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.     

CT-guided transvenous or transcaval needle biopsy of pancreatic and peripancreatic lesions

PURPOSE: To evaluate the safety and efficacy of direct computed tomography (CT)-guided fine needle aspiration biopsy (FNAB) of pancreatic and peripancreatic masses via a posterior approach that traverses the inferior vena cava (IVC) or renal vein. MATERIALS AND METHODS: From January 2000 to July 2003, 55 patients underwent 58 biopsies of masses located within the pancreas (n = 28) or in a peripancreatic location (n = 30) with use of a posterior approach that crossed the IVC or renal vein. Biopsies were performed with needles ranging in size from 18 to 22. Cytology reports and medical records of all patients were retrospectively reviewed to evaluate diagnostic accuracy and complication rates. RESULTS: Masses were safely accessed with a direct (noncoaxial) pathway traversing the IVC (n = 54), renal vein (n = 4), or both (n = 3). Overall diagnostic accuracy was 86% (50 of 58). Cytologic examination was positive for malignancy in 39 of 58 biopsies (67%). Benign lesions were demonstrated in 12 of 58 biopsies. In seven cases (12%), the sample was deemed nondiagnostic. Of those, four were diagnosed later by endoscopy (n = 1), surgical biopsy (n = 2), or repeat FNAB (n = 1). A false-negative result was noted in one case, which was later diagnosed by repeat biopsy. A total of four inadvertent passes through the right renal artery were recorded. CT evidence of perilesional blood was seen in eight of 55 patients (eight of 58 cases). Three of these occurred after a passage via the right renal artery. All patients remained asymptomatic, and no transfusion or change in management was necessary. No other complications occurred. CONCLUSION: CT-guided noncoaxial FNAB with an approach that traverses the IVC or renal vein is safe and effective in obtaining diagnostic specimens from pancreatic and peripancreatic masses.     

Diagnosis of glomus caroticum tumors with transvenous digital subtraction angiography

This paper demonstrates the diagnostic value of transvenous DSA in carotid body tumours. Angiographic results in 6 patients show that this method was of diagnostic significance in all cases; in 5 of 6 patients the angiographic diagnosis was confirmed by subsequent surgery. Transvenous DSA, the invasiveness of which is only minimal, is useful in outpatients for identifying obscure palpable tumours of the lateral neck. Unnecessary or even highly dangerous surgical diagnostic interventions can thus be prevented.     

Fine-needle aspiration biopsy: pancreatic and biliary tumors

Fine-needle aspiration biopsy was performed in 240 patients with suspected pancreatic or biliary tumors between 1978 and 1984. Between 1978 and 1982, using only sonographic guidance, the sensitivity of the technique was 66.7% for pancreatic and 40% for biliary tumors compared with 79.4% for carcinomas in other locations. The main reasons for failure to obtain positive cytology were small tumor size and sampling errors. From 1983 onward, combined sonographic and fluoroscopic biopsy guidance with opacification of the bile duct or pancreatic duct was routinely used together with heavier sedation to allow more careful needle placement. The sensitivity of the technique improved from 1983 to 1984 and was 77.5% for pancreatic tumors and 60% for biliary tumors. Failure of the cytologic technique to identify well-differentiated tumors and lymphomas has become a major source of tumor misdiagnosis.     

Use of the external jugular vein approach for transvenous liver biopsy.

Transjugular liver biopsy (TJLB) with use of a right external jugular vein (EJ) approach obviates a deep neck puncture, thereby reducing the risk associated with the procedure in patients with severely disordered coagulation. The EJ approach was successful in 21 of 24 consecutive patients referred for TJLB (88%). The approach was unsuccessful in three cases due to thrombosis or congenital absence of the right EJ. TJLB via the right EJ was successful in all cases in which EJ access could be obtained. In the 21 successful cases, the EJ approach simplified the procedure and shortened its duration. There were no procedure-related complications attributable to the EJ approach. The authors now use the EJ route routinely for patients undergoing TJLB and other transjugular procedures in their laboratory. The EJ approach is particularly recommended in patients with impaired coagulation.     

Diagnosis of primary bone tumors with image-guided percutaneous biopsy: experience with 110 tumors

