超声引导下纵隔病变穿刺活检临床应用

目的:探讨超声引导下纵隔病变穿刺活检技术及临床应用价值.方法:选用14～18G切割式自动活检穿刺针,在超声引导下对34例纵隔病变需明确诊断者行超声引导下经皮穿刺活检术.结果:34例患者均穿刺成功,成功率100%,35次穿刺取材,32例做出了明确的组织学分型诊断, 组织学确诊阳性率为94.1%(32/34).结论:超声引导下纵隔病变穿刺活检具有定位准确、操作简便、安全性好、并发症少及确诊率高等优点,可作为疑难纵隔病变确诊的首选方法.     

比较超声引导下14G针与18G针在经皮肝穿刺活检中的应用价值

本文总结了应用14G针与18G针行超声引导下肝脏穿刺活检的病例,旨在评价二者在安全性及有效性方面的异同,探讨应用价值。     

US-guided percutaneous liver biopsy with plugging of the needle track: a prospective study in 72 high-risk patients.

The efficiency, accuracy, and safety of ultrasound-guided liver biopsy with plugging of the needle track were prospectively assessed in 72 patients at high risk for hemorrhage. Seventy-eight biopsy procedures were performed in 72 consecutive patients prospectively classified into four different groups on the basis of coagulation parameters. Sixty-two patients (86%) had severe or moderately severe coagulation disorders. Fifty-four biopsy procedures were performed in 50 patients with diffuse liver disease, and 24 were performed in 24 patients with focal liver lesions. The biopsy track was embolized with gelatin particles and thrombin. Biopsy specimens adequate for histologic diagnosis were obtained in 69 of the 72 patients (96%). In focal lesions, accuracy and sensitivity in the diagnosis of malignancy were 75% and 89%, respectively. Two serious bleeding complications (2.8%) were encountered in two of the patients with major coagulation disorders. Liver biopsy with plugging of the needle track is a practical technique and is a feasible alternative to the transjugular approach. Respective indications for both methods depend on the severity of coagulation disorders and the presence of focal lesions.     

Percutaneous transjugular kidney biopsy in swine with use of a side-cutting needle with a blunt-tipped stylet.

PURPOSE: To evaluate a new 19-gauge blunt-tipped, side-cutting, single throw transjugular biopsy needle for transvenous kidney biopsies. MATERIALS AND METHODS: Transjugular transvenous kidney biopsies were performed with a modified 70-cm biopsy needle utilizing fluoroscopic guidance in nine swine. Three tissue specimens were obtained with four biopsy device passes in five animals and three biopsy device passes in four animals. Renal arteriography and venography were performed immediately before and after renal biopsy. Five animals were killed immediately after biopsy. Four animals were allowed to recover and underwent arteriography and venography prior to being killed, which varied from 1 to 6 weeks. Gross and histologic examinations of the biopsied kidney were performed after euthanasia. A pathologist reviewed all biopsy specimens for quality based on the number of glomeruli present. RESULTS: Results of immediate and delayed arteriography and venography were normal in all cases. Histologic evaluation of all biopsy specimens demonstrated a range of two to 13 glomeruli per sample (mean, 6.5), with successful acquisition of the cortex. In one animal killed immediately after biopsy, a small subcapsular hematoma was present. CONCLUSION: The 19-gauge, side-cut biopsy needle with a blunt-tip stylet proved to be efficacious for obtaining renal cortical samples in right swine kidneys via a transjugular approach.     

