Real-time ultrasound image fusion with FDG-PET/CT to perform fused image-guided fine-needle aspiration in neck nodes: Feasibility and diagnostic value

Petra K. de Koekkoek-Doll; M. Maas; W. Vogel; J. Castelijns; L. Smit; I. Zavrakidis; R. Beets-Tan; M. van den Brekel

doi:10.3174/AJNR.A6938

Real-time ultrasound image fusion with FDG-PET/CT to perform fused image-guided fine-needle aspiration in neck nodes: Feasibility and diagnostic value

Petra K. de Koekkoek-Doll, M. Maas, W. Vogel, J. Castelijns, L. Smit, I. Zavrakidis, R. Beets-Tan, M. van den Brekel

Maxillofacial Surgery (AMC)

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

BACKGROUND AND PURPOSE: New imaging techniques such as hybrid imaging of ultrasound and FDG-PET/CT are available but not yet investigated for node staging. The aim of the study was to evaluate the feasibility and added diagnostic value of real-time image-fused ultrasound-guided fine-needle aspiration with FDG-PET/CT data for node staging. MATERIALS AND METHODS: Ninety-six patients who were referred for cervical lymph node staging with FDG-PET/CT before ultrasound were prospectively included. After routine ultrasound-guided fine-needle aspiration, all FDG-PET-positive nodes were marked on FDG-PET/CT, and real-time image fusing of ultrasound and FDG-PET/CT was performed using the electromagnetic navigation system PercuNav. Already-punctured nodes were confirmed to be PET-positive, and additional fused-ultrasound-guided fine-needle aspiration was performed in previously missed PET-positive nodes. RESULTS: Of 96 patients, 87 (91%) patients had suspicious nodes requiring fine-needle aspiration cytology. Ultrasound-guided fine-needle aspiration was performed in 175 nodes. Cytology was inconclusive in 9/175 (5%) nodes, and 85/166 (51%) nodes were malignant. Target planning was performed in 201 PET-positive nodes; 195/201 (97%) of those nodes were fused successfully. Twenty of 175 ultrasound-guided fine-needle aspiration nodes turned out to be FDG-PET-negative, and 149/175 (85%) of the fused ultrasound-guided fine-needle aspiration nodes were confirmed to be FDG-PET-positive. Of 201 PET-positive nodes, 46 (23%) were additionally identified, and fused ultrasound-guided fine-needle aspiration was performed. Cytology was inconclusive in 4/46 nodes (9%), and 13/42 (31%) nodes were malignant. CONCLUSIONS: Real-time ultrasound image fusion with FDG-PET-positive nodes is feasible in cervical lymph nodes, and fused ultrasound-guided fine-needle aspiration increases the number of malignant nodes detected.

Original language	English
Pages (from-to)	566-572
Number of pages	7
Journal	American Journal of Neuroradiology
Volume	42
Issue number	3
DOIs	https://doi.org/10.3174/AJNR.A6938
Publication status	Published - 1 Mar 2021

Funding

The authors would like to acknowledge Pedro Sanches, PhD, and Frans Gleuwink (Philips Benelux, Boschdijk 525, 5621JG Eindhoven) for providing knowledge and training on PercuNav image fusion (MR imaging, CT, PET).

Funders	Funder number
Pedro Sanches

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de Koekkoek-Doll, P. K., Maas, M., Vogel, W., Castelijns, J., Smit, L., Zavrakidis, I., Beets-Tan, R., & van den Brekel, M. (2021). Real-time ultrasound image fusion with FDG-PET/CT to perform fused image-guided fine-needle aspiration in neck nodes: Feasibility and diagnostic value. American Journal of Neuroradiology, 42(3), 566-572. https://doi.org/10.3174/AJNR.A6938

