Computed tomography-guided percutaneous biopsy of abdominal lesions: indications, techniques, results, and complications

Abstract

Objective: To evaluate the performance of computed tomography (CT)-guided percutaneous biopsy of abdominal lesions.

Materials and methods: This retrospective, single-center study evaluated patients submitted to CT-guided percutaneous biopsy of abdominal lesions at a cancer center, between January 2014 and June 2015. The images and patient medical records were reviewed using a standardized data collection form.

Results: We included 225 procedures performed in 212 patients, of whom 143 (63.5%) had a prior diagnosis of cancer. Of the 225 lesions biopsied, 88 (39.1%) had a suspected primary origin and 137 (60.9%) were suspected metastatic lesions. Complications occurred in only 14 (6.2%), the most common being self-limited bleeding, which occurred in 12 (85.7%) of the 14. The occurrence of complications was not found to be significantly associated with the lesion location, age of the patient, presence of comorbidities, use of a supplementary technique, vascularization pattern, or proximity of the lesion to large vessels. The pathology findings were sufficient for making the diagnosis in 202 cases (89.8%), and the diagnosis was consistent with the clinical suspicion in 132 (58.6%).

Conclusion: The procedure demonstrated a high (approximately 90%) rate of providing a sufficient sample for the diagnosis and a low complication rate, the most common complication being self-limiting bleeding.

Keywords: Abdominal neoplasms/diagnostic imaging; Image-guided biopsy; Tomography, X-ray computed.

Figure 1

CT-guided percutaneous biopsy using direct access. A: Non-contrast-enhanced axial CT scan of the abdomen showing an expansile lesion in the pancreatic body. B: Contrast-enhanced axial CT scan of the abdomen showing the path of the coaxial needle through a posterior paravertebral approach.

Figure 2

CT-guided percutaneous biopsy using the hydrodissection technique. A-C: A schematic CT image of the thorax showing the path from the skin to the lesion in the head of the pancreas, with interposition of intestinal loops along the needle path (A), which are displaced after administration of liquid (B,C), allowing the needle to be advanced safely. D: Axial CT scan showing proper positioning of the needle in the lesion to perform the biopsy. (Images courtesy of Dr. João Paulo Kawaoka Matsushita Jr.).

Figure 3

CT-guided percutaneous biopsy using the trans-organ approach. A: Contrast-enhanced axial CT scan of the abdomen showing an expansile lesion in the pancreatic head and body. B: Axial CT scan of the abdomen, showing the path of the coaxial needle through the liver to the pancreatic lesion.