US-guided breast biopsy with an automated cutting needle

The authors report their experience on the use of a biopsy gun for histological sampling in the field of breast lesions. The use of cytological sampling by (FNAB) fine needle aspiration biopsy has been preferred so far, because it has been thoutht to be simpler, less risky and reliable. Nevertheless, the cytological sampling shows a number of drawbacks such as the need for passes to get sufficient cellular material, frequent problems in diagnosing benign lesions and the decisive influence of the operator's skill. By using a biopsy gun for histological sampling these disadvantages are eliminated. In this case, in fact, the validity of the sample is not influenced by the operator's skill; fewer passes are necessary and their validity does not depend on the nature of the lesion. The personal series of cases involves 91 patients subjected to histological sampling for suspected lesions. Two different kinds of needles were used with one an 18 G diameter and a 23-mm extension of the sytlet, as well as a sampling window 17 mm; the other with the same diameter and extension of the stylet, as as a sampling window 8 mm. The first needle was used in all 91 patients, and the second only in 30. The results were not influenced by the employ of the different kinds of needles. A total of 268 samples were made and 110 lesions were discovered, 79 of which were malignant and 31 benign (fibroadenoma, fibrocystic change and epitheliosis). Three carcinomas were not found (3 false-negative) and one specimen was inadequate. The values of sensibility, specificity and diagnostic accuracy of the method were, respectively, 96.2%, 100% and 97.2%, with 3.8% false-negative due to three cases where the lesion was not centred for guidance mistake.     

Bowel lesions: percutaneous US-guided 18-gauge needle biopsy--preliminary experience.

Ultrasonography-guided percutaneous biopsy was performed with local anesthesia and an 18-gauge needle in 10 patients with bowel-wall lesions. All patients underwent clinical review within 1 month. Biopsy was diagnostic in all patients. There were no complications, and all patients tolerated the procedure well. The technique appears to be safe and had an excellent diagnostic yield in our series.     

Image-guided percutaneous needle biopsy: an overview

Image-guided percutaneous needle biopsy (IGPNB) is a valuable tool for diagnosis of nonpalpable or deep-seated lesions that cannot be characterized definitively with diagnostic imaging alone. The procedure entails inserting a needle through the skin into an area of suspected pathology under the guidance of various imaging techniques to retrieve a sample of tissue or fluid for analysis. This article discusses the historical development, indications, contraindications, patient preparation, equipment and possible complications of IGPNB, with particular attention to biopsies of the thorax, breast, abdominal organs, head and neck and the musculoskeletal system.     

CT or US-guided fine needle aspiration biopsy in gastric neoplasms

Gastric carcinoma of the linitis plastica type is occasionally difficult to diagnose endoscopically because of the large inflammatory response and the sparsity of tumor cells. Five patients who presented with signs and symptoms of gastric carcinoma underwent upper gastrointestinal endoscopy to confirm the diagnosis of carcinoma. In each case the gross appearance of the stomach was felt to represent gastric carcinoma but the biopsy and/or brushing specimens were unable to make the diagnosis. Ultrasound or CT in each of these five patients demonstrated thickening of the gastric wall and, in one instance, evidence of extensive metastatic disease. Fine needle aspiration biopsy was performed and a diagnosis of adenocarcinoma was made cytologically. Four were primary gastric adenocarcinoma of the linitis plastica type and one was metastatic adenocarcinoma from the breast. It is suggested that guided aspiration biopsy be performed when the diagnosis of gastric carcinoma cannot be confirmed endoscopically.     

Safety and efficacy of a spring-propelled 18-gauge needle for US-guided liver biopsy.

Two hundred three liver biopsies were performed on 114 patients suspected of having diffuse liver disease. More than one-half of the biopsies (107 of 203) were performed in liver allografts. Biopsies were performed under ultrasound (US) guidance with use of a spring-propelled 18-gauge cutting needle. Half of the biopsies were performed in patients with abnormal coagulation studies, decreased platelet counts, or both. The left lobe was chosen for biopsy over the right lobe in the majority of cases (112 vs 91). Sufficient tissue for diagnosis was obtained in 197 cases (97%). Four complications (2%) occurred that required treatment: one vasovagal reaction and three episodes of bleeding. All bleeding complications occurred in patients with coagulopathy. There was no difference in safety or efficacy between biopsies of native and transplanted livers; similarly, there was no difference in safety or efficacy between biopsies of the left and right lobe. Pain occurred less frequently with biopsies of the left lobe. US-guided biopsy with a spring-propelled 18-gauge needle is safe and efficacious in the diagnosis of diffuse liver disease.     

