Ultrasound-guided fine-needle biopsy of focal liver lesions: techniques, diagnostic accuracy and complications

Buscarini, L; Fornari, Fabio; Bolondi, Luigi; Colombo, Paolo; Livraghi, Tito; Magnolfi, Fabrizio; Rapaccini, Gian Ludovico; Salmi, Andrea

doi:10.1016/0168-8278(90)90219-h

Cited by 174 publications

(99 citation statements)

References 22 publications

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“…[3][4][5] On the basis of the results, FNB appears to be a safe and accurate procedure for diagnosing FLLs. The most recently reported mortality rates related to FNB are very low, ranging from 0.018% to 0.096%, with an average of 0.046% (1 per 2,143 patients), and the morbidity reported in a large retrospective review was only 6 major complications per 2,701 procedures (0.22%).…”

Section: Discussionmentioning

confidence: 99%

“…1,2 It is generally accepted that in most cases, fineneedle biopsy (FNB) is safe, accurate, and enables a definitive diagnosis to be made quickly. [3][4][5][6][7][8][9][10] However, some problems, such as the well known possibility of neoplastic seeding 11,12 and the conflicting results of diagnosis in patients with well-differentiated hepatocellular carcinomas (HCCs) [13][14][15] and benign tumors, 1,16 represent limitations that should be considered further. In particular, precise details of the prevalence of tumor cell seeding along the needle tract have yet to be determined, despite the fact that this problem is real 17 and its occurrence leads to a worse prognosis.…”

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confidence: 99%

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Accurate preoperative evaluation of liver mass lesions without fine-needle biopsy

et al. 1999

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Fine-needle biopsy (FNB) is associated with problems, such as tumor seeding, which are probably underestimated. The aim of this study was to validate prospectively the accuracy of our diagnostic work-up without FNB, for defining indications for surgery in a cohort of patients with focal liver lesions (FLLs). Between January 1997 and December 1998, 160 consecutive patients carrying 225 FLLs admitted to our department were evaluated prospectively. Preoperative diagnoses were established by means of clinical histories, serum tumor marker levels, ultrasonography, and spiral computed tomography (CT). Angiography, magnetic resonance imaging (MRI), and Lipiodol-CT were performed when it was considered necessary to plan the surgical strategy. All the patients underwent surgery and results of pathological examinations were obtained for all of them. The preoperative diagnoses of 221 of the 225 lesions (98.2%) were confirmed, and the indications for liver resection in 156 of the 160 patients (97.5%) were correct. The respective accuracy, sensitivity, specificity, and positive and negative predictive values were 99.6%, 100%, 98.9%, 99.3%, and 100% for diagnosis of hepatocellular carcinoma (HCC); 99.1%, 100%, 98.8%, 96.9%, and 100% for metastases; 99.6%, 100%, 99.5%, 91%, and 100% for cholangiocellular carcinomas (CCCs); all 100% for mixed HCC-CCCs; and 98.7%, 57.1%, 100%, 100%, and 98.6% for benign tumors. In view of these results, the fact that the real risks of FNB have yet to be established and the possibility that tumor seeding has a major impact on patient prognosis, the use of FNB should be drastically limited. (HEPATOLOGY 1999;30:889-893.)Differential diagnosis of focal liver lesions (FLLs) is not always easy, despite the progress made with the latest imaging techniques. 1,2 It is generally accepted that in most cases, fineneedle biopsy (FNB) is safe, accurate, and enables a definitive diagnosis to be made quickly. [3][4][5][6][7][8][9][10] However, some problems, such as the well known possibility of neoplastic seeding 11,12 and the conflicting results of diagnosis in patients with well-differentiated hepatocellular carcinomas (HCCs) 13-15 and benign tumors, 1,16 represent limitations that should be considered further. In particular, precise details of the prevalence of tumor cell seeding along the needle tract have yet to be determined, despite the fact that this problem is real 17 and its occurrence leads to a worse prognosis.Our diagnostic work-up for FLLs has never included FNB, and the aim of this study was to validate prospectively its accuracy for diagnosing FLLs, and consequently establishing the correct indications for surgery, in a cohort of patients admitted to our department. MATERIALS AND METHODSPatients were entered into the study if they satisfied the following selection criteria: (1) they were carrying hepatic solid nodules that had not been treated previously and (2) they had not undergone previous FNB of the liver. We considered the possibility of a selection bias owing to the fact that only patien...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Accurate preoperative evaluation of liver mass lesions without fine-needle biopsy

et al. 1999

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“…Buscarini ve ark. 2091 olguluk US eşliğinde karaciğer kesici iğne biyopsisinde %95.1 doğruluk oranı bildirmişlerdir (6). Bizim serimizdeki doğruluk oranı %92.1 olup literatür ile uyumludur Görüntüleme yöntemleri eşliğinde biyopsi yapıl-ması ile birlikte gereksiz operasyonlar engellenmiştir.…”

