Safety and diagnostic accuracy of percutaneous ultrasound‐guided biopsy of the spleen: A multicenter study

Gómez-Rubio, Mariano; López-Cano, Antonio; Rendón, Paloma; Muñoz-Benvenuty, Agustín; Macías, Manuel; Garrè, C.; Segura-Cabral, José María

doi:10.1002/jcu.20608

Cited by 56 publications

(37 citation statements)

References 22 publications

(31 reference statements)

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“…Of these, 25 were excluded from the complication rate arm of the study, while 30 were excluded from the diagnostic accuracy arm of the study for reasons specifi ed in Figure 1 . Nine studies were included in the complication rate arm of the study ( 5,(14)(15)(16)29,(32)(33)(34)(35), and four studies were included in the diagnostic accuracy arm of the study ( 5,6,16,29 ). Personal communication with the author confi rmed that one study contained a subset of patients from another article ( 5,36 ) (Luigi Cavanna, MD, personal communication, July 2010).…”

Section: Resultsmentioning

confidence: 99%

“…Several more recent publications have reported much lower complication rates with smaller needle diameters (18 gauge or smaller) ( 5,6,16 ). Diseases that commonly affect the spleen can pose a diagnostic challenge to the clinician, radiologist, and pathologist, and the reported diagnostic accuracy of splenic biopsy varies, ranging between 84% and 90% ( 5,14,(16)(17)(18)(19)(20)(21).…”

Section: Search Strategymentioning

confidence: 99%

See 1 more Smart Citation

Percutaneous Image-guided Biopsy of the Spleen: Systematic Review and Meta-Analysis of the Complication Rate and Diagnostic Accuracy

McInnes

Kielar²,

Macdonald³

2011

Radiology

109

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Purpose:To use meta-analysis to determine the complication rate and diagnostic accuracy of image-guided percutaneous needle biopsy of the spleen. Materials and Methods:Several electronic databases were searched through July 2010 without language restrictions. Two reviewers independently selected studies that met the inclusion criteria for the diagnostic accuracy and complication rate arms of the study. Study data were independently extracted by the two reviewers. The primary 2 3 2 data were investigated with a random-effects meta-analysis of sensitivity and specifi city. The complication rate data were investigated with a random-effects meta-analysis; sensitivity analysis of complication rate, excluding needles larger than 18 gauge, was performed. Results:Four studies met the inclusion criteria for the diagnostic accuracy arm (639 patients), and nine met the inclusion criteria for the complication rate arm (741 patients). The meta-analysis showed a pooled sensitivity of 87.0% (95% confi dence interval [CI]: 80.7%, 91.4%) and specifi city of 96.4% (95% CI: 81.4%, 99.4%). The pooled major complication rate was 2.2% (95% CI: 0.8%, 5.6%). Sensitivity analysis with the removal of biopsies performed with needles larger than 18 gauge showed a major complication rate of 1.3% (95% CI: 0.6%, 2.5%). The most commonly encountered complications were hemorrhage followed by pain. Conclusion:Image-guided percutaneous biopsy of the spleen demonstrates high diagnostic accuracy and a major complication rate, for needles 18 gauge or smaller, that is similar to that reported for the liver and kidney. This technique should be considered a favorable alternative to splenectomy.q RSNA, 2011

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Section: Resultsmentioning

confidence: 99%

Section: Search Strategymentioning

confidence: 99%

Percutaneous Image-guided Biopsy of the Spleen: Systematic Review and Meta-Analysis of the Complication Rate and Diagnostic Accuracy

McInnes

Kielar²,

Macdonald³

2011

Radiology

109

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“…Ultrasoundguided needle biopsy is a safe and effective diagnostic tool with high diagnostic accuracy for both focal and diffuse splenic involvement by disease. Overall, similar diagnostic accuracies were reported for fine-needle aspiration (FNA) (86.5%) and core-needle biopsy (CNB) (92%) in splenic diseases [25]. Reported complications have included haemorrhage (1.4-8.3%) and rarely pneumothorax, pleural effusion, colonic or other adjacent organ injuries with lower reported risk of bleeding associated with FNA than with CNB.…”

Section: Role Of Splenic Biopsymentioning

confidence: 62%

“…Reduced complication rates owing to real time visualisation of the needle track in multiple planes under sonographic guidance make it safer, with CT-guided biopsy being reserved for the lesions that are not well visualised on sonography [26]. Diagnostic splenectomy has a higher reported mortality rate of 2.9%, a morbidity rate of 37% and higher post-operative sepsis and pneumonia [25]. (a) (b) Figure 13.…”

Section: Role Of Splenic Biopsymentioning

confidence: 99%

Spleen in haematological malignancies: spectrum of imaging findings

Saboo¹,

Krajewski²,

O’Regan³

et al. 2012

BJR

115

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ABSTRACT. Imaging morphology and metabolic activity of splenic lesions is of paramount importance in patients with haematological malignancies; it can alter tumour staging, treatment protocols and overall prognosis. CT, MRI and positron emission tomography (PET)/CT have been shown to be powerful tools for the noninvasive assessment of splenic involvement in various haematological malignancies. Since many haematological malignancies and non-neoplastic conditions can involve the spleen and imaging manifestations can overlap, imaging and clinical findings outside of the spleen should be looked for to narrow the differential diagnosis; confirmation can be obtained by pathological findings. Radiologists should be familiar with the cross-sectional imaging patterns of haematological malignancies involving the spleen as well as non-neoplastic splenic findings common in these patients to facilitate their care and follow-up. This pictorial review provides the common and uncommon imaging appearances and complications of various haematological malignancies involving the spleen on CT, MRI and PET/CT, and common pitfalls in diagnosis.

