Percutaneous needle biopsy of retroperitoneal lesions: technical developments

Abstract

Percutaneous Needle Biopsy (PNB) is the insertion of a needle into a suspected lesion or an organ with the aim to obtain cells or tissue for diagnosis. It's a relatively non-invasive procedure and is performed by radiologist under guidance of imaging techniques such as ultrasound (US), computed tomography (CT), fluoroscopy, magnetic resonance imaging (MRI), and positron emission tomography CT (PET-CT). The choice of imaging technique depends on the evaluation of the target lesion and patient compliance. PNB includes two categories: fine-needle aspiration biopsy (FNAB) that is the use of a thin needle (18-25 gauge) to extract cells for cytological evaluation; and core needle biopsy (CNB) that is the use of a larger needle (9-20 gauge) to extract a piece of tissue for histological evaluation. The indications for biopsy are the characterization of nature (benign or malignant) of a lesion, diagnosis and staging of tumor, and biological or immunohistochemical/genetic analisys on tissue. Success of PNB is the procurement of sufficient material to characterize lesions and to guide the patient outcome. Major complications are rare. PNB became a useful technique in diagnosis and study of retroperitoneal lesions, because of a more suitable access to specific intra-abdominal structures, lowering the risk of injury of interposed structures (such as bowel, great vessels).

Figure 1.

A 72 years