Interventional Radiology in Oncology

A review of percutaneous transhepatic biliary drainage at a tertiary referral centre

“…2,23 Infected bile has been detected in 25% to 36% of patients with malignant biliary obstruction, 24 making pre-procedural administration of appropriate prophylactic antibiotics to this group of patients even more important; and overall, prophylactic antibiotic, including cover for Escherichia coli, Klebsiella, Enterococcus, Streptococcus, Enterobacter and Pseudomonas aeruginosa, is strongly recommended for all patients prior to biliary procedures, to minimise the risk of potential septic complications. 2,10 Previously recommended prophylaxis regimens included ampicillin and gentamycin or cefotetan and mezocillin 25 ; however, in Beaumont Hospital, the prophylactic antibiotic of choice is monotherapy with piperacillin/tazobactam (Tazocin, Pfizer, Cork, Ireland), which is a broad-spectrum antibiotic that has Gram-negative, Gram-positive, and aerobic coverage, and importantly, high levels of biliary excretion.…”

“…2,9 Depending on the cholangiographic findings, placement of a catheter or stent may be considered to facilitate internal or external drainage of bile, allowing decompression of the biliary system. 1,2,10 Apart from the primary underlying cause and the level of the biliary obstruction, different technical aspects of the interventional procedure, including the access, internal versus external biliary drainage, position and type of stent, tract embolisation and duration of drainage have all been investigated as factors that may influence the outcome of the percutaneous biliary drainage (PBD). 11 PTBD is effective at relieving biliary obstruction; however, it has been associated with complications including sepsis, haemorrhage and localised infective, as well as inflammatory processes such as abscess, peritonitis, cholecystitis, and pancreatitis, 2,12 with an overall 30-day in hospital mortality rate of approximately 20% in one recent study.…”

Interventional radiology in the elderly

“…Any hypervascular tumor such as metastastic renal cell or thyroid carcinoma may benefit from embolization. Further analysis about the application of transarterial embolization techniques in cancer treatment is described elsewhere 2,29…”

Interventional Radiology and the Care of the Oncology Patient

“…In cases where surgical biopsy remains the preferred diagnostic approach, pre-operative tumour localisation can be performed with image guidance in many situations; an example of this is wire-localisation prior to excisional breast biopsy [6] and in the chest to guide video-assisted thorascopic surgery (VATS) for removal of lung nodules that would otherwise require open thoracotomy [7]. Increasingly, percutaneous biopsy is utilised for microbiological diagnosis of lesions suspicious for opportunistic infections (particularly fungal) in oncology patients with febrile neutropenia [8]. Choice of image guidance modality is multifactorial and there are many available options.…”

“…Complications, if any, are easily recognised on CT scan. It finds particular utility in thoracic, pelvic, and retroperitoneal biopsies which are frequently difficult to perform under ultrasound guidance [8]. The main disadvantage is exposure to ionising radiation; both patient and, to a lesser extent, staff are exposed to this at time of biopsy, and the extent of such radiation exposure is related to the total scan time, scan parameters such as peak tube kilovoltage (kVp) and milliamperage (mA), the body part imaged, and the size of the patient.…”