@article{a98c05d85ce240d091ba8fb3b51210bd,

title = "Real-time ultrasound image fusion with FDG-PET/CT to perform fused image-guided fine-needle aspiration in neck nodes: Feasibility and diagnostic value",

abstract = "BACKGROUND AND PURPOSE: New imaging techniques such as hybrid imaging of ultrasound and FDG-PET/CT are available but not yet investigated for node staging. The aim of the study was to evaluate the feasibility and added diagnostic value of real-time image-fused ultrasound-guided fine-needle aspiration with FDG-PET/CT data for node staging. MATERIALS AND METHODS: Ninety-six patients who were referred for cervical lymph node staging with FDG-PET/CT before ultrasound were prospectively included. After routine ultrasound-guided fine-needle aspiration, all FDG-PET-positive nodes were marked on FDG-PET/CT, and real-time image fusing of ultrasound and FDG-PET/CT was performed using the electromagnetic navigation system PercuNav. Already-punctured nodes were confirmed to be PET-positive, and additional fused-ultrasound-guided fine-needle aspiration was performed in previously missed PET-positive nodes. RESULTS: Of 96 patients, 87 (91%) patients had suspicious nodes requiring fine-needle aspiration cytology. Ultrasound-guided fine-needle aspiration was performed in 175 nodes. Cytology was inconclusive in 9/175 (5%) nodes, and 85/166 (51%) nodes were malignant. Target planning was performed in 201 PET-positive nodes; 195/201 (97%) of those nodes were fused successfully. Twenty of 175 ultrasound-guided fine-needle aspiration nodes turned out to be FDG-PET-negative, and 149/175 (85%) of the fused ultrasound-guided fine-needle aspiration nodes were confirmed to be FDG-PET-positive. Of 201 PET-positive nodes, 46 (23%) were additionally identified, and fused ultrasound-guided fine-needle aspiration was performed. Cytology was inconclusive in 4/46 nodes (9%), and 13/42 (31%) nodes were malignant. CONCLUSIONS: Real-time ultrasound image fusion with FDG-PET-positive nodes is feasible in cervical lymph nodes, and fused ultrasound-guided fine-needle aspiration increases the number of malignant nodes detected.",

author = "{de Koekkoek-Doll}, {Petra K.} and M. Maas and W. Vogel and J. Castelijns and L. Smit and I. Zavrakidis and R. Beets-Tan and {van den Brekel}, M.",

year = "2021",

month = mar,

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doi = "10.3174/AJNR.A6938",

language = "English",

volume = "42",

pages = "566--572",

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de Koekkoek-Doll, PK, Maas, M, Vogel, W, Castelijns, J, Smit, L, Zavrakidis, I, Beets-Tan, R & van den Brekel, M 2021, 'Real-time ultrasound image fusion with FDG-PET/CT to perform fused image-guided fine-needle aspiration in neck nodes: Feasibility and diagnostic value', American Journal of Neuroradiology, vol. 42, no. 3, pp. 566-572. https://doi.org/10.3174/AJNR.A6938

TY - JOUR

T1 - Real-time ultrasound image fusion with FDG-PET/CT to perform fused image-guided fine-needle aspiration in neck nodes

T2 - Feasibility and diagnostic value

AU - de Koekkoek-Doll, Petra K.

AU - Maas, M.

AU - Vogel, W.

AU - Castelijns, J.

AU - Smit, L.

AU - Zavrakidis, I.

AU - Beets-Tan, R.

AU - van den Brekel, M.

