Ultrasonically guided percutaneous needle aspiration biopsies (author's transl)]

Ultrasonically guided percutaneous fine needle aspiration biopsies were carried out in 179 patients with sonographically proven space occupying lesions of the liver, pancreas and kidneys as well as the retroperitoneal space. The fine needle aspiration biopsies were done using a B-scan-aspiration-biopsy transducer with a special needle having an outer diameter of 0,4--0,6 mm. Liver metastases were proven cytologically in 57/70 patients (81%), pancreatic carcinomas in 20/31 patients (64%), kidney tumours in 15/20 patients (75%), retroperitoneal lymph node metastases and primary malignant lymphomas in 20/32 patients (62%). The ultrasonically guided fine needle aspiration biopsy is simple, practically without pain, risk or complications for the patient, and is an economically feasible examination method.     

Ultrasonically guided percutaneous fine needle aspiration biopsy of solid masses

Fine needle aspiration biopsy is a highly accurate cytologic technique in the differentiation of benign vs. malignant disease. After careful localization with the ultrasound beam, a 22 gauge 0.6 mm needle is used to obtain four to five cell samples. Seventy percutaneous fine needle aspiration biopsies were performed nodes, subcutaneous nodules, and other retroperitoneal masses. Ninety-three percent accuracy was obtained with no complications. Studies in four patients with carcinoma of the tail of the pancreas were falsely negative for malignant cells; all four patients had desmoplastic tumors. Complications of hemorrhage, tumor seeding, infection, fistula formation, and pain encountered with other methods and using larger bore needles have not been found with the fine needle technique. It is a safe, accurate method that can be performed as an out-patient procedure.     

Percutaneous drainage of postoperative abdominal and pelvic lymphoceles

Eleven patients with postoperative abdominal and pelvic lymphoceles underwent percutaneous diagnostic and therapeutic intervention with either needle aspiration or catheter drainage. Although initial sonographic or CT examinations accurately identified these collections, definitive diagnosis required fluid sampling and laboratory analysis for confirmation. Seven pelvic and two retroperitoneal lymphoceles demonstrated a gross appearance and composition different from two lymphatic collections in the upper peritoneum. Nine patients underwent catheter drainage; two were managed by needle aspiration alone. Duration of catheter drainage was 4-120 days, substantially longer than is customary for standard fluid collections. Nine of 11 patients were cured by percutaneous aspiration or drainage alone. Bacterial colonization developed in three persistently draining lymphoceles. However, no clinical sepsis or bacteremia occurred. In another patient with persistent high-volume lymphatic output, sclerotherapy with tetracycline instillation was successful in rapidly closing the lymphatic fistula. Percutaneous drainage is a safe, effective procedure for drainage of postoperative lymphoceles.     

Percutaneous catheter drainage of abdominal abscesses guided by ultrasound and computed tomography.

Ultrasonography and computed tomography were used to diagnose, localize, and guide the percutaneous drainage of 24 intraabdominal and retroperitoneal abscesses in 23 surgical and medical inpatients 16 of whom had abscess formation as a postoperative complication. On the basis of anatomic detail from sectional imaging, safe percutaneous drainage routes similar to surgical approaches were defined. After confirmation by needle aspiration, one of two methods of percutaneous catheter introduction were used: (1) a modified Seldinger technique for placement of an 8 French pigtail catheter and (2) a trocar catheter technique for placement of a 12 or 16 French catheter. Once in position, the catheters were managed as a surgically placed drain. In 22 of 24 cases, percutaneous catheter drainage was curative with no surgery required. There were no deaths or recurrences with an average follow-up period of 12 months ranging from 1 week to 3 years. Percutaneous aspiration and drainage should be considered as an alternative to surgery in the treatment of intraabdominal or retroperitoneal abscess.     

Abscess and intra-abdominal fluid collections. Diagnosis and percutaneous drainage

The diagnosis of intraabdominal abscess or fluid collections is considerably helped by the precise anatomic delineation yielded by ultrasound and CT-scan. However, the lack of complete specificity of these modalities necessitates needle aspiration for diagnosis. The indications of CT-scan or US guided percutaneous drainage have been expanded with operator experience. Most of intra-abdominal collection, purulent or not, intra or retroperitoneal can be percutaneously treated. Percutaneous drainage can either replace surgery or "temporarize" a critically ill patient until he is able to undergo surgical treatment.     

