Ultrasound guided percutaneous fine needle aspiration biopsy / automated needle core biopsy of abdominal lesions: Effect on management and cost effectiveness

Abstract

Aims: This prospective study was designed to determine whether ultrasound (US)-guided percutaneous fi ne needle aspiration biopsy (PFNAB)/US-guided percutaneous needle core biopsy (PNCB) of abdominal lesions is effi cacious in diagnosis, is helpful in treatment choice, to evaluate whether various other investigations can be avoided, especially invasive ones, its time (shortening hospitalization) and cost-effectiveness. Materials and Methods: A total 159 US-guided PFNAB (67) and US-guided automated PNCB (92) of abdominal lesions were performed percutaneously in 150 patients; the youngest patient was a 3-month-old female and eldest was a 75-year-old female. The patient selection was irrespective of age, sex, or location of the abdominal lesion. These patients presented with abdominal mass/lesions, suspected malignancy, jaundice, and in some cases, however, biopsy was performed to determine the nature of indeterminate lesion (malignant / benign versus abscesses). They were 47 hepatobiliary, 6 pancreas, 24 gastrointestinal tract (GIT), 20 kidneys and urinary bladder, 20 prostate, 3 lymph nodes, 4 adrenals, 8 retroperitoneal, 13 ovaries, and 9 other types of lesions. We used free-hand technique (without biopsy attachment) in 129 cases, and transrectal and transvaginal with biopsy attachment was used in 30 cases. Results: In 91.99% of cases, US-guided PFNAB/US-guided PNCB contributed signifi cantly to diagnosis in which USguided PFNAB/US-guided PNCB was the diagnostic test in 23.33% cases. It confi rmed a highly suspected diagnosis in 64% patients, and indicated a specifi c diagnosis that was not suspected in the remaining 36%. In 57.33% cases, the results of US-guided PFNAB/US-guided PNCB, did not alter treatment choice but increased physician confi dence in the choice. US-guided PFNAB/US-guided PNCB was responsible in avoiding 107 planned investigations, including 8 laparotomies, with no signifi cant complications and decreasing length of stay and resulting in 20% cost savings. Conclusions: Thus, the US-guided PFNAB/US-guided PNCB contributed signifi cantly in diagnosis, and in most of the cases it did not change treatment choice but increased clinicians confi dence in the choice. We can avoid the number of investigations, decrease morbidity and mortality, shorten hospitalization and cost by using these methods.Key-words: Biopsy, cost-effectiveness, effect on diagnosis, effect on treatment, percutaneous fi ne needle aspiration biopsy, percutaneous needle core biopsy, ultrasound RésuméObjectifs: Cette étude prospective a été conçue afi n de déterminer si l'échographie (US)-guidé percutanée fi ne aiguille biopsie d'aspiration (PFNAB) / biopsie guidée par U.S. percutanée aiguille (PNCB) des lésions abdominales est effi cacious en diagnostic, est utile dans le choix de traitement, d'évaluer si les divers autres enquêtes peuvent être évités, surtout envahissantes, son temps (raccourcissement hospitalisation) et la rentabilité.

A Systematic Review of Health Economic Evaluations of Diagnostic Biomarkers

“…Genetic testing was employed for treatment selection in patients ( N = 7) [ 40 – 46 ] or to test for a familial disease in patients and their relatives ( N = 6) [ 47 – 52 ]. Biomarkers were applied to diagnose several types of cancer ( N = 23) [ 20 , 21 , 24 – 30 , 32 – 40 , 44 – 48 ], cardiovascular/circulatory diseases ( N = 9) [ 22 , 23 , 31 , 41 , 43 , 49 – 52 ], and respiratory disease ( N = 1) [ 42 ]. Economic evaluations were most often performed in colorectal cancer and evaluated genetic testing strategies like testing of BRAF and KRAS genetic mutations.…”

Fine needle aspiration of abdominal organs: a review of current recommendations for achieving a diagnostic sample

“…A study by Gani et al ( 2011 ) of 67 cases concluded that the FNA procedure played a significant role in obtaining a diagnosis in the majority of patients, with no major clinical complications observed. In the veterinary world, the success of obtaining a diagnosis using FNA for abdominal organs is variable.…”

Fine needle biopsy of abdominal organs in dogs – indications, contraindications and performance technique

“…Numerous studies carried out in human medicine also confirmed that FNF is safety and represents the effectiveness of biopsy (Gazelle at al. 1992, Vignoli and Saunders 2009, Gani at al. 2011).…”

“…Prior to biopsy an ultrasound examination must be performed in order to precisely evaluate location of lesions, their size and depth of situation as well as to determine the best biopsy needle insertion site (Wang at al. 2004, Gani at al. 2011.…”

“…Fine needle aspiration biopsy (FNAB) is a more and more frequently used diagnostic technique allowing the collection of cell material for cytological and microbiological examinations (Barr 1995, Britton 1999, Gani at al. 2011, Wypij 2011.…”