Section: Discussionunclassified

“…BT derin yerleşimli lezyonlarda, US ile görüntülemenin mümkün olmadığı durumlarda tercih edilebilir (6,7). Karaciğer biyopsilerinde US; parankimin net olarak değer-lendirilmesi, gerçek zamanlı görüntü vermesi, hastayı radyasyona maruz bırakmaması, intrahepatik ana vasküler yapılarla safra kesesini iyi gö-rüntüleyebilmesi, ucuz, kolay ve taşınabilir olması nedeni ile ilk tercih edilen kılavuz görüntüleme yöntemidir (3,6). Bu nedenle bizim de kesici karaciğer kitle biyopsilerinde ilk tercih ettiğimiz kılavuz görüntüleme yöntemi US'dir.…”

Section: Discussionunclassified

“…Hemanjiomlarda kanama riskinin diğer lezyonlarla istatistiksel bir farklılık göstermediği saptanmıştır (15). Ağrı, hemoraji, bilier peritonit, pnömotoraks, vazovagal reaksiyon, biloma, hipotansiyon, peritoneal irritasyon, baş dönmesi, fistül formasyonu, septik şok, döküntü, pnömo-periton, iğne traktına yayılım, ölüm gelişebilecek komplikasyonlardır (6,(16)(17)(18). Komplikasyonların % 61'i ilk iki saatte, % 95'i ilk 24 saatte gelişmek-tedir (7).…”

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Ultrasound-guided Percutaneous Hepatic Mass Biopsies with 18G Cutting Needle: Our Clinical Experiences

İnci¹,

Özkan²,

Balakan³

2012

Turk J Bioch

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Amaç: Bu çalışmanın amacı fokal karaciğer kitle lezyonların-da perkütan karaciğer biyopsilerinin ultrasonografi kılavuzlu-ğunda yapılması durumunda, etkinliğinin ve güvenilirliğinin değerlendirilmesi ve kendi klinik tecrübemizi paylaşmaktır. Yöntem: Son bir yıl içerisinde 38 hastanın karaciğer kitle lezyonlarından ultrasonografi kılavuzluğuna serbest el tekniği ile karaciğer biyopsisi işlemi yapıldı. Biyopsiler, bir gecelik açlığı takiben 18G otomatik biyopsi iğneleri kullanılarak yapıldı. Biyopsilerden sonra, tüm hastalar 1 gece yatırılarak takip edildi. Biyopsi örnekleri patolog tarafından normal koşullarda değerlendirildi. Bulgular: Son bir yıl içerisinde 38 hastaya ait toplam 38 karaciğer kitlesinden biyopsi alındı (kadın: 16 (42,1%), erkek: 22 (57,9%); ortalama yaş: 48,9 yıl). 38 biyopsinin 35'i (%92,1) tanısal, 3 (%7,9) tanesi yetersiz olarak değerlendirildi. Kitle boyutları 14 mm ile 155 mm arasında değişmekte olup ortalama kitle boyutu 42± 27 mm ölçüldü. Hastalarda ciddi bir komplikasyon görülmedi. Sonuç: Bizim klinik tecrübemize göre, ultrasonografi kılavuz-luğunda 18 G otomatik biyopsi iğnesi ile yapılan perkütan karaciğer kitle biyopsisi hızlı, etkili, minimal invaziv ve güven-li bir yöntemdir. Komplikasyon oranı çok düşüktür. Ultrasonografi ile lezyonun görüntülenebildiği tüm olgularda ultrasonografi kılavuzluğunda perkütan karaciğer kitle biyopsisin yapılabileceğini düşünüyoruz. Background:The aim of this study was to evaluate efficacy and safety of percutaneous liver biopsy performed with 18G automatic needles under the assistance of ultrasonography in focal hepatic lesions and share our clinical experiences. Method: We performed percutaneous biopsies in the 38 patient's liver masses with ultrasound-assisted free-hand technique in last one year. The liver biopsies were performed following one-night fasting using 18G automatic needles. After the biopsies, all patients were hospitalized and monitored for one day. All specimens were examined without immediate assessment by a pathologist. Results: A total of 38 hepatic masses from 38 patients were biopsied in last one year (female: 16 (42,1%), male: 22 (57,9%); mean age: 48,9 years). Of 38 biopsies, 35 (%92,1) specimens were considered diagnostic and 3 (%7,9) specimens were considered as non-diagnostic. Hepatic mass sizes varied between 14 mm and 155, with a mean diameter of 42± 27 mm. No major complication was seen. Conclusion: According to our experiences, we conclude that ultrasound assisted percutaneous liver mass biopsy with 18 G automatic needles is a quick, effective, minimally invasive and, safe procedure. The complication rate is very low. The ultrasound assisted percutaneous liver mass biopsy modality should be used in all cases that the lesion can be visualized by ultrasonography.

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Impact of Preoperative Fine-needle Aspiration Cytologic Examination on Clinical Outcome in Patients With Hepatocellular Carcinoma in a Tertiary Referral Center

Poon²,

Lo³

et al. 2004

Arch Surg

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Ultrasound-guided fine-needle biopsy of focal liver lesions: techniques, diagnostic accuracy and complications

Cited by 174 publications

References 22 publications

Accurate preoperative evaluation of liver mass lesions without fine-needle biopsy

Accurate preoperative evaluation of liver mass lesions without fine-needle biopsy

Ultrasound-guided Percutaneous Hepatic Mass Biopsies with 18G Cutting Needle: Our Clinical Experiences

Impact of Preoperative Fine-needle Aspiration Cytologic Examination on Clinical Outcome in Patients With Hepatocellular Carcinoma in a Tertiary Referral Center

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