Image-guided Percutaneous Biopsy Research Articles

Image-Guided Biopsy for the Diagnosis and Molecular Profiling of Hepatoblastoma.

Studies on the use of image-guided percutaneous biopsy for hepatoblastoma (HB), and recommendations put forth by the pediatric hepatic international tumor trial (PHITT), are limited. It is unknown if sufficient tissue can be obtained for trial enrollment as well as molecular profiling, which will likely play a key role in informing future treatment strategies. Patients with HB who underwent percutaneous biopsy at initial diagnosis in interventional radiology (IR) over a 12-year period at a single center were included. Patient demographics, pretreatment extent of disease (PRETEXT) stage, tumor size, and procedure details were collected. Pathology reports and tumor genomic analysis, when performed, were assessed for specimen adequacy. Post-procedure records were assessed for hemoperitoneum. A total of 33 percutaneous biopsies were performed on 32 patients [17 female; median age 1.3 years (IQR: 0.7-2.5 years); median weight 10.5kg (IQR: 7.4-12.7kg)]. Most (n=27) had a single liver lesion, and most (n=18) were PRETEXT II. A total of 15 were positive for at least one annotation factor. Median longest tumor axis was 9.3cm (IQR: 5.0-13.5cm). A total of 16 patients had concurrent non-targeted liver biopsy, per PHITT recommendations. An 18-gauge instrument was most commonly used (n=24, 73%) with a median of 8 cores (IQR: 6-12) obtained. There were no instances of hemoperitoneum. Tissue was adequate for histologic diagnosis in 97% (n=32), with histologic subtyping obtained in 94% (30/32). When available (n=29), comparison with the subsequent surgical resection specimen showed subtype concordance in 15 (52%) patients and minor variations secondary to sampling or treatment effect in 14 patients. Molecular profiling was completed on 21/21 specimens (100%), with 19/21 (90%) showing potentially clinically significant variants, most commonly in CTNNB1 (16/21). In this single-center study, percutaneous biopsy resulted in no serious adverse events, a high rate of diagnosis, and successful subtyping and molecular characterization of HB.

Image-guided biopsy of clinically occult nipple lesions: techniques and learning points.

Percutaneous biopsy is the standard of care for breast lesions, except nipple lesions which are primarily biopsied by excision due to perceived risks of pain and bleeding. However, excisional biopsy of nipple lesion inevitably leads to disfigurement and possible loss of the nipple-areolar complex (NAC), highlighting the need for minimally invasive biopsy techniques. We present our experience of seven patients who underwent ultrasound-guided core biopsy or vacuum-assisted biopsy (VAB) for sampling of clinically occult nipple lesions. All patients tolerated the biopsy procedures well with minimal to mild pain. A patient was complicated by a subcentimetre skin laceration which was sutured with good wound healing and cosmesis. Radiopathological concordance was achieved in all patients. Five out of 7 patients did not require further surgical management after biopsy, avoiding the unnecessary disfigurement from conventional excisional biopsy of nipple. The remaining two patients were diagnosed with pre-malignant lesions and further surgical treatment was performed. This study highlights the important pre-procedural preparation, biopsy techniques and learning points derived from our experience. Learning points that increase the efficacy of obtaining suitable tissue samples, such as enhancing lesion visualisation, appropriate biopsy needle selection and optimising analgesia were discussed. Potential complications and common pitfalls, such as mimics of nipple calcifications, were also included. In conclusion, image-guided percutaneous biopsy techniques are feasible minimally invasive alternatives to excisional biopsy of the nipple.

Image-guided percutaneous mesenteric biopsy: diagnostic yield and safety profile.

