Question 2613
{"accessible":false,"alternatives":[{"id":12820,"text":"advise this is likely benign and no further action is required"},{"id":12821,"text":"agree to image-guided core biopsy and use an 18G or finer needle"},{"id":12822,"text":"agree to image-guided fine needle aspiration biopsy (FNAB)"},{"id":12823,"text":"suggest FDG PET-CT prior to considering biopsy"},{"id":12824,"text":"suggest MRI liver protocol prior to considering biopsy"}],"archived":false,"correctAlternativeId":12823,"explanation":"\u003cp\u003eIn a patient with known colorectal cancer, an incidental splenic lesion cannot be confidently dismissed as benign, as up to 30% turn out to be metastases.\u003c/p\u003e\u003cp\u003eGiven the risks associated with biopsy, it is, however, reasonable to suggest further imaging work-up that could potentially obviate the need for biopsy.\u003c/p\u003e\u003cp\u003eThe most correct answer in this case is PET-CT. If the primary colorectal lesion is FDG-avid then a negative study is very reassuring that the splenic lesion is likely benign and may thus circumvent invasive biopsy completely. PET-CT also has the added benefit of showing potential occult metastatic sites which could be accessible and have a lower risk profile.\u003c/p\u003e\u003cp\u003eMRI is a valid answer but is preferable for cases without a known, likely FDG-avid, primary malignancy, whereas PET-CT can provide information that will directly influence the management plan in this case.\u003c/p\u003e","id":2613,"imageUrl":null,"imageAttribution":null,"imageAttributionCaseInfo":null,"firstQuestionPath":"/questions/2613","nextQuestionPath":null,"relatedArticles":[{"id":29716,"title":"Positron emission tomography","link":"/articles/positron-emission-tomography?lang=us"},{"id":72576,"title":"Splenic biopsy","link":"/articles/splenic-biopsy?lang=us"}],"alsoUsedIn":[{"id":1730,"kind":"Course","title":"2023 Virtual Conference Private Use - page 1730","link":"https://radiopaedia.org/courses/2023-virtual-conference-private-use/pages/1730"},{"id":365,"kind":"LiveSchedule","title":"365","link":"https://radiopaedia.org/admin/live_schedules/365"},{"id":287,"kind":"LiveSchedule","title":"287","link":"https://radiopaedia.org/admin/live_schedules/287"},{"id":1488,"kind":"Course","title":"2023 Virtual Conference Private Use - page 1488","link":"https://radiopaedia.org/courses/2023-virtual-conference-private-use/pages/1488"},{"id":1488,"kind":"Course","title":"Abdominal Lectures - page 1488","link":"https://radiopaedia.org/courses/abdominal-lectures/pages/1488"}],"stem":"\u003cp\u003eAn incidental, solitary hypodense splenic lesion (HU\u0026gt;20) is demonstrated on a staging CT for rectal cancer. No other extra-colonic finding on is demonstrated on the CT. The surgical team ask for an image-guided biopsy. What would be the most appropriate next step?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/2613"}],"attemptsPercentages":[{"alternativeId":"12822","percentage":2},{"alternativeId":"12821","percentage":10},{"alternativeId":"12823","percentage":52},{"alternativeId":"12824","percentage":25},{"alternativeId":"12820","percentage":11}],"promptToLogin":false,"questionManager":false,"articleId":"incidental-splenic-lesion-an-approach"}