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“…Percutaneous spleen biopsy has historically been regarded as a high risk procedure due to the soft consistence, highly vascularized & stroma-poor composition of this organ. However, recent use of smaller gauge needles (18)(19)(20) and the possibility of performing ancillary studies on cytology and small biopsies has enabled performing either fine needle aspiration (FNA) or core needle biopsies (CNB) with high diagnostic yield, and complication rates comparable to other solid organs: spleen: <1-3% vs. liver <1-3% vs. kidney <1-6.3% [16,17]; this procedure is now considered preferable to diagnostic splenectomy and performed routinely in several institutions including ours. The most common indication for biopsy is suspected lymphoma, sensitivity and specificity are 87% and 96%, respectively, and the most common major complication is hemorrhage [16][17][18][19].…”

Section: Commentarymentioning

confidence: 99%

Between a rock and a hard place

et al. 2016

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A 60 year old male consulted the outpatient clinic for progressively worsening right shoulder pain over the last few months, lightheadedness, and intermittent shortness of breath. He also complained of loss of balance with multiple falls in the past few weeks. He denied fever, chills, rigors, night-sweats, hematochezia, melena, or recent illness. Significant past medical history included localized diffuse large B cell lymphoma (DLBCL) of the forehead skin 4 years prior, for which he was treated with 5 of 6 cycles of rituximab, cyclophosphamide, adriamycin, vincristine and prednisone chemotherapy, bipolar disorder, a 50 pack-year smoking history, and alcohol consumption of 12 beers 4-5 times/week.The initial presentation does not raise concern for an acute illness, and is most consistent with a smoldering, progressive process with possible neurologic manifestations. The anamnesis raises the possibility of alcohol abuse related disease and/or malignancy potentially due to relapsed hematological disease or related to tobacco abuse.Physical examination showed overall good general conditions, the patient's weight did not show change compared to previous records (BMI 27.1), there was hepatosplenomegaly, 3 and 2 cm below the respective costal margins, and limited range of motion of the right shoulder. The rest of the physical was normal. The initial neurological exam was normal. Complete blood count at presentation showed normal white cell and differential counts, severe anemia and moderate thrombocytopenia: Hg 5.9 g/dL, WBC 7.2 K/uL, PLT 70 K/uL.The presence of joint pain, severe bicytopenia, organomegaly and neurologic symptoms raises the differential of alcohol induced hepatitis and alcohol toxicity derived symptoms, malnutrition, Still's disease, coagulopathy, and malignancy, especially hematolymphoid neoplasms. All these conditions warrant a hospital admission.The patient was admitted and received blood transfusions. Additional blood chemistry showed slightly abnormal liver function tests: aspartate aminotransferase 45 U/L, alanine aminotransferase 26 U/L, Gamma-glutamyl transferase 169 U/L, total bilirubin: 1.2 mg/dL, direct bilirubin 0.4 mg/dL; nutritional studies showed a normal B12, folate and zinc; the iron panel showed severe hyperferritinemia: 1,388.7 ng/ mL, hemolysis panel showed a high LDH 746 U/L, undetectable haptoglobin < 7.8 mg/dL, normal plasma free hemoglobin and negative direct antibody test. Electrolytes, creatinine, coagulation studies, thyroid function tests were normal. Imaging studies showed superior subluxation of the humeral head as the cause for the shoulder pain, but also showed a significant increase in splenic size (16 x 7cm) compared to a previous study 4 years ago. There was no evidence of masses or lymphadenopathy.Acute alcoholic hepatitis and nutritional deficiencies can be excluded. The studies are suggestive of hemolysis, however the normal plasma hemoglobin and relatively low bilirubin are neither proportional to the degree of anemia nor consistent with significant hemolytic acti...

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Safety and diagnostic accuracy of percutaneous ultrasound‐guided biopsy of the spleen: A multicenter study

Abstract: USG needle biopsy is safe and effective for diagnosing both focal and diffuse splenic lesions. The risk of bleeding may be lower with FNA than with CNB.

Cited by 56 publications

References 22 publications

Percutaneous Image-guided Biopsy of the Spleen: Systematic Review and Meta-Analysis of the Complication Rate and Diagnostic Accuracy

Percutaneous Image-guided Biopsy of the Spleen: Systematic Review and Meta-Analysis of the Complication Rate and Diagnostic Accuracy

Spleen in haematological malignancies: spectrum of imaging findings

Between a rock and a hard place

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