Cytopuncture of lymph nodes opacified by lymphography in the pretreatment evaluation of prostatic cancer

Fine needle aspiration of iliac lymph nodes after lymphography was performed in nineteen patients with prostatic carcinoma, ranging from stage A to C. In four patients (21%), fine needle aspiration showed lymph node dissemination. 3 patients were classified as stage B, and 1 as stage C before aspiration. In this study, fine needle aspiration biopsy proved to be useful in the staging of prostatic carcinoma.     

Ultrasound-guided aspiration cytology of enlarged lymph nodes

Cytological results of US-guided fine needle aspiration biopsies of enlarged lymph nodes from 179 patients were analyzed retrospectively. The final diagnoses were benign lymphadenopathy in 90 cases, metastasis in 56, and malignant lymphoma in 33 cases. The material was sufficient for cytological analysis in 174 cases (97.2%). Correct diagnosis of malignant (C-IV-V) and benign (C-I-II) lymphadenopathy in the whole material was possible in 80 percent of cases. Correct subtyping of lymphoma was possible in 63.6 percent of the cases. There was one (0.6%) false positive (C IV), 6 (8.5%) false negative (C-I-II), and 24 (13.8%) suspicious (C III) cytological findings. All but one of the false negative cytological findings were from superficial lymph nodes. No complications occurred. US-guided lymph node aspiration biopsy is safe and accurate in the superficial, anterior mediastinal, abdominal, and retroperitoneal lymphonodal areas. Lymph nodes with a C 0 cytological result should undergo rebiopsy and suspicious (C III) or clinically doubtful cases should be referred for a surgical biopsy.     

The utility of a drainage needle for percutaneous abscess drainage

OBJECTIVE: In this article, I describe a percutaneous drainage needle that consists of six side holes in its cannula. The needle is specially designed for effective evacuation of complex abscess collections consisting of internal solid components, including floating debris, that tend to block the needle aperture during aspiration. The characteristic features of the needle and its performance in both in vitro and in vivo environments are described. MATERIALS AND METHODS: An in vitro experiment was performed with the use of a model of a fluid collection containing floating sheets of gelatin sponge to mimic a complex body collection consisting of floating fibrinous strands. Five radiologists were asked to perform aspiration from two collections of normal saline and 5% methylcellulose of two different volumes using an ordinary aspiration needle and the drainage needle. The needle was evaluated in a prospective in vivo study of 30 postoperative abdominal collections in 29 consecutive patients that were drained by a single radiologist. Complete evacuation was attempted initially with a conventional aspiration needle. When there was sonographic evidence of residual fluid collection, a repeat aspiration using a drainage needle was performed during the same session. RESULTS: In the in vitro experiment, the median percentage of fluid aspirated with the conventional needle from the 10- and 15-mL collections of saline was 10% and 15% and from the 10 mL and 15 mL of methylcellulose solution was 20% and 26.67%, respectively, whereas the drainage needle was able to remove 100% of fluid in all attempts. In the in vivo study, the conventional needle was able to remove all drainable fluid from the 12 simple collections. For the 18 complex collections, the drainage needle was always able to remove some residual fluid from the collection after aspiration with the conventional needle. The median percentage of fluid volume aspirated with the conventional needle was 55.6%, whereas that aspirated with both the conventional and drainage needles was 95.5%, with a significant difference by Wilcoxon's signed rank test (p < 0.001). CONCLUSION: This drainage needle was effective in evacuating fluid from complex abdominal collections that could not be drained with conventional end-hole needles.     

骨骼肌肉恶性肿瘤病变CT引导下经皮穿刺活检正确性分析

目的 探讨CT导引下经皮穿刺活检对骨骼肌肉恶性肿瘤性疾病的诊断价值.方法 106例骨骼肌肉病变行CT导引下经皮穿刺活检,对比穿刺病理结果与临床诊断最终结果.结果 106例CT导引下经皮骨骼肌肉穿刺活检病例,经临床手术及切开活检病理结果全部为恶性肿瘤病变,其中89例病理结果与CT导引下经皮穿刺活枪结果相符,17例CT导引下穿刺活检病理结果为"阴性".活检正确率84.0%;结论CT导引下经皮穿刺对骨骼肌肉恶性肿瘤性病变是安全、简便、有效的诊断手段,对于活检结果为"阴性"的病例适时的切开活检可能是必要的.     

