A retrospective analysis on the diagnostic value of ultrasound-guided percutaneous biopsy for peritoneal lesions

Abstract

BackgroundRoutine examinations have a low specificity and a low positive rate for the diagnosis of peritoneal lesions. This study aimed to evaluate the diagnostic value and safety of ultrasound-guided percutaneous peritoneal lesion biopsies in patients with ascites and/or abdominal distension with unclear causes.MethodsA retrospective analysis was performed in 153 consecutive patients with ascites and/or abdominal distension with unclear causes. All of the patients showed abnormalities of the peritoneum or greater omentum after ultrasonography, and underwent ultrasound-guided percutaneous biopsies using a Bard auto-biopsy gun with 18- or 16-gauge biopsy needles.ResultsThe success rate of the procedures was 100% (153/153) and the satisfaction rate of the tissue specimens in the biopsy was 91.5% (140/153). A specific histopathological diagnosis was made in 142 out of 153 patients, with an overall diagnostic accuracy of 92.8%. Among the diagnosed patients, 62 were peritoneal metastatic adenocarcinoma, 49 were peritoneal tuberculosis, 11 were peritoneal malignant mesothelioma, 8 were chronic peritoneal infections, 7 were pseudomyxoma peritonei, and 5 were primary peritoneal lymphoma. Only 11 patients did not get a pathologic diagnosis due to the lack of sufficient tissue specimen. No serious complications occurred.ConclusionsUltrasound-guided percutaneous biopsy could be a simple, safe and accurate diagnostic method in patients with ascites and/or abdominal distension with unclear causes.

Is Ultrasound‐Guided Core Biopsy as Safe as Fine‐Needle Aspiration, and Does It Add Significantly to the Diagnosis of Suspected Peritoneal Malignancy?

“…The safety, benefit, and utility of performing peritoneal biopsies percutaneously with image guidance using CB and FNA techniques has been well documented and is not new . For instance, US guidance for biopsy of the omentum was performed by Sistrom et al in 1992, who described the use of aspiration biopsy in evaluations of omental masses with success in 9 of 11 cases, which included 8 with various types of carcinoma and 1 lymphoma.…”

“…In studies performed in countries where tuberculosis is endemic, there is a greater likelihood that it is the cause of peritoneal disease . In a publication by Govindarajan and Keshava, 47% of patients had diagnoses of malignancies, and 34% had granulomatous inflammation, which was consistent with tuberculosis.…”

“…Historically, tissue from peritoneal disease has been obtained surgically with laparotomy or laparoscopy; however, image‐guided minimally invasive percutaneous biopsies have been performed using ultrasound (US) or computed tomography (CT) guidance with promising results . Two techniques are used when performing percutaneous biopsy: core biopsy (CB) and fine‐needle aspiration (FNA), with a recent trend toward CB for diagnosis and treatment planning.…”

Role of laparoscopy in the diagnosis of peritoneal tuberculosis in endemic areas

“…Dans l'avenir, la biopsie péritonéale percutanée sous contrôle radiologique pourrait être une nouvelle méthode peu invasive, avec peu ou pas de complications, et qui pourrait éviter les inconvénients de la chirurgie [49]. Wang et al ont rapporté un taux de diagnostic histologique des échantillons de tissus par la biopsie percutanée de 91,5 % (140/153), sans aucune complication [50]. Des études sur de plus grands essais à grande échelle aideront à confirmer la contribution de cette nouvelle procédure de diagnostic.…”

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part II

“…Although US plays a minor diagnostic role in the imaging of peritoneal malignancy, it is the modality of choice for imaging-guided biopsy for histological diagnosis. US is cost-and time-effective (no repeated needle position check like CT) and is radiation-free [201,205]. The multiplanar capability of US allows the operator to avoid vessels, the bowel and solid viscera.…”