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.     

Fine-needle biopsy of hepatic hemangioma with sonographic guidance

Thirty-three focal hepatic lesions later proven to be hemangiomas underwent sonographically guided fine-needle aspiration biopsy. Indications for cytologic assessment were an atypical sonographic pattern in 11 cases, the need to differentiate from liver metastases in 12 patients with a history of neoplasm, and other indications in 10. The aspirated material consisted of blood alone in 24 cases; in the other nine cases, endothelial cells and/or agglomerates of capillaries were demonstrated also, and this was considered to be diagnostic. In one case, intratumoral bleeding was demonstrated sonographically, but no treatment was needed. The possible angiomatous nature of an hepatic lesion should not be considered an absolute contraindication to biopsy, provided that a fine needle is used and the optimal route to the lesion is chosen.     

Percutaneous liver biopsy: a cost-benefit analysis comparing sonographic and CT guidance.

OBJECTIVE: We compared the relative cost of a liver biopsy performed with sonographic guidance with that of one performed with CT guidance in a cost-benefit analysis model. MATERIALS AND METHODS: Variables were estimated from a search of the literature and from clinical experience with 437 hepatic biopsies at our institution. Probability variables included the probability of obtaining an adequate sample and the probability of a major complication. Cost variables included the direct and indirect costs, the cost of a major complication, and the opportunity costs of foregone revenue from preempted diagnostic studies. One-way and two-way sensitivity analyses were performed. RESULTS: Using baseline values, CT guidance was 1.89 times more expensive than sonographic guidance. Sensitivity analyses indicate that CT and sonographic guidance costs would be equivalent if the success rate with sonographic guidance was 39.8%, the opportunity costs of CT guidance were 3.13 times less than best estimates, and the opportunity costs of sonography were 3.15 times greater than best estimates. CONCLUSION: Sonographic guidance for hepatic biopsies is substantially more economical than CT guidance across a wide range of estimated costs.     

Mediastinal tumors: biopsy under US guidance

Percutaneous biopsies of mediastinal tumors were successfully performed under sonographic guidance in 14 of 21 patients. In 10 of 11 malignant lesions, malignancy was determined by means of cytologic and histologic examination of the specimens obtained. A histologic diagnosis was reached in seven patients with malignant mediastinal tumors, including all four cases of Hodgkin lymphoma. Mediastinal biopsy under sonographic guidance is a technically simple, rapid, and accurate procedure, but its application is limited to tumors of the anterior mediastinum.     

Usefulness of sonographic guidance during percutaneous biopsy of mesenteric masses

OBJECTIVE: The objective of our study was to determine the usefulness of sonographic guidance for biopsy of mesenteric masses. MATERIALS AND METHODS: Twenty-five sonographically guided percutaneous biopsies of mesenteric masses were performed in 23 patients. Biopsies were performed with an 18-, 20-, or 22-gauge self-aspirating needle or core biopsy device. Final pathology results and patient medical records were reviewed for biopsy accuracy and complications. A biopsy was considered successful if a specific benign or malignant diagnosis was rendered by the pathologist or if surgical-pathologic confirmation was obtained. RESULTS: Open surgical biopsy was performed after sonographically guided biopsy in 13 patients and led to 12 concordant diagnoses (nine true-positives and three true-negatives) and one discordant diagnosis (false-negative). Specific pathologic diagnosis was rendered for the 10 percutaneous biopsies that were not confirmed by surgical biopsy: five biopsies matched known primary malignancies, consistent with metastases; four biopsies revealed primary tumors, and one biopsy revealed chronic inflammation (nine true-positives and one true-negative). Two biopsies were nondiagnostic because of insufficient material (n = 1) and necrotic tumor (n = 1). In the biopsies with diagnostic tissue specimens, sonographically guided biopsy achieved a sensitivity of 95% (18/19) and specificity of 100% (4/4) for allowing neoplastic tissue to be distinguished from nonneoplastic tissue. Complications included a mesenteric hematoma and abdominal wall cellulitis. CONCLUSION: Percutaneous biopsy of mesenteric masses is a useful and safe procedure.     

Incidental finding of rectal carcinoma during transrectal US for prostatic diseases.

During transrectal ultrasound (TRUS), rectal carcinoma was an incidental finding in seven patients among a series of 5,000 TRUS examinations. TRUS was performed in seven patients with symptoms characteristic of prostatic diseases. All seven patients underwent examination by at least one physician before TRUS and, except for abnormal prostatic findings, no tumors were detected during digital rectal examination (DRE). The tumors were clearly visualized with TRUS and were easily palpated during DREs performed after TRUS. They were large and were located mainly along the posterior and lateral walls of the rectum. All the tumors were diagnosed by means of proctoscopy; the biopsy findings were positive, and the pathologic staging indicated advanced disease: adenocarcinoma of the rectum with a minimum grade of Dukes C. It is recommended that, in addition to evaluation of scans obtained in the transverse plane, the multiplane transducer be used to evaluate the longitudinal plane of the rectum for detection of possible undiscovered tumors.     

MR兼容性气动驱动设备作为经直肠前列腺活检导航的可行性研究

目的评估使用一种与MR兼容的遥控气动驱动机械装置在实时动态3TMR影像引导下进行经直肠前列腺活检的可行性。材料与方法本前瞻性研究经伦理审查委员会     

Deep pelvic abscesses: transrectal drainage with radiologic guidance.

Transrectal catheter drainage was performed under radiologic guidance in eight patients with deep pelvic abscesses during a 7-month period. One patient underwent two procedures. In five patients, the abscess could not be palpated at rectal examination. Seven procedures were performed with fluoroscopic guidance. Transrectal ultrasound was performed in conjunction with fluoroscopy for two procedures. Medium to large (8-14-F) locking catheters were used in seven procedures, and small (5-F) nonlocking pigtail catheters were used in two. The catheter was left in place for 3 days or less in all but one patient, in whom the catheter was left in place for 20 days. Five abscesses were drained through the anterior or anterolateral rectal wall and four, including one repeat drainage, through the posterior rectal wall. No complications occurred as a direct result of transrectal drainage. Successful initial drainage was established with clinical improvement in all cases. Two patients eventually required surgery, one for continued bleeding into an infected hematoma and one for abscess recurrence after tube dislodgment. Transrectal drainage performed with radiologic guidance is a safe, feasible procedure; is well tolerated by patients; and is relatively easy to perform with the techniques described.     

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.     

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 -     

Recurrent rectal carcinoma treated with high-dose-rate intraluminal brachytherapy

A 63-year-old man with recurrent rectal carcinoma was treated with high-dose-rate intraluminal brachytherapy (6 Gy x 4). After treatment, anal pain and bleeding were greatly improved. He died as a result of liver metastasis, but he was able to evacuate the bowels until death. bowels until death.     

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.     

Transcutaneous pulmonary fine-needle aspiration biopsy under fluoroscopic guidance. Our experience

The authors report the radiological method and the cytohistologic and bacteriologic technique of percutaneous fine-needle aspiration biopsy of the lung under fluoroscopic guidance. The results are reported of 620 biopsies of benign and malignant lung lesions; the biopsies were performed from January 1981 to September 1989. Surgery, follow-up, and autopsy confirmed the high diagnostic accuracy of this method. The advantages of fluoroscopic guidance are discussed and compared with those of CT guidance.