To evaluate the diagnostic yield and safety profile of percutaneous image-guided biopsy of mesenteric lesions. Image-guided percutaneous biopsies of the mesentery at a single institution from 2000 to 2022 were identified and reviewed. Relevant demographic and procedural data were abstracted from the medical record. Surgical pathology was reviewed to evaluate if the biopsy was diagnostic and concordant with the patient's final diagnosis. One hundred ninety five patients (mean age, 62.6 ± 14.; M/F, 113/82; mean BMI, 30.4) underwent mesenteric biopsy procedure. Of these, 173 (89%) were performed using ultrasound and 22 (11%) were performed using CT or a hybrid/combined approach. Core needle biopsy was used in 164 (84%) patients, fine-needle aspiration (FNA) was used in 21 (11%), and both were used 10 (5%). Mean/median number of biopsy passes was 2.8 ± 1.3 and 3, respectively (core mean 2.7 ± 1.2; FNA mean 3.4 ± 1.5). Average lesion size was 5.3 ± 4.4cm in the long axis and 2.9 ± 2.0cm in the target plane. Diagnostic yield of core biopsies was 97.7% (n = 170/174) and FNA was 80.6% (n = 25/31) for an overall combined yield of 96.4% (n = 188/195). Of diagnostic biopsies, 95.7% (n = 180/188) were concordant with the final diagnosis, 70.8% (n = 138) of which were considered malignant. Overall concordant diagnostic rate was 180/195 (92.3%). Neuroendocrine tumor pathology was the only factor associated with lower diagnostic yield (13/15, 87%).For all biopsies, average shortest skin-to-target-distance on CT was 6.3 ± 2.8cm, decreased to 4.1 ± 1.3cm with US compression (approximately 35% reduction, p < 0.001). Additionally, ultrasound created a safe path not available on CT in 29 (15%) biopsies. Moderate IV sedation was used in 91.3% (n = 178) of mesenteric procedures. Complications occurred in 11 (5.6%) biopsies, and all were considered minor. This represents a large cohort of image-guided percutaneous biopsies of mesenteric lesions with the majority representing core biopsy performed under US guidance. This technique offers high diagnostic yield and a favorable safety profile for tissue diagnosis. Furthermore, compression with ultrasound reduced skin-to-target distance by 35% and created a biopsy path that would not be possible on CT in 15% of US cases.

Percutaneous image-guided mesenteric biopsy: how we do it in a high-volume training center.

Lesions in the mesentery are unique from other potential biopsy targets in the abdomen or pelvis for several reasons. Mesenteric lesions are among the deepest in the abdomen and are often surrounded by or adjacent to small bowel or colon. Mesenteric vasculature is often crowded, and traversing the mesentery often involves crossing multiple vascular planes. Mesenteric lesions and the structures surrounding them within the peritoneal cavity are often highly mobile. All these features can be daunting to any radiologist asked to perform a mesenteric biopsy. We provide a comprehensive overview and guide to percutaneous mesenteric biopsy informed by available literature and experience at two high volume teaching centers. Topics covered include the pitfalls of using prior imaging to determine whether mesenteric biopsy is possible, techniques specific to US or CT-guidance and complications including hemorrhage and bowel injury.

Bipolar radiofrequency track cautery during abdominal biopsies: teaching points and lessons learned.

Abdominal percutaneous needle biopsies are commonly performed minimally invasive procedures to obtain tissue samples for histopathological diagnosis. Severe post-biopsy bleeding is uncommon but can be associated with prolonged hospitalization, additional interventions, morbidity, and death. Many factors may increase bleeding risk and various peri-procedural and intra-procedural strategies may minimize bleeding risk. Bipolar radiofrequency track cautery is one method that may reduce the risk of post-biopsy bleeding or tumor seeding. This paper offers an illustrative case-based review of teaching points and lessons learned in our experience using a commercially available bipolar radiofrequency track cautery device during percutaneous image-guided abdominal biopsies.

The effect of concurrent acetylsalicylic acid on hemorrhagic complications during percutaneous image-guided lung biopsy

The effect of concurrent acetylsalicylic acid on hemorrhagic complications during percutaneous image-guided lung biopsy

Role of Image-Guided Biopsy in Nonpalpable Breast Lesions: A Study in the Sub-Himalayan Region of North India

Background Nonpalpable breast lesions pose a challenge in their early diagnosis. Image-guided biopsy is preferred in these cases so that a pathological diagnosis of breast carcinoma is reached timely for a better prognosis as the disease has an increased chance of successful outcome with early identification and treatment. Objective The study aims at evaluating the role of stereotactic core needle biopsy (CNB) and percutaneous ultrasound-guided core needle biopsy (US-CNB) in diagnosing suspicious nonpalpable breast lesions. Methods Our study included 35 patients with nonpalpable breast lesions and having a Breast Imaging Reporting and Data System (BI-RADS) risk assessment category IV or V on mammography or sonography. These 35 lesions were subjected to percutaneous image-guided (stereotactic or US) biopsy for histopathological analysis. Results Out of a total of 35 cases, 17 were pathologically malignant (48.6%), with the most common subtype being invasive ductal carcinoma (82.3%). Twenty-nine cases underwent US-CNB, 16 (55.1%) of which were malignant and 13 (44.8%) were benign on histopathological evaluation (HPE). The remaining six cases, which on mammography showed no mass but suspicious malignant calcification only, were subjected to stereotactic CNB, out of which one (16.6%) was malignant and five (83.3%) were benign on HPE. Hence, the lesions visible on sonography were more likely to be malignant. Conclusion Sonography and mammography play a complimentary role in detecting breast carcinoma. Percutaneous biopsy under image guidance can be used as an accurate diagnostic alternative to open surgical excisional biopsy to avoid diagnostic delay.

Bone Biopsies: Practical Considerations and Technical Tips.

Percutaneous image-guided needle biopsies are a safe and minimally invasive method of obtaining tissue of bone lesions. Radiologists are an integral part of a multidisciplinary team (MDT) approach to patient care in obtaining tissue for both pathologic diagnosis and advanced genetic/molecular testing. By utilizing image guidance, radiologists can target bone lesions with a very low complication rate. This review will discuss our approach to image-guided biopsies of bone lesions. Radiologists should be familiar with patient selection and imaging workup prior to performing biopsies, as well as the importance of coordinating the biopsy approach and sampling with the patient's clinical team. Management of bleeding and thrombotic risk in patients undergoing bone biopsies is also an important preprocedural consideration and will be discussed. The majority of bone biopsies are performed utilizing moderate sedation for patient analgesia and comfort, but close attention should be paid to patient comorbidities and potential interacting medications. Although computed tomography guidance remains the mainstay of image-guided biopsy, there are some circumstances in which ultrasound or fluoroscopic guidance may be beneficial. New advances in powered drill technology have made tissue sampling of bone lesions particularly sclerotic bone lesions both safer and faster with increased tissue yield. Finally, we will discuss image-guided biopsy of difficult anatomic regions that require special techniques to yield tissue safely.

What is the Safe Observation Period for Image-Guided Percutaneous Liver Biopsies?

Current observation period post-liver biopsy is typically 4h. This study investigates the safety of reducing the observation period after percutaneous liver biopsy. Patients who underwent percutaneous liver biopsy between 2017 and 2022 in the Radiology Department of a tertiary centre were included in this retrospective, institutional review board-approved study. Patient demographics, procedure details and complication data were collected from the electronic medical records. Complications were graded according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification. Conditional survival probabilities were calculated for the 4-h observation period. Among 1125 patients, 275 complications were seen; 255 grade 1, 15 grade 2 and five grade 3. Post-procedural pain represented 93% (256) of complications, whereas post-procedural haemorrhage occurred in 17 (6%) patients: 13 were of grade 2 severity requiring prolonged observation, and 4 were of grade 3 severity. Of these grade 3 complications, two required blood transfusion whereas two required embolization. A total of 215 (78%) complications occurred within 1h, 244 (89%) within 2h of observation. 16 (94%) of 17 post-procedural haemorrhages occurred within 2h post-biopsy. If complication-free after 2h, the probability of experiencing a complication within the next 2h was 4%. The majority of complications were identified within 2h of observation. Complications recognised after this period were largely pain-related, with only one grade 3 complication seen (post-procedural haemorrhage).Our findings suggest 2h of post-procedural observation may be safe. Level 2B, Retrospective Cohort Study.

Conventional and Contrast-enhanced US of the Lung: From Performance to Diagnosis.

In recent years, lung US has evolved from a marginal tool to an integral component of diagnostic chest imaging. Contrast-enhanced US (CEUS) can improve routine gray-scale imaging of the lung and chest, particularly in diagnosis of peripheral lung diseases (PLDs). Although an underused tool in many centers, and despite inherent limitations in evaluation of central lung disease caused by high acoustic impedance between air and soft tissues, lung CEUS has emerged as a valuable tool in diagnosis of PLDs. Owing to the dual arterial supply to the lungs via pulmonary and bronchial (systemic) arteries, different enhancement patterns can be observed at lung CEUS, thereby enabling accurate differential diagnoses in various PLDs. Lung CEUS also assists in identifying patients who may benefit from complementary diagnostic tests, including image-guided percutaneous biopsy. Moreover, lung CEUS-guided percutaneous biopsy has shown feasibility in accessible subpleural lesions, enabling higher histopathologic performance without significantly increasing either imaging time or expenses compared with conventional US. The authors discuss the technique of and basic normal and pathologic findings at conventional lung US, followed by a more detailed discussion of lung CEUS applications, emphasizing specific aspects of pulmonary physiology, basic concepts in lung US enhancement, and the most commonly encountered enhancement patterns of different PLDs. Finally, they discuss the benefits of lung CEUS in planning and guidance of US-guided lung biopsy. ©RSNA, 2024 Supplemental material is available for this article.

Imaging-Guided Percutaneous Endovascular Biopsy Applied in Patients with Pulmonary Artery Masses: A Review.

Pulmonary artery (PA) masses are rare. Distinguishing PA tumours from embolism is sometimes difficult, and surgical biopsy is expensive and risky. We aimed to evaluate the efficacy of imaging-guided percutaneous endovascular biopsy (PEB) for obtaining tissues for histological diagnosis. We searched Cochrane, Medline, Embase, and Web of Science for PEB trials involving patients with PA masses, published from the inception of the database until August 2023. We retrospectively reviewed 33 studies including 87 patients (median age 55 ± 69.3years, 44 men) with PA masses who underwent a total of 110 PEBs. Of these patients, 34.5% (n = 38) underwent PEB-catheter aspiration (PEB-CA), 50.9% (n = 56) underwent PEB-forceps biopsy (PEB-FB) and 2.7% (n = 3) underwent PEB-directional atherectomy (PEB-DA). The most common histological aetiology of PA masses was mesenchymal tumours (n = 67, 75.9%). Tumour embolism (n = 6, 6.9%) and pulmonary embolism (n = 3, 3.4%) were the second and third most common types of PA masses, respectively. The technical success rates of PEB-CA, PEB-FB and PEB-DA were 92.1%, 94.6% and 100% (p = 0.796), respectively. Histopathological analysis provided clinical diagnostic success rates of 44.7%, 85.7% and 100% for PEB-CA, PEB-FB and PEB-DA (p < 0.001), respectively. In pairwise comparison, PEB-FB had a higher success rate in pathological diagnosis than PEB-CA (p = 0.000). Apart from one patient suffering from haemorrhagic cardiac tamponade, no other complications occurred. Imaging-guided PEB is a safe and effective technique for the early pathological diagnosis of PA masses.

An Image-Guided Percutaneous Core Needle Biopsy for Accurate Assessment of Musculoskeletal Tumors: A Targeted Diagnosis.

Background Accurate diagnosis of musculoskeletal tumors is essential for guiding appropriate treatment strategies. Percutaneous core needle biopsy (PCNB) is increasingly recognized as a valuable method for obtaining tissue samples for histopathological examination. This study aims to evaluate the diagnostic accuracy and clinical utility of PCNB in diagnosing musculoskeletal tumors. Methodology A total of 152 cases suspected of musculoskeletal tumors underwent PCNB at our tertiary care center between 2020 and 2023. Pre-biopsy evaluation included comprehensive clinical assessment and imaging studies. Core biopsies were performed under image guidance, with specimens sent for histopathological examination and culture sensitivity analysis. Diagnostic yield, accuracy, and performance metrics of PCNB were assessed. Results PCNB demonstrated a diagnostic yield of 93.4%. However, in cases where initial biopsies were inconclusive, repeat core biopsy or open biopsy provided the necessary diagnostic clarity. PCNB demonstrated a remarkable diagnostic accuracy of 97.9%, with a specificity and positive predictive value of 100%. There were no post-biopsy complications and no instances of local recurrence from the biopsy tract. Conclusions PCNB can be a reliable method for diagnosing musculoskeletal tumors, offering high diagnostic accuracy and minimal complications. The utilization of image guidance enhances precision and reduces the risk of complications. PCNB proves effective in diagnosing both primary tumors and bone infections, facilitating timely and appropriate treatment strategies in orthopedic oncology.

Abstract PO5-07-09: ACCURACY OF STEREOTACTIC VACCUM-ASSISTED BREAST BIOPSY FOR INVESTIGATING SUSPICIOUS CALCIFICATIONS IN 2,021 PATIENTS A PUBLIC HOSPITAL IN BRAZIL

Abstract Backgroud: the gold standard for breast biopsy procedures is currently an open excision of the suspected lesion. The cost and morbidity associated with this procedure has prompted many physicians to evaluate less invasive, alternative procedures. More recently, image-guided percutaneous core-needle biopsy has become a frequently used method for diagnosing palpable and non-palpable breast lesions. Although sensitivity rates for core-needle biopsy are high, it has the disadvantage of histological underestimation. Vacuum-assisted stereotactic biopsy (VASB) was developed to overcome some of these negative aspects of core-needle biopsy. Objectives: to evaluate the accuracy of vacuum-assisted stereotactic biopsy (VASB) in the investigation of non palpable suspicious calcifications. Methods: it was a retrospective study from July 2012 to December 2020, in which 2,021 women with suspicious calcifications detected on mammography (BI-RADS 4 and 5) had VASB performed at Hospital Estadual Pérola Byington, São Paulo, Brazil. Fragments were obtained and sent to anatomopathological study; a metal clip was placed on the biopsy site. Four groups were analyzed, based on the biopsy results: benign, precursor lesions, Ductal Carcinoma In Situ (DCIS) and Invasive Ductal Carcinoma (ICD). Results: patients median age was 55y (49-63y). Pathology results on VASB were classified respectively as benign n=1,340 (66.3%), precursor lesions n=84 (4.1%), DCIS n=441 (21.8%) and ICD n=156 (7.7%). The 60 patients with results benign on VASB, because anatomopathological disagreement, surgery was performed, with the following results: benign n=30 (50%), ICD e DCIS n=21 (35%) e precursor lesions n=9 (15%). The sensitivity of the method was 91.7 %, specificity was 97.1%, false negative rate was 3%, positive predictive value was 92.4%, negative predictive value was 96.9%. Conclusion: the VASB method has a good accuracy to distinguish lower and higher risk lesions groups comparing to the gold standard. It has high predictive value in both benign and malignant lesions, guiding therapeutic planning. Keywords: Calcifications; Vacuum-assisted stereotactic biopsy; Breast cancer; Diagnosis. Citation Format: Andressa Amorim, Andre Mattar, Marcelo Antonini, Reginaldo Coelho Lopes, Luciana Damous, Luiz Henrique Gebrim, Marina Diogenes, Marcellus Ramos. ACCURACY OF STEREOTACTIC VACCUM-ASSISTED BREAST BIOPSY FOR INVESTIGATING SUSPICIOUS CALCIFICATIONS IN 2,021 PATIENTS A PUBLIC HOSPITAL IN BRAZIL [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-07-09.

Evaluation of Imaging-Guided Peritoneal Biopsy in Diagnosis of Ascites of Unknown Origin

AbstractAscites is a common clinical problem, which can be a result of liver cirrhosis, neoplasm, tuberculous or pyogenic peritonitis, heart failure, nephrosis, and pancreatic disorders. This study aimed to evaluate the role of imaging-guided peritoneal biopsy in the diagnosis of ascites of unknown origin (ascites of local cause). Sixty-three patients with ascites of unknown etiology were included. Abdominal ultrasonography (US) with colored Duplex was performed, followed by laboratory investigations such as, ascitic fluid samples, magnetic resonance imaging, multislice computed tomography (CT), or PET/CT scan (if indicated). Imaging-guided peritoneal biopsy such as US-guided or CT-guided percutaneous peritoneal biopsy (in cases of failure of US-guided technique) of omentum or extravisceral masses was performed. Cytological and histopathological examinations of the tissue specimens were done by a single experienced pathologist. Other more invasive procedures (e.g., laparoscopy) were needed when the imaging-guided biopsy was not diagnostic. Fifty-four patients underwent US-guided biopsies, 48 patients were successfully diagnosed, and other 9 patients underwent CT-guided biopsies (not accessible by US-guided modality); laparoscopy was needed only in 6 patients. Malignant peritoneal pathology was found in 48 patients, while tuberculous peritonitis was diagnosed in 14 patients. Imaging-guided biopsies had perfect sensitivity (100%) and negative predictive value (100%) in differentiating neoplastic lesions. Percutaneous imaging-guided biopsy (US/CT guided) of the peritoneum, omenta, and mesentery has been established as a safe, simple, noninvasive, and well-tolerated procedure with high diagnostic accuracy. It can minimize further unnecessary invasive procedures such as laparoscopy.

Chronic Nonspinal Osteomyelitis in Adults: Consensus Recommendations on Percutaneous Bone Biopsies from the Society of Academic Bone Radiologists.

The diagnosis and management of chronic nonspinal osteomyelitis can be challenging, and guidelines regarding the appropriateness of performing percutaneous image-guided biopsies to acquire bone samples for microbiological analysis remain limited. An expert panel convened by the Society of Academic Bone Radiologists developed and endorsed consensus statements on the various indications for percutaneous image-guided biopsies to standardize care and eliminate inconsistencies across institutions. The issued statements pertain to several commonly encountered clinical presentations of chronic osteomyelitis and were supported by a literature review. For most patients, MRI can help guide management and effectively rule out osteomyelitis when performed soon after presentation. Additionally, in the appropriate clinical setting, open wounds such as sinus tracts and ulcers, as well as joint fluid aspirates, can be used for microbiological culture to determine the causative microorganism. If MRI findings are positive, surgery is not needed, and alternative sites for microbiological culture are not available, then percutaneous image-guided biopsies can be performed. The expert panel recommends that antibiotics be avoided or discontinued for an optimal period of 2 weeks prior to a biopsy whenever possible. Patients with extensive necrotic decubitus ulcers or other surgical emergencies should not undergo percutaneous image-guided biopsies but rather should be admitted for surgical debridement and intraoperative cultures. Multidisciplinary discussion and approach are crucial to ensure optimal diagnosis and care of patients diagnosed with chronic osteomyelitis.

Clinical indications, safety, and effectiveness of percutaneous image-guided adrenal mass biopsy: an 8-year retrospective analysis in 160 patients.

To assess indications, safety, and effectiveness of percutaneous adrenal mass biopsy in contemporary practice. This institutional review board-approved, retrospective study included all patients undergoing percutaneous image-guided adrenal mass biopsies at an academic health system from January 6, 2015, to January 6, 2023. Patient demographics, biopsy indications, mass size, laboratory data, pathology results, and complications were recorded. Final diagnoses were based on pathology or ≥ 1 year of imaging follow-up when biopsy specimens did not yield malignant tissue. Test performance calculations excluded repeat biopsies. Continuous variables were compared with Student's t test, dichotomous variables with chi-squared test. A total of 160 patients underwent 186 biopsies. Biopsies were indicated to diagnose metastatic disease (139/186; 74.7%), for oncologic research only (27/186; 14.5%), diagnose metastatic disease and oncologic research (15/186; 8%), and diagnose an incidental adrenal mass (5/186; 2.7%). Biopsy specimens were diagnostic in 154 patients (96.3%) and non-diagnostic in 6 (3.8%). Diagnostic biopsies yielded malignant tissue (n = 136), benign adrenal tissue (n = 12), and benign adrenal neoplasms (n = 6) with sensitivity = 98.6% (136/138), specificity = 100% (16/16), positive predictive value = 100% (136/136), and negative predictive value = 88.9% (16/18). Adverse events followed 11/186 procedures (5.9%) and most minor (7/11, 63.6%). The adverse event rate was similar whether tissue was obtained for clinical or research purposes (10/144; 6.9% vs. 1/42; 2.4%, p = 0.27), despite more specimens obtained for research (5.8 vs. 3.7, p < 0.001). Percutaneous adrenal mass biopsy is safe, accurate, and utilized almost exclusively to diagnose metastatic disease or for oncologic research. The negative predictive value is high when diagnostic tissue samples are obtained. Obtaining specimens for research does not increase adverse event risk.

Magnetic resonance imaging-guided renal biopsy shows high safety and diagnostic yield: a tertiary cancer center experience.

To evaluate the technical success and outcomes of renal biopsies performed under magnetic resonance imaging (MRI) using a closed-bore, 1.5-Tesla MRI unit. We retrospectively reviewed our institutional biopsy database and included 150 consecutive MRI-guided biopsies for renal masses between November 2007 and March 2020. We recorded age, sex, BMI, tumor characteristics, RENAL nephrometry score, MRI scan sequence, biopsy technique, complications, diagnostic yield, pathologic outcome, and follow-up imaging. Univariate logistic regression was used to assess the association between different parameters and the development of complications. McNemar's test was used to assess the association between paired diagnostic yield measurements for fine-needle aspiration and core samples. A total of 150 biopsies for 150 lesions were performed in 150 patients. The median tumor size was 2.7 cm. The median BMI was 28.3. The lesions were solid, partially necrotic/cystic, and predominantly cystic in 137, eight, and five patients, respectively. Image guidance using fat saturation steady-state free precession sequence was recorded in 95% of the biopsy procedures. Samples were obtained using both fine-needle aspiration (FNA) and cores in 99 patients (66%), cores only in 40 (26%), and FNA only in three (2%). Tissue sampling was diagnostic in 144 (96%) lesions. No major complication developed following any of the biopsy procedures. The median follow-up imaging duration was 8 years and none of the patients developed biopsy-related long-term complication or tumor seeding. MRI-guided renal biopsy is safe and effective, with high diagnostic yield and no major complications. Image-guided renal biopsy is safe and effective, and should be included in the management algorithm of patients with renal masses. Core biopsy is recommended. • MRI-guided biopsy is a safe and effective technique for sampling of renal lesions. • MRI-guided biopsy has high diagnostic yield with no major complications. • Percutaneous image-guided biopsy plays a key role in the management of patients with renal masses.

Safety and Diagnostic Efficacy of Image-Guided Biopsy of Small Renal Masses.

Image-guided renal mass biopsy is gaining increased diagnostic acceptance, but there are limited data concerning the safety and diagnostic yield of biopsy for small renal masses (≤4 cm). This study evaluated the safety, diagnostic yield, and management after image-guided percutaneous biopsy for small renal masses. A retrospective IRB-approved study was conducted on patients who underwent renal mass biopsy for histopathologic diagnosis at a single center from 2015 to 2021. Patients with a prior history of malignancy or a renal mass >4 cm were excluded. Descriptive statistics were used to summarize patient demographics, tumor size, the imaging modality used for biopsy, procedure details, complications, pathological diagnosis, and post-biopsy management. A biopsy was considered successful when the specimen was sufficient for diagnosis without need for a repeat biopsy. Complications were graded according to the SIR classification of adverse events. A chi-squared test (significance level set at p ≤ 0.05) was used to compare the success rate of biopsies in different lesion size groups. A total of 167 patients met the inclusion criteria. The median age was 65 years (range: 26-87) and 51% were male. The median renal mass size was 2.6 cm (range: one-four). Ultrasound was solely employed in 60% of procedures, CT in 33%, a combination of US/CT in 6%, and MRI in one case. With on-site cytopathology, the median number of specimens obtained per procedure was four (range: one-nine). The overall complication rate was 5%. Grade A complications were seen in 4% (n = 7), consisting of perinephric hematoma (n = 6) and retroperitoneal hematoma (n = 1). There was one grade B complication (0.5%; pain) and one grade D complication (0.5%; pyelonephritis). There was no patient mortality within 30 days post-biopsy. Biopsy was successful in 88% of cases. A sub-group analysis showed a success rate of 85% in tumors <3 cm and 93% in tumors ≥3 cm (p = 0.01). Pathological diagnoses included renal cell carcinoma (65%), oncocytoma (18%), clear cell papillary renal cell tumors (9%), angiomyolipoma (4%), xanthogranulomatous pyelonephritis (1%), lymphoma (1%), high-grade papillary urothelial carcinoma (1%), and metanephric adenoma (1%), revealing benign diagnosis in 30% of cases. The most common treatment was surgery (40%), followed by percutaneous cryoablation (22%). In total, 37% of patients were managed conservatively, and one patient received chemotherapy. This study demonstrates the safety and diagnostic efficacy of image-guided biopsy of small renal masses. The diagnostic yield was significantly higher for masses 3-4 cm in size compared to those <3 cm. The biopsy results showed a high percentage of benign diagnoses and informed treatment decisions in most patients.

Percutaneous Computed Tomography (CT) Fluoroscopy-Guided Biopsy of the Spleen Using Fibrin Glue as a Sealant.

Some authors consider the risk of bleeding an absolute contraindication to percutaneous image-guided splenic puncture. While splenic punctures are mainly performed at specialized centers, no technique for the closure of the puncture tract has been broadly established. The aim of this study was to investigate the effectiveness and safety of a percutaneous image-guided biopsy of the spleen using fibrin glue to plug the tract. A total of 27 requests for splenic image-guided interventions were identified between 2010 and 2021 and considered for inclusion in our retrospective single-center study. Seven patients needed to be excluded, which left twenty patients who underwent a percutaneous computed tomography (CT) fluoroscopy-guided biopsy of a splenic lesion during this period. In all patients, a 17G coaxial needle with an 18G core biopsy needle was used. Diagnostic adequacy and accuracy were evaluated, and complications were classified using the CIRSE classification system for adverse events. Diagnostic adequacy was 100% (20/20), and a median of four samples were collected. Diagnostic accuracy was 80% (16/20). The four off-target samples included one inconclusive finding and three samples of regular spleen tissue. The overall complication rate was 5% (1/20). No mild (grade 1-2) or moderate (grade 3-4) complications occurred. One severe (grade 5-6) complication occurred. Although controversial and potentially high-risk, diagnostic percutaneous biopsies of the spleen appear to be relatively safe with the use of fibrin glue to seal the tract.

Ultrasound Guided Biopsy among Patients with Lung Lesions Undergoing Procedures in Interventional Radiology of a Tertiary Care Centre.

Minimally invasive image-guided percutaneous core needle biopsy can obtain tissue samples for diagnosis of subpleural lung cancer, which is crucial for the correct management of lung lesions. Common complications of lung biopsy include pneumothorax, parenchymal haemorrhage and haemoptysis. The study aimed to determine the prevalence of ultrasound-guided biopsy among patients with lung lesions undergoing procedures in interventional radiology of a tertiary care centre. A descriptive cross-sectional study was performed in the Department of Radiology and Imaging from 1 August 2018 to 30 September 2019 after obtaining ethical approval from the Institutional Review Committee. USG-guided biopsy of peripheral lung lesions was performed with an 18 gauge semiautomatic biopsy instrument and a 17 gauge coaxial needle. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Among 188 biopsy of lung lesions, ultrasound-guided biopsies were performed in 28 (14.89%) (9.80-19.98, 95% Confidence Interval). The prevalence of ultrasound guided biopsy among lung lesions is lower than other studies done in similar settings. biopsy; interventional radiology; lung neoplasms; prevalence.