CT of peritoneal lymphomatosis

The CT and clinical findings are presented in seven patients with diffuse peritoneal malignancy caused by non-Hodgkin lymphoma. All seven patients had CT evidence of ascites, omental infiltration, and peritoneal implants mimicking carcinomatosis. Bulky retroperitoneal or mesenteric adenopathy was present in only one patient. Four of the seven patients had documented AIDS. Paracentesis provided a diagnosis of lymphoma in only one of the seven patients. In the other six patients, the final diagnosis was established by surgery (three patients), by autopsy (one patient), by laparoscopy (one patient), and by guided needle aspiration (one patient). Although uncommon, lymphoma should be considered in patients who have diffuse peritoneal malignancy, particularly those who are at risk for AIDS.     

超声介入治疗细菌性肝脓肿的两种方法疗效比较

 目的 对比研究超声引导下经皮肝穿刺细针抽吸术与置管引流术治疗细菌性肝脓肿的疗效。方法 细菌性肝脓肿98例,其中直径≥5 cm 46例,直径＜5 cm 52例。对以上两种大小的脓肿,分别采取超声引导下经皮肝穿刺细针抽吸术和置管引流术两种方法治疗,比较两种方法治疗后脓肿消失时间、患者住院时间、血象、体温恢复正常时间等。结果 直径≥5 cm肝脓肿,置管引流术组在住院天数、脓腔消失时间等方面优于细针抽吸术组（P＜0.05）,在术后血象、体温恢复正常时间方面两种方法无统计学差异（P>0.05）。直径＜5 cm肝脓肿,两种方法在住院天数、脓腔消失时间、术后血象、体温恢复正常时间方面无统计学差异（P>0.05）。结论 对于直径≥5 cm、直径＜5 cm的细菌性肝脓肿,应分别首选超声引导下经皮肝穿刺置管引流术、细针抽吸术。     

US-guided needle aspiration and catheter drainage as an alternative to open surgical drainage for uniloculated neck abscesses

PURPOSE: To prospectively evaluate the effectiveness of ultrasound (US)-guided needle aspiration and catheter drainage as an alternative to open surgical drainage of uniloculated neck abscesses. MATERIALS AND METHODS: Fifteen consecutive patients (11 female, four male; age range from 18 days to 78 years, mean 42.5 y +/- 22.4) diagnosed with deep neck infections associated with uniloculated neck abscesses were treated. The patients were originally scheduled for surgical incision and drainage after a period of unsuccessful treatment with antibiotics. US-guided needle aspiration (in 10 patients) and US-guided catheter drainage (in five patients) were performed under local anesthesia. Open surgical drainage was performed when US-guided drainage procedures failed. RESULTS: Surgical open drainage was avoided in 13 of the 15 patients (87%). An average of 6 mL of pus was obtained in patients in the needle aspiration group and 140 mL of pus was drained by catheter. One patient had a recurrent pyogenic lymphadenitis at the same location and was treated successfully by repeated needle aspiration. No complications occurred in this study. CONCLUSION: In a selected group of patients without imminent airway obstruction, most uniloculated neck abscesses may be managed initially by US-guided needle aspiration and catheter drainage before resorting to open surgical drainage.     

Computer tomographic guided fine needle puncture of abdominal masses

CT-guided fine-needle aspiration biopsy was carried out in 177 patients with proven intra-, retro- or extraperitoneal lesions. This method verified the diagnosis in 89/132 cases (66%) with malignant neoplasia, metastases and recurrent malignant tumors. In 45 patients with benign or inflammatory lesions of the intra- and retroperitoneal space, fine-needle puncture showed a purulent liquid, inflammatory altered cell elements or a positive bacteriological result. The success of CT fine-needle puncture depends mainly on the examiner's experience, the exact localization of the needle, and careful handling of the cytological material. Fine-needle puncture should be applied simultaneously with CT when an undefined space-occupying lesion is present. Unsuccessful sonography is an indication for CT-guided fine-needle puncture.     

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。     

CT导引下胸部肿块切割及抽吸活检配合应用的临床价值

目的：探讨切割及抽吸活检配合应用诊断胸部肿块的临床价值。材料与方法；对68例胸部肿块病人在CT导引下同时行切割及抽吸两种术式采取标本，对两种活检方法各自的准确率及总准确率做对照研究。结果：切割活检与抽吸活检的准确率分别为79．47％，77．94％，二者之间无显著差异（P＞0．05），但均明显低于总准确率92．65％（P＜0．05）。结论：切割及抽吸活检的配合应用能明显提高活检准确率，具有较高的临床使用价值。     

