Synovial biopsy under US guidance: technical considerations and results

PURPOSE: To describe and assess ultrasound (US) guided biopsy of peripheral joint synovial membrane. METHOD: Between January 2002 and January 2005, 83 patients have undergone biopsies of synovial membrane performed under ultrasonographic guidance, as a diagnostic procedure for monoarthritis of unknown etiology. After synovial thickening was confirmed by US examination, the optimal approach to the joint was decided in accordance with maximal synovial thickening localization and adjacent anatomic structures. The absence of complications related to the biopsy was verified by continuous ultrasonographic scanning during and immediately after the procedure. The procedure was rated as successful if synovial tissue was identified by histologic examination of the biopsy specimen. Success rate of the procedure was compared to the fluoroscopic guided biopsy success rate that was formely published in medical literature. RESULTS: Synovial tissue was obtained in 78 cases (94%) (shoulder (100%), elbow (75%), wrist (85.7%), hip (88.2%), knee (97%), ankle (100%). No complication occurred. CONCLUSION: US guided biopsy of peripheral joint synovial membrane is a safe and effective technique that has multiple advantages compared to fluoroscopic guided procedure.     

CT导向下纵隔肿瘤穿刺活检术

目的：评价CT导向下纵隔肿瘤穿刺活检的临床应用价植。方法：回顾性分析74例纵隔病变CT导向下纵隔穿刺活检术。芽刺针采用18G CHIBA针、18G切割针，74例均做病理组织学检查．8例作免疫组化。结果：①病变部位前纵隔62例，中纵隔8例，后纵隔4例；②63例病理诊断明确：胸腺瘤16例。恶性淋巴瘤12例．转移性腺癌7例、鳞癌4例、小细胞癌2例，畸胎瘤、恶性精原细胞瘤各5例、内胚窦癌2例。神经纤维瘤、恶性神经鞘膜瘤、节细胞神经纤维瘤各1例，3例诊断为小圆细胞恶性肿瘤，3例为异型细胞。1例诊断为结核；③11例病理诊断不确定：临床诊断为恶性淋巴瘤1例、纵隔淋巴结结核1例，经手术病理诊断为胸腺瘤、纵隔脂肪瘤、血管肉瘤、纤维肉瘤各1例，2例失访；④穿刺活检正确率为85．1％，假阴性率为14．9％，未见假阳性病例；⑤气胸发生率为5．4％。为少量气胸，3例术后痰带血丝．1例纵隔局限性血肿。结论：CT导向下纵隔肿瘤穿刺活检术是纵隔病变安全而有效的诊断方法。     

Pelvic masses: aspiration biopsy with transrectal US guidance

Biplanar, transrectal ultrasound guidance was used in the transrectal aspiration of two pelvic abscesses, one recurrent tumor, and one sterile, nonmalignant fluid collection. This method provides an alternative path that allows precise localization for aspiration biopsy of pelvic masses.     

Percutaneous ethanol injection of parathyroid tumors under US guidance: treatment for secondary hyperparathyroidism

In 12 patients with secondary hyperparathyroidism, 13 parathyroid tumors detected with the use of sonography and confirmed by fine-needle aspiration biopsy were treated by percutaneous injection of absolute ethanol under ultrasonographic guidance. Indications for this procedure were recurrence of parathyroid tumors after previous subtotal surgery, high surgical risk, or refusal of surgery. Significant volume reductions were recorded for the larger glands; in the smaller ones, structural changes were observed as well. Clinical and biochemical therapeutic effects were obtained in most cases of single hyperplastic glands treated. Percutaneous alcoholic ablation of enlarged parathyroid glands can be used in cases of secondary hyperparathyroidism when surgery is contraindicated or problematic; it can also improve responsiveness to medical therapy, delaying the need for surgery.     

US guidance for thoracic biopsy: a valuable alternative to CT

PURPOSE: To determine the role, accuracy, and selection criteria of ultrasonographic (US) guidance for biopsy for thoracic lesions. MATERIALS AND METHODS: Imaging-guided thoracic biopsies (n = 86) were performed in 84 consecutive patients. US guidance was used for lesions abutting the chest wall; computed tomographic (CT) guidance was used for all masses surrounded by aerated lung. Mass location and size, guidance modality, histologic results, procedure time, and complications were recorded. RESULTS: Thirty-four lesions (19 parenchymal, six pleural, six chest wall, three mediastinal) were amenable to US-guided biopsy. The mean mass diameter was 4.3 cm, the mean number of passes was 3.2, and the mean procedure time was 31.4 minutes. A histologic diagnosis was achieved in 31 (91%) patients, including all with small (< 2-cm) masses (n = 9). There was one case of pneumothorax. CT guidance was used in 52 (60%) of 86 cases. Lesions were parenchymal (n = 41), pleural (n = 1), and mediastinal and hilar (n = 10). The mean diameter was 2.9 cm, the mean number of passes was 2.3, and the mean procedure time was 45.2 minutes. A histologic diagnosis was achieved in 37 (71%) patients, including 18 of 27 with a small mass. Complications included pneumothorax (n = 21) and parenchymal hemorrhage (n = 2). CONCLUSION: US is an effective and safe alternative to CT for guidance at biopsy of masses abutting the chest wall. Real-time US visualization allows accurate needle placement, shorter procedure time, and performance in debilitated and less cooperative patients.     