PURPOSE: To determine the diagnostic accuracy of image-guided percutaneous biopsy in 110 primary bone tumors of varying internal compositions. MATERIALS AND METHODS: One hundred ten consecutive patients with primary bone tumors underwent biopsy with computed tomography (CT) or fluoroscopy. Ninety-one patients underwent surgical follow-up and 19 received medical treatment and underwent subsequent imaging studies. Final analysis of bone biopsy results included tumor type, malignancy, final tumor grade, biopsy complications, and effect on eventual treatment outcome. RESULTS: Seventy-seven tumors were malignant and 33 were benign. Most common tumors at biopsy were osteosarcoma (n = 20), lymphoma (n = 18), chondrosarcoma (n = 16), and giant cell tumor (n = 16). Correct final diagnosis was attained in 97 (88%) patients. Sixty-three lesions were solid nonsclerotic; 26, sclerotic; and 21, lytic with cystic centers containing internal areas of fluid, hemorrhage, or necrosis. In six of 21 lesions with a predominant cystic internal composition, problems occurred in determining a final diagnosis. In 13 patients, definite correct diagnosis was not obtained with initial percutaneous bone biopsy. Of these patients, benign bone tumors were better defined with surgical specimens in seven, a diagnosis of malignancy was changed to that of another malignancy in four, and the diagnosis was changed from benign to malignant in two. Nine patients underwent open surgical biopsy. Seven of the difficult cases were of cystic tumors with hemorrhagic fluid levels visible at CT or magnetic resonance imaging. The only complication was a small hematoma. CONCLUSION: Percutaneous biopsy of primary bone tumors is safe and accurate for diagnosis and grade of specific tumor. In cases with nondiagnostic biopsy, open-procedure biopsy is likely to be associated with similar diagnostic difficulties.     

Compartmental anatomy: relevance to staging and biopsy of musculoskeletal tumors

A thorough understanding of compartmental anatomy is essential for accurate staging of a suspected musculoskeletal tumor with MR imaging and for avoiding potentially devastating biopsy-related complications. Imaging-guided, percutaneous needle biopsy is a safe and cost-effective technique but requires careful planning in conjunction with the surgeon who will perform the definitive surgery because it constitutes the final step in the staging process and the first step in surgical therapy.     

Sonographically guided fine-needle biopsy of peripheral lung tumors

Sonographically guided transthoracic fine-needle biopsy of peripheral pulmonary masses was performed in seven patients. None of the masses was accessible to fiber bronchoscopy. Three tumors were apical, two paravertebral and two lateral. The puncture specimen allowed a histological diagnosis in all five cases of malignant disease. One of the other two patients was found to have tuberculosis and the last, radiation fibrosis. Pneumothorax did not occur in any of these cases.     

Primary bone tumors: percutaneous needle biopsy. Radiologic-pathologic study of 222 biopsies

Findings of 222 needle biopsies were evaluated to determine the accuracy of the procedure in diagnosis, the role of the biopsy in limb-salvage procedures, the contribution of needle biopsy in the assessment of tumor effect in patients receiving chemotherapy or radiotherapy, and reasons for failure to obtain diagnostic tissue. The overall accuracy of needle biopsy in diagnosis of benign and malignant tumors was 78.6%. The major tumor categories included osteosarcoma (50 patients), giant-cell tumor (33 patients), Ewing sarcoma (22 patients), and spindle-cell sarcoma (15 patients). The accuracy of needle biopsy in diagnosis for these tumors was 78%, 88%, 95%, and 87%, respectively. The results of follow-up needle biopsy were encouraging, with roughly a 70% adequacy in the patients who had osteosarcoma and 50% in the patients who had Ewing sarcoma. The major reason for failure to obtain tissue for diagnosis in 17 of 35 patients was the presence of blastic tumors. The presence of cystic lesions and faulty technique were other reasons for failure. Percutaneous needle biopsy in patients who have primary bone tumors is a helpful diagnostic tool, forms an important part of the limb-salvage procedure, and contributes to the assessment of tumor effects in patients receiving chemotherapy or radiotherapy. To minimize failure in obtaining adequate tissue for diagnosis, biopsy specimens of blastic tumors should be obtained from their soft tissue components, lytic areas, or the least dense areas, while a smear of aspirate from cystic lesions should be prepared for cytologic examination and the clot embedded in paraffin for histologic study.     

Sentinel node biopsy in midline tumors: we should be careful and accurate

Annals of Nuclear Medicine -     

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引导下脑肿瘤穿刺活检的安全性及有效性

【摘要】 目的 了解CT引导下颅脑肿瘤穿刺活检的安全性和有效性。方法 2018年1月至2020年1月在郑州大学第一附属医院接受CT引导下颅脑穿刺活检术的患者83例,完善其基本信息,病理活检结果及并发症情况,并对所有病例进行穿刺准确性及并发症的分析。结果 83例患者中,男性43例,女性40例,年龄为（52.9±13.9）岁。颅内进针深度为（3.5±1.2）cm,调针次数（2.8±1.3）次,靶病灶为（28.0±8.7）mm,67例为多发病灶,16例为单发灶,病理活检结果阳性为68例,阴性为15例,假阳性0例,假阴性6例,穿刺准确率92.8%（77/83）。活检病理诊断恶性结果包括弥漫性大B细胞淋巴瘤,脑胶质细胞瘤,肺转移瘤,良性结果包括炎性病变,胶质增生。18例出现局部小片出血,5例出现颅高压,1例死亡。结论 CT引导下颅脑穿刺活检是一种安全性高,且十分有效的临床诊断手段。