Breast abscess in lactating women: US-guided treatment

PURPOSE: To retrospectively evaluate the use of ultrasonography (US)-guided treatment of breast abscesses in lactating women. MATERIALS AND METHODS: One hundred eight consecutive lactating women who were clinically suspected of having a breast abscess were examined with US. Abscesses depicted at US were treated with US guidance, and the success of US-guided treatment was retrospectively determined. RESULTS: Fifty-six abscesses were identified at US in 43 women; all abscesses were treated with US guidance: 23 with needle aspiration and 33 with catheter drainage. Treatment method was determined according to the size of the abscess. Abscesses that were smaller than 3 cm in maximum diameter were treated with needle aspiration, and abscesses that were 3 cm or larger in maximum diameter were treated with catheter insertion. One patient who was treated with needle aspiration subsequently underwent surgical intervention; all others were successfully treated with US intervention. Catheter placement was well tolerated (mean pain score 2.3 in 22 women by using a subjective pain scale of 0-10). CONCLUSION: US-guided needle aspiration of abscesses smaller than 3 cm and US-guided catheter drainage of abscesses 3 cm or larger are successful means of treating breast abscesses.     

CT导引下骶骨病变穿刺活检

目的 探讨CT导引下对骶骨病变穿刺活检技术和应用价值.方法 在CT导引下对21例骶骨病变联合使用Ackermann骨钻针、切割式活检针和抽吸式活检针采集骨性标本和非骨性标本.结果穿刺成功率100%,除1例标本为含坏死组织和凝血块外,其余均获得病理结果,病理活检成功率95.2%.结论 CT导引下穿刺活检是对骶骨病变作出正确诊断的可靠方法,操作简便、安全,并发症少,为术前诊断提供重要的参考依据.正确合理使用操作方法可以提高穿刺的成功率和缩短穿刺时间.     

MDCT-Guided Transthoracic Needle Aspiration Biopsy of the Lung Using the Transscapular Approach

The purpose of this study is to report our preliminary experience using MDCT-guided percutaneous transthoracic needle aspiration biopsy using the transscapular approach in the upper posterolateral lung nodules, an area that it is difficult or hazardous to reach with the conventional approach. Five patients underwent CT-guided percutaneous transthoracic needle aspiration biopsy of the lung via the transscapular approach. A coaxial needle technique was used in all patients. Biopsy was successful in all patients. No major complications were encountered. One patient developed a minimal pneumothorax next to the lesion immediately after biopsy, which resolved spontaneously. MDCT-guided percutaneous transthoracic needle aspiration biopsy of the lung via the transscapular approach is an effective and safe procedure that reduces the risk of pneumothorax in selected patients.     

Masses in or around the pancreatic head: CT-guided coaxial fine-needle aspiration biopsy with a posterior transcaval approach.

PURPOSE: To evaluate the safety and feasibility of computed tomographic (CT)-guided coaxial fine-needle aspiration biopsy (FNAB) of masses in or around the head of the pancreas with a posterior approach that transgresses the inferior vena cava (IVC). MATERIALS AND METHODS: The authors retrospectively reviewed the records of 29 patients with lesions located within (n = 24) or around (n = 5) the pancreatic head who underwent CT-guided FNAB with the posterior transcaval route due to obstruction of the anterior approach by bowel, liver, and/or other structures. A coaxial needle technique was used, with an outer 18-gauge needle positioned posterior to the IVC and an inner 22-gauge needle traversing the IVC to obtain a biopsy of each lesion. All biopsy specimens were subjected to cytologic evaluation. Medical records of all patients were evaluated for complications. RESULTS: All lesions were safely accessed with the posterior transcaval approach without major complications. The biopsies revealed a malignant process in 21 patients, benign pancreatic cysts in two patients, and pancreatitis in one patient. There were five false-negative biopsy results. Minor complications occurred in four patients (small retroperitoneal hematomas occurred in three and abdominal pain occurred in one). CONCLUSION: CT-guided coaxial FNAB by means of a posterior transcaval approach is a safe method for obtaining samples from lesions in or around the pancreatic head.     

Mediastinal cysts: diagnosis by CT and needle aspiration

Five patients with bronchogenic or enteric cysts were diagnosed by using a combination of CT and transbronchial or transesophageal needle aspiration. Serous or mucoid fluid was successfully aspirated in each case. Cultures of the fluid were negative for pathogens, and cytologic examinations showed no malignancy. Mediastinoscopy and thoracotomy were avoided in all patients, including one symptomatic patient whose symptoms resolved after needle aspiration. CT with transbronchial or transesophageal needle aspiration represents a practical alternative to surgery in the evaluation of congenital mediastinal cysts.