Mediastinal needle biopsy

A review of 52 consecutive needle biopsies of the mediastinum is presented. The aspirated material yielded cytologic and/or histologic diagnosis in 50 needle biopsies; two needle biopsies failed to yield adequate cellular material for diagnosis. All but two of the 50 patients had confirmation of the biopsy diagnosis by surgical, autopsy, or clinical correlation. In 32 patients, a 20-gauge needle was used for the biopsy. A larger-bore (17-gauge) needle with a cutting device was used in 20 cases to obtain more tissue for histologic diagnosis of benign or unusual malignant lesions. Despite the larger size of the needle, the rate of complications remained low.     

Selective renal biopsy under ultrasonic real-time guidance

A new technique for performing renal biopsy using ultrasonic real-time guidance was developed at our clinic in 1978. The puncture procedure is monitored in 2-dimensional real-time images by a mechanical sector scanner equipped with an attachment for needle guidance. The technique is called “selective renal biopsy” because tissue can be obtained selectively from any portion of the kidney. During the last 4 years, 150 such procedures have been performed on 148 patients. The success rate has been 96%. No serious complications occurred.     

Targeted tumour biopsy under contrast-enhanced ultrasound guidance

European Radiology -     

Comparison of core needle breast biopsy techniques: freehand versus three-dimensional US guidance

RATIONALE AND OBJECTIVES: No single method is generally accepted for evaluating the accuracy of breast biopsy techniques before their clinical implementation. The purpose of this study was to test a new process for evaluating biopsy techniques by using it in the evaluation of a prototype three-dimensional ultrasound (US)-guided biopsy device. MATERIALS AND METHODS: The biopsy accuracy of a new three-dimensional US-guided breast biopsy device was compared to that of the accepted clinical practice of biopsy by expert radiologists with two-dimensional freehand US guidance. Biopsies were performed in chicken tissue phantoms containing 3.2-mm lesions made of poly(vinyl alcohol) cryogel. The criterion for a successful biopsy was the presence of lesion in the sample. The equivalence limit difference tested was 10% by using a power of 90% and a two-sided test significance level, a, of 10%. RESULTS: The biopsy success rate of the three-dimensional US-guided system (96%) was equivalent to that of expert radiologists using two-dimensional freehand US guidance (94.5%) in tissue phantoms containing poly(vinyl alcohol) cryogel lesions. CONCLUSION: This evaluation procedure is a valuable precursor to clinical trials in the assessment of biopsy techniques. The three-dimensional US-guided breast biopsy system provides a suitable alternative to two-dimensional freehand US guidance for biopsy of breast cancer.     

Palpable prostatic nodules: comparison of US and digital guidance for fine-needle aspiration biopsy

This study was undertaken to evaluate the use of transrectal sonographically guided fine-needle aspiration biopsy and to compare sonographic with digital guidance for biopsy. In 62 patients in whom prostatic carcinoma was suspected at digital rectal examination, fine-needle aspiration biopsies were performed transperineally under sonographic guidance and transrectally under digital guidance. These patients had 89 nodules, 73 of which were sampled with both techniques. Malignant cells were obtained under digital guidance in 17 of 73 nodules (23%) and under sonographic guidance in 16 (22%). An additional seven nodules, which were not seen sonographically, were sampled under digital guidance and proved to be negative. In nine other nodules that were nonpalpable and evident only with sonography, malignant cells were obtained under sonographic guidance in three. These findings indicate that sonographic guidance for fine-needle aspiration biopsy is as good as digital guidance for palpable lesions.     

