target highly suspected areas with a significant improvement in lung cancer diagnosis.

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Abbreviations

ADC:

Apparent diffusion coefficient

CT:

Computed tomography

DWI-MR:

Magnetic resonance diffusion

EPI:

Ultra-fast echoplanar imaging

FDG:

F18-fluorodeoxyglucose

HE:

Hematoxylin-Eosin

HSA:

Areas of higher suspicion

LSA:

Areas of lower suspicion

MRI:

Magnetic resonance

ND:

Non-diagnostic

PET:

Positron emission tomography

PET-CT:

Positron emission tomography-computed tomography

SUV:

Standard uptake value

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Acknowledgments

C.E.Z. takes full responsibility for the content of the manuscript, including the data analysis. M.D.G. and R.C. contributed to conception and design. C.J.T., P.N.B., A.G.V.B., E.N.P.L., J.L.G., and C.A.L.P. contributed to patient selection, execution of the imaging, procedure, and sample analysis. A.C.B.S.C. and J.P.K.M.J. contributed to manuscript preparation.

Funding

This study has received funding by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (no. 2013/15143-1).

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Authors and Affiliations

  1. AC Camargo Cancer Center, R. Prof. Antônio Prudente, 211, São Paulo, BR, 01509-010, Brazil

    Charles E. Zurstrassen, Chiang J. Tyng, Marcos D. Guimarães, Paula N. V. P. Barbosa, Clovis A. L. Pinto, Almir G. V. Bitencourt, Jeffersson L. Gross, Eduardo N. P. Lima, Aline C. B. S. Cavalcante, João P. K. Matushita Junior & Rubens Chojniak

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  1. Charles E. Zurstrassen
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  3. Marcos D. Guimarães
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Corresponding author

Correspondence to Charles E. Zurstrassen.

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Guarantor

The scientific guarantor of this publication is Charles Edouard Zurstrassen.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

Methodology

• prospective

• cross-sectional study

• performed at one institution

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Zurstrassen, C.E., Tyng, C.J., Guimarães, M.D. et al. Functional and metabolic imaging in transthoracic biopsies guided by computed tomography. Eur Radiol 30, 2041–2048 (2020). https://doi.org/10.1007/s00330-019-06591-0

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  • DOI: https://doi.org/10.1007/s00330-019-06591-0

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