Diagnostic performance of real-time robotic arm-assisted 18F-FDG PET/CT-guided percutaneous biopsy in metabolically active abdominal and pelvic lesions

  • Rajender Kumar
  • Bhagwant Rai MittalEmail author
  • Anish Bhattacharya
  • Harmandeep Singh
  • Amanjit Bal
  • Shelvin Kumar Vadi
  • Ashwani Sood
  • Gaurav Prakash
  • Harjeet Singh
  • Aman Sharma
Original Article



To evaluate the feasibility and diagnostic performance of 18F-FDG PET/CT-guided biopsy of abdominal and pelvic lesions with automated robotic arm (ARA) assistance.


This prospective study included 114 patients (75 men, 39 women; mean age 51.3 ± 14.7 years, range: 18–90 years) who underwent PET/CT-guided biopsy of FDG-avid abdominal and pelvic lesions from October 2014 to December 2017. Of these patients, 54 had a prior inconclusive CT-guided biopsy. The biopsies were done with ARA assistance, and a real-time sample was obtained after confirming the position of the needle tip within the target lesion on PET/CT. Histopathology reports were reviewed to evaluate the diagnostic performance of the procedure. Clinical or imaging follow-up was done to confirm negative results.


The lesions were successfully targeted in 110 of the 114 patients (96.5%) and yielded a pathological diagnosis. Pathological diagnoses were confirmed in 50 of the 54 patients with a prior inconclusive biopsy. Of the 110 lesions, 82 were malignant, 20 were benign, and 8 showed minimal residual FDG uptake at the end of treatment and had no active disease even on clinical and imaging follow-up of at least 3 months. Findings were true-positive in 102 lesions, false-positive in none, true-negative in eight and false-negative in four. The procedure showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 96.2%, 100%, 100%, 66.7 and 96.5%, respectively. No immediate complications or delayed life-threatening events were observed.


Percutaneous biopsy of metabolically active abdominal and pelvic lesions with ARA assistance is a technically feasible, safe and accurate method for pathological diagnosis with high diagnostic performance. PET-guided biopsy is highly practical and useful in patients, especially in those with a previous inconclusive biopsy.


Automated robotic arm (ARA) assistance 18F-FDG PET/CT-guided biopsy Diagnostic performance Abdominal and pelvic lesions 



The present study did not receive any funding.

Compliance with ethical standards

Conflicts of interest


Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Rajender Kumar
    • 1
  • Bhagwant Rai Mittal
    • 1
    Email author
  • Anish Bhattacharya
    • 1
  • Harmandeep Singh
    • 1
  • Amanjit Bal
    • 2
  • Shelvin Kumar Vadi
    • 1
  • Ashwani Sood
    • 1
  • Gaurav Prakash
    • 3
  • Harjeet Singh
    • 4
  • Aman Sharma
    • 5
  1. 1.Department of Nuclear Medicine and PET/CTPost Graduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Department of PathologyPost Graduate Institute of Medical Education and ResearchChandigarhIndia
  3. 3.Department of Hemato-OncologyPost Graduate Institute of Medical Education and ResearchChandigarhIndia
  4. 4.Department of SurgeryPost Graduate Institute of Medical Education and ResearchChandigarhIndia
  5. 5.Department of RheumatologyPost Graduate Institute of Medical Education and ResearchChandigarhIndia

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