A CT-guided fat transversing coaxial biopsy technique for pancreatic lesion biopsy that avoids major organs and vessels

Lin, Chia Ying; Ou, Ming Ching; Liu, Yi Sheng; Chuang, Ming Tsung; Shan, Yan Shen; Tsai, Hann-Huei; Wang, Chien-Kuo; Tsai, Yi Shan

doi:10.4103/sjg.sjg_199_17

Cited by 5 publications

(4 citation statements)

References 17 publications

(32 reference statements)

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“…Over the past 10 years, our institute has developed a fat-transversing route approach for pancreatic biopsies which is able to reach most tumors in the pancreas without penetrating organs or vessels. The safety and efficacy of CT-CNB through this approach in a small cohort of 122 patients with a 96.7% success rate and 4.1% complication rate has been previously described [19]. Herein, we report the updated results in 420 patients.…”

Section: Introductionmentioning

confidence: 81%

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Percutaneous Computed Tomography-Guided Coaxial Core Biopsy for the Diagnosis of Pancreatic Tumors

Liu

Chao

et al. 2019

JCM

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Endoscopic, ultrasound-guided tissue acquisition (EUS-TA) with rapid on-site evaluation is recommended as a first choice in the diagnosis of pancreatic lesions. Since EUS facilities and rapid on-site evaluation are not widely available, even in medical centers, an alternative for precise diagnoses of pancreatic tumor is warranted. The percutaneous computed tomography-guided, core needle biopsy (CT-CNB) is a commonly applicable method for biopsies. Our institute has developed a fat-transversing approach for pancreatic biopsies which is able to approach most tumors in the pancreas without penetrating organs or vessels. Herein, we report a 15-year experiment of pancreatic tumor coaxial CT-CNB in 420 patients. The success rate of tissue yielding by the technique was 99.3%. The overall sensitivity, specificity, and accuracy were 93.2%, 100%, and 93.4%, respectively. The diagnostic accuracy could be increased to 96.4% in 2016–2018 (after the learning curve period). The overall complication rate was 8.6%. Neither life-threatening major complications, nor seeding through the biopsy tract, were observed. Our study supported the hypothesis that CT-CNB could be a complementary option for diagnostic tissue acquisition in patients with unresectable or metastatic pancreatic tumors when EUS-TA is either unsuitable or unavailable.

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Section: Introductionmentioning

confidence: 81%

“…Each patient was accessed by three well-experienced, interventional radiologists to determine the proper route of the biopsy. Six major fat-transversing routes have been previously developed at our institute (Figure 1) [19].…”

Section: Methodsmentioning

confidence: 99%

Percutaneous Computed Tomography-Guided Coaxial Core Biopsy for the Diagnosis of Pancreatic Tumors

Liu

Chao

et al. 2019

JCM

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“…High success rates have been reported for CT-guided biopsies of other organs: liver, 86–100% [8,13]; retroperitoneal tumors, 95.9 % [14]; pancreas, >90% [15,16]; adrenal glands, 96% [17]; kidney, 79–90.8% [18,19]; bone, >94% [20,21]. With an overall biopsy success rate of 92.3%, our results were similar with those reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

CT-guided procedures: an initial experience

Roman

Achimaș-Cădariu

Fetică

et al. 2018

Medicine and Pharmacy Reports

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Background and aimsDespite their usefulness, CT-guided procedures have a low profile in Romania. The current study has the purpose of describing a first experience in performing these procedures.MethodsTumors and fluid collections that were inaccessible for biopsy or drainage by ultrasound or endoscopic guidance were included. The procedures were performed using a 64-slice GE Optima CT660 CT scanner. The biopsies were carried out using the coaxial technique with an 18 G semiautomatic needle. The drainages were performed using 10 F pig-tail drains that were inserted using the Seldinger technique. Data regarding the size and location of the target lesion, puncture technique, success and complication rates were recorded.ResultsBetween May 2017 and April 2018, 30 procedures were performed, of which 26 biopsies and 4 drainage insertions. Of the biopsies 3 were mediastinal, 8 pulmonary, 6 retroperitoneal, 4 pelvic, and 5 of the bone. The drainages were performed for pelvic lymphoceles. The average lesion size was 3.2 cm (0.7–9 cm), with a depth from the skin of 9.1 cm (0.6–15.2 cm). The average procedure duration was 58 minutes (31–93 minutes). A conclusive histopathological diagnosis was set after 92.3% of biopsies. Three procedures resulted in complications, two being minor (hemothorax, soft tissue hematoma) and one severe (tension pneumothorax requiring drainage).ConclusionsCT guidance offers safe access to lesions that cannot be biopsied or drained under ultrasound or endoscopic guidance.

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“…Imaging control was initially transabdominal ultrasonography [10] or computerized tomography [15], with reported sensitivities reaching 80%. However, the risk of injuring vital intraabdominal structures remains a significant problem, even with the use of the most advanced imaging techniques [16]. Since the mid-1990s, the introduction of fine-needle aspiration under EUS control [17] has opened a new era for pancreatic lesion diagnosis and management.…”

Section: Discussionmentioning

confidence: 99%

Influence of the Histopathological Features of the Lesion on the Diagnostic Yield of Fine-Needle Aspiration Cytology of Pancreatic Solid Lesions

et al. 2018

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Objective: The rate of pancreatic lesions has increased in recent decades due to the widespread use of advanced imaging techniques. Nowadays, a significant proportion of cases are incidentally discovered in asymptomatic patients and cytology is an important tool for the diagnosis and multidisciplinary management of these cases. Study Design: In this study we retrospectively review the experience with pancreatic fine-needle aspiration cytology in the last 17 years at a single large tertiary hospital in Madrid, Spain. Results: Our results indicate that more than 60% of pancreatic malignant lesions are cytologically confirmed before surgery and 30% of the patients are asymptomatic. Despite this, we have noted that the total number of malignant lesions surgically resected in our hospital has basically remained unchanged over the years, because incidental diagnosis is not always synonymous with resectability and a substantial number of patients are already metastatic at the time of diagnosis. Our series also shows an increase in the number of neuroendocrine tumors, which now represent almost 20% of all cytological diagnoses at our hospital. The sensitivity in our series is 70% and the false negative rate remains 30%, despite sample quality control by experienced cytologists and standardized technical conditions. Fibrosis and necrosis are the 2 features of the primary tumor that significantly and negatively influence the accuracy of cytologic diagnosis. Conclusion: We herein report our experience with cytologic diagnosis of pancreatic lesions in a single tertiary hospital. Our results confirm that cytology is a safe, reliable, and important tool for pancreatic lesion diagnosis and management.

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A CT-guided fat transversing coaxial biopsy technique for pancreatic lesion biopsy that avoids major organs and vessels

Cited by 5 publications

References 17 publications

Percutaneous Computed Tomography-Guided Coaxial Core Biopsy for the Diagnosis of Pancreatic Tumors

Percutaneous Computed Tomography-Guided Coaxial Core Biopsy for the Diagnosis of Pancreatic Tumors

CT-guided procedures: an initial experience

Influence of the Histopathological Features of the Lesion on the Diagnostic Yield of Fine-Needle Aspiration Cytology of Pancreatic Solid Lesions

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