CT导向经皮肝穿刺活检的临床应用

目的：提高CB导向经皮肝穿刺活检的技术水平，并评价其临床应用价值。方法：采用SiemensSOMA－TOMHiQ-S型全身CT扫描仪及自动活检他（18G）对16例肝脏占位性病变患者行CT导向经皮肝穿刺活检术。穿刺部位；肝右叶10例，肝左叶5例，肝尾叶1例。病灶直径1．5－11．7cm。结果：16例患者均一次穿刺成功，穿刺成功率为100％。15例肝脏占位性病变得到病理学诊断，活检确诊率为93．75％（15／16），原发性肝癌8例、转移性腺癌5例，恶性肿瘤1例，炎性假瘤1例，1例未见肿瘤细胞。无1例发生出血等并发症。结论：CT导向经皮肝自动活检枪穿刺活检或功率和确诊率高，创伤小，并发症少，是肝脏占位性病变及鉴别诊断的一种操作简便、安全可靠重要手段。     

弹簧芯状活检针在CT引导经皮肺穿刺活检中的应用

目的：探讨CT引导下使用弹簧芯状活检针行比皮肺穿刺活检的诊断准确性和并发症发生率。方法：38例使用弹簧芯状活检针的经皮肺穿刺活检。CT扫描确定并引导穿刺途径,达预定位置取材。结果：35例有明显的病理诊断,诊断准确性92％,恶性肿瘤和良性病变的诊断准确性分别为97％和100％。活后并发气胸4例,咯血1例,结论：CT引导下使用弹簧芯状活检针行经皮肺穿刺活检的气胸发生率与细针抽吸相近,使弹簧芯状活检针行CT引导下肺穿刺活检可以提高诊断的准确性。     

Mediastinal tumors: evaluation with suprasternal sonography

Twelve patients with mediastinal masses evaluated by computed tomography (CT) and histologically verified were evaluated sonographically by means of the suprasternal approach. Eleven of 12 mediastinal tumors could be visualized sonographically, mainly as hypoechoic and perivascularly situated masses, and could be located topographically with a fair degree of certainty. Suprasternal sonography is particularly useful in the detection of small, perivascular lymphomas of the supraaortic branches. In patients with problematic CT findings, particularly children and patients with allergies to contrast media, suprasternal sonography can provide important additional information. Moreover, suprasternal sonography can be used to determine the consistency and to monitor the treatment of mediastinal tumors. Finally, the suprasternal approach is suitable for sonographically guided biopsies of mediastinal tumors.     

Real-time US guidance during renal biopsy in children: a different approach. Technical note.

To minimize procedural failures and complications, a real-time ultrasound (US) approach was developed for percutaneous renal biopsy in the pediatric population. With use of a 3- or 5-MHz transducer, the medial border of the kidney is localized and a line, which parallels the renal axis, is drawn on the skin. The lower pole and renal hilum are identified, and lines are drawn perpendicular to the long axis. After the patient is sedated, the entry site is selected above the lower pole. The transducer is placed on the child's side in an oblique transverse plane parallel to the axis of the kidney, the needle is guided into the renal cortex, and a specimen is obtained. Sixty-five biopsies were performed in 63 children. Fifty-five specimens were obtained from native kidneys. Success was achieved in all cases with only three minor complications. This approach appears to be an easy, safe, and accurate guide for renal biopsy in the pediatric population.     

Needle aspiration and core biopsy of prostate cancer: comparative evaluation with biplanar transrectal US guidance

Biplanar, transrectal ultrasound (US) guidance of needles was used in the transperineal biopsy of possibly malignant prostatic lesions in 80 patients (83 biopsies). A 22-gauge cytologic needle was used to locate and fixate the lesion, and aspiration specimens for cytologic and histologic evaluation were obtained (with 22- and 14-gauge needles, respectively). Twenty-one 19-gauge needle core biopsies were also performed. Forty-nine patients (61%) had histologically prove adenocarcinoma. The rate of cancer diagnosis was 53% with cytologic evaluation and 54% with histologic evaluation (combined yield, 61%). This included 34% of cancers less than 1.0 cm in diameter and 56% of those 1.0-1.5 cm. Thirteen of 23 (57%) of these lesions were nonpalpable or equivocal on digital rectal examination. These results suggest that transrectal US guidance of thin-needle biopsies is useful in diagnosing early prostate cancer.     

CT定位导向下软组织活检术的临床应用

目的探讨在CT导引下半自动活检枪经皮软组织活检术对病变的诊断价值及临床应用,提高CT导向经皮穿刺活检技术的水平。方法采用ToshibaXvision螺旋CT机和SiemensEmotion6型多层螺旋CT扫描仪及半自动活检枪(16G～22G),对100例胸、腹部占位性病变患者行CT导向经皮穿刺活检术。病灶直径1.5cm～11.7cm。结果99例患者穿刺成功,穿刺成功率为99%,其中,93例取得满意的细胞和组织学材料。本组患者均未发生与操作相关的严重并发症。结论CT导向经皮半自动活检枪穿刺活捡成功率和确诊率高,创伤小,并发症少,是胸、腹部占位性病变诊断及鉴别诊断的一种操作简便、安全可靠的检查方法。