超声引导经皮肺穿刺活检在肺外周型病变诊断中的价值

目的探讨超声引导下经皮肺穿刺活检对肺外周型病变定性诊断的应用价值。方法在超声引导下对80例胸部影像学检查显示的肺周边型肿块需明确诊断者行超声引导下经皮肺穿刺活检术。结果 80例病人均穿刺成功,成功率100%。病理诊断结果:恶性肿瘤64例,其中鳞癌38例,腺癌20例,大细胞癌2例,小细胞癌2例,恶性淋巴瘤1例,恶性间皮瘤1例;良性病变16例,其中良性错构瘤1例,结核8例,炎症7例。并发气胸、咯血各1例,并发症发生率为3%。结论超声引导下经皮肺穿刺活检术具有定位准确、操作简便、安全性好、并发症少及重复性强等优点,可作为肺外周型病变定性诊断的首选诊断方法。     

Analysis of false-negative results after US-guided 14-gauge core needle breast biopsy

Objectives

To determine the false-negative rate and to evaluate the clinical, radiologic or histologic features of false-negative results at ultrasound (US)-guided 14-gauge core needle biopsy (CNB).

Methods

A total of 3,724 masses from 3,308 women who had undergone US-guided 14-gauge CNB and who had a rebiopsy or at least 2 years’ follow-up were included. The histology of CNB was correlated with the rebiopsy or long-term imaging follow-up. In cases of missed cancer, the time interval between CNB and rebiopsy, the reasons for rebiopsy, and the procedural or lesion characteristics were analysed.

Results

Of 1,706 benign CNBs, 50 additional malignancies were found at excision (false-negative rate, 2.5% of 1,982 with a final diagnosis of malignancy). Of 50 false negatives, 41 were found immediately of which 28 had rebiopsy because of imaging-histological discordance. Regarding the frequency of malignancy according to the reasons for rebiopsy, suspicious imaging finding (24%) showed significantly higher frequency than suspicious clinical findings or request (1%). Regarding the characteristics except invasiveness, no significant differences in false-negative rates were found.

Conclusions

Most false negatives were found immediately and imaging-histological discordance was the most important clue. Careful correlation of clinical, radiological and histological results as well as appropriate follow-up is essential.

     

Experimentally induced small-bowel tumor in rabbits: US-guided percutaneous 18-gauge core biopsy

PURPOSE: To evaluate the safety and diagnostic yield of percutaneous 18-gauge core biopsy for an experimentally induced small-bowel tumor in a rabbit model. MATERIALS AND METHODS: Small-bowel tumors were induced by injecting VX2 tumor into 20 rabbits. After 3 weeks, the small bowel was filled with 100 mL of 2% diluted contrast agent containing methylene blue by using a 5-F catheter. Fifty biopsy firings for small-bowel tumor were performed with ultrasonographic (US) guidance by using an 18-gauge automatic gun. Computed tomography (CT) was performed before and immediately after biopsy. Any procedure-related complications, including leakage of air or fluid, hematoma, and perforation as seen at CT and identified at laparotomy, which was performed 48 hours after biopsy, were evaluated. White blood cell (WBC), red blood cell, and platelet counts; hemoglobin and hematocrit levels; and erythrocyte sedimentation rate were also obtained before and 48 hours after biopsy. Comparison was performed with paired t test. The diagnostic yield was calculated, and the specimen was evaluated whether fragments of mucosa were included or not. RESULTS: No contrast agent leakage or pneumoperitoneum suggesting perforation was identified at CT or laparotomy. Fluid leakage was observed with manual squeezing at two biopsy sites (4%). In two rabbits, hemoperitoneum was observed at CT or laparotomy. Hematoma larger than 3 cm was observed in six rabbits. WBC count and erythrocyte sedimentation rate slightly increased, and red blood cells, hemoglobin, hematocrit, and platelets counts had decreased slightly after biopsy but were not significant (P >.05). Definitive histologic diagnosis of tumor was obtained in 44 (88%) of 50 biopsy sites. Fragments of mucosa were observed in 13 (28%) specimens of 10 rabbits. CONCLUSION: Core biopsies of small-bowel tumor can be performed safely with an 18-gauge gun without severe complications and allow histologic diagnosis of small-bowel tumor with a good diagnostic yield.     

Pancreas transplants: experience with 232 percutaneous US-guided biopsy procedures in 88 patients

PURPOSE: To retrospectively assess the authors' experience with percutaneous ultrasonographic (US)-guided biopsy of pancreas transplants. MATERIALS AND METHODS: Data from 232 percutaneous US-guided pancreas transplant biopsies performed in 88 patients were retrospectively reviewed. Biopsies were typically performed on an outpatient basis by using local anesthesia. Considerations included the indication for the biopsy, the type of pancreas transplant, the number of needle passes, the size of the biopsy needle, the use of aspirin, and the success of the biopsy. Important complications were detailed. RESULTS: Of the 232 biopsies performed, 78 were for clinically indicated reasons and 154 were for surveillance purposes. The number of biopsy procedures per patient ranged from one to nine (mean, 2.6). Two needle passes were performed in 196 (84.5%) of the biopsy procedures. Almost all biopsies (ie, 228 [98.3%]) were performed by using an 18-gauge biopsy device. Adequate pancreatic tissue was obtained in 223 (96.1%) of the procedures. One hundred sixty-seven biopsies (72.0%) were performed while patients were receiving therapeutic aspirin. Six biopsies (2.6%) resulted in clinically important complications: three cases of intraabdominal hemorrhage and one case each of gross hematuria, allograft pancreatitis, and severe pain requiring overnight hospitalization. Two of the four bleeding complications occurred while patients were receiving therapeutic aspirin. CONCLUSION: US-guided biopsy of pancreas transplants yielded tissue that was adequate more than 96% of the time. Important complications in this study were few (2.6%) and did not appear to be related to aspirin use.     

超声引导经皮穿刺治疗乳腺脓肿的临床应用

目的评价超声引导下经皮穿刺治疗乳腺脓肿的临床应用价值。方法在超声引导下,对诊断为乳腺脓肿的病人采用经皮穿刺脓肿抽吸法及脓腔置管引流法进行治疗。结果 45例病人共有54个脓肿,22个最大径≤3 cm的脓肿采用脓肿抽吸法治愈21例,1例改行脓腔置管引流后治愈;32个最大径>3 cm的脓肿实施脓腔置管引流法,治愈30例,切开引流2例。随访41例,复发4例,2例再次行脓腔置管引流治愈,另2例行脓肿切开引流治愈。结论超声引导下穿刺抽吸治疗不超过3 cm的乳腺脓肿与置管引流治疗超过3 cm的乳腺脓肿均是有效的治疗手段。     

Dedifferentiated chondrosarcoma: use of MRI to guide needle biopsy

AIM: To describe the use of MRI to identify and biopsy areas of dedifferentiation in patients with a suspected diagnosis of dedifferentiated chondrosarcoma. MATERIALS AND METHODS: Low-grade chondrosarcoma is characterized at magnetic resonance imaging (MRI) as having a lobulate, hyperintense appearance on T2-weighted spin-echo sequences. T2-weighted MR images were assessed in 15 patients with a final pathological diagnosis of dedifferentiated chondrosarcoma for regions of atypical reduced signal intensity. Information regarding the site of ultrasound or computed tomography (CT)-guided biopsy was available in 10 cases. RESULTS: Nine patients were male and six female with a mean age of 60 years (range 25-77 years). The sites involved were the distal femur (n+4) pelvis (n=3) proximal femur (n=4) femoral diaphysis (n=1) proximal humerus (n=2) and proximal tibia (n=1). The dedifferentiated component consisted of osteosarcoma (n=5) malignant fibrous histiocytoma (n=6) spindle cell sarcoma (n=1) leiomyosarcoma (n=1) and pleomorphic sarcoma (n=1). In 14 of the 15 cases, areas of lower signal intensity lacking in lobulation were identified. In nine of the 10 cases, biopsy site included such areas and yielded high-grade sarcoma. CONCLUSIONS: Dedifferentiation within chondrosarcoma may be identified on T2-weighted MRI as areas of reduced signal intensity. These areas should be the preferred site of biopsy.