PY - 2021/3/1

Y1 - 2021/3/1

N2 - BACKGROUND AND PURPOSE: New imaging techniques such as hybrid imaging of ultrasound and FDG-PET/CT are available but not yet investigated for node staging. The aim of the study was to evaluate the feasibility and added diagnostic value of real-time image-fused ultrasound-guided fine-needle aspiration with FDG-PET/CT data for node staging. MATERIALS AND METHODS: Ninety-six patients who were referred for cervical lymph node staging with FDG-PET/CT before ultrasound were prospectively included. After routine ultrasound-guided fine-needle aspiration, all FDG-PET-positive nodes were marked on FDG-PET/CT, and real-time image fusing of ultrasound and FDG-PET/CT was performed using the electromagnetic navigation system PercuNav. Already-punctured nodes were confirmed to be PET-positive, and additional fused-ultrasound-guided fine-needle aspiration was performed in previously missed PET-positive nodes. RESULTS: Of 96 patients, 87 (91%) patients had suspicious nodes requiring fine-needle aspiration cytology. Ultrasound-guided fine-needle aspiration was performed in 175 nodes. Cytology was inconclusive in 9/175 (5%) nodes, and 85/166 (51%) nodes were malignant. Target planning was performed in 201 PET-positive nodes; 195/201 (97%) of those nodes were fused successfully. Twenty of 175 ultrasound-guided fine-needle aspiration nodes turned out to be FDG-PET-negative, and 149/175 (85%) of the fused ultrasound-guided fine-needle aspiration nodes were confirmed to be FDG-PET-positive. Of 201 PET-positive nodes, 46 (23%) were additionally identified, and fused ultrasound-guided fine-needle aspiration was performed. Cytology was inconclusive in 4/46 nodes (9%), and 13/42 (31%) nodes were malignant. CONCLUSIONS: Real-time ultrasound image fusion with FDG-PET-positive nodes is feasible in cervical lymph nodes, and fused ultrasound-guided fine-needle aspiration increases the number of malignant nodes detected.

AB - BACKGROUND AND PURPOSE: New imaging techniques such as hybrid imaging of ultrasound and FDG-PET/CT are available but not yet investigated for node staging. The aim of the study was to evaluate the feasibility and added diagnostic value of real-time image-fused ultrasound-guided fine-needle aspiration with FDG-PET/CT data for node staging. MATERIALS AND METHODS: Ninety-six patients who were referred for cervical lymph node staging with FDG-PET/CT before ultrasound were prospectively included. After routine ultrasound-guided fine-needle aspiration, all FDG-PET-positive nodes were marked on FDG-PET/CT, and real-time image fusing of ultrasound and FDG-PET/CT was performed using the electromagnetic navigation system PercuNav. Already-punctured nodes were confirmed to be PET-positive, and additional fused-ultrasound-guided fine-needle aspiration was performed in previously missed PET-positive nodes. RESULTS: Of 96 patients, 87 (91%) patients had suspicious nodes requiring fine-needle aspiration cytology. Ultrasound-guided fine-needle aspiration was performed in 175 nodes. Cytology was inconclusive in 9/175 (5%) nodes, and 85/166 (51%) nodes were malignant. Target planning was performed in 201 PET-positive nodes; 195/201 (97%) of those nodes were fused successfully. Twenty of 175 ultrasound-guided fine-needle aspiration nodes turned out to be FDG-PET-negative, and 149/175 (85%) of the fused ultrasound-guided fine-needle aspiration nodes were confirmed to be FDG-PET-positive. Of 201 PET-positive nodes, 46 (23%) were additionally identified, and fused ultrasound-guided fine-needle aspiration was performed. Cytology was inconclusive in 4/46 nodes (9%), and 13/42 (31%) nodes were malignant. CONCLUSIONS: Real-time ultrasound image fusion with FDG-PET-positive nodes is feasible in cervical lymph nodes, and fused ultrasound-guided fine-needle aspiration increases the number of malignant nodes detected.

U2 - 10.3174/AJNR.A6938

DO - 10.3174/AJNR.A6938

M3 - Article

C2 - 33509917

SN - 0195-6108

VL - 42

SP - 566

EP - 572

JO - American Journal of Neuroradiology

JF - American Journal of Neuroradiology

IS - 3

ER -

Real-time ultrasound image fusion with FDG-PET/CT to perform fused image-guided fine-needle aspiration in neck nodes: Feasibility and diagnostic value

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