CT-guided procedures: an initial experience

Abstract

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.

Rescue computed tomography-guided drainage of a giant mediastinal mature teratoma causing airway obstruction prior to surgical resection: a case report

“…The advantage of ultrasound-guided drainage is that it is easy to perform at bedside in real-time without irradiation. However, lesions near the bone or lungs or deep lesions cannot be detected owing to artifacts and ultrasound attenuation [7]. CT-guided drainage enables the accurate assessment of the tumor, vascular location, puncture route, and depth from the skin.…”

Minimally invasive biopsy in retroperitoneal tumors (Review)

“…RADU DRAGOS MARCU 1,2 , CAMELIA CRISTINA DIACONU 1,3 , TRAIAN CONSTANTIN 1,4 , BOGDAN SOCEA 1,5 , FLORENTINA IONITA-RADU 6 , DAN LIVIU DOREL MISCHIANU 1,2,7 and OVIDIU GABRIEL BRATU 1,2,7 such as needle core biopsy (NCB) or fine needle aspiration biopsy (FNAB), guided using ultrasonography (US) or computed tomography (CT), offer the possibility of obtaining a correct diagnosis, differentiating between benign and malignant tumors and also between metastatic and primary tumors, as well as establishing the tumor subtype. This allows the physician to establish the most appropriate therapeutical management: radiotherapy or chemotherapy, with or without surgery (3).…”

“…Regarding tissue sampling procedures, both NCB and FNAB are minimally invasive techniques, that can be used in order to obtain sufficient tissue fragments for the cytopathological examination and ancillary tests such as molecular studies and cytogenetics, polymerase chain reaction (PCR), fluorescent in situ hybridization (FISH), flow cytometry, and microbiological evaluation (6). FNAB started to be used more frequently in the 1950s, especially in the evaluation process of breast masses, in spite of the fact that it was first reported in the beginning of the 1930s (7,8). The core needle biopsy technique was introduced much later, in the 1990s and it has become more popular due to its several advantages compared to FNAB: it has higher sensitivity and specificity than FNAB, it permits an accurate differentiation between benign and malignant tumors, as well as the distinction between invasive tumors and in situ carcinoma (8).…”

A semi-automated robotic system for percutaneous interventions

“…Needle-based percutaneous interventions are used in clinical routine for a number of diagnostic and therapeutic procedures such as tissue biopsy or radiofrequency ablation [ 1 , 2 ]. Although not yet established in clinical routine, approaches exist to support such procedures by robotic instrument guidance [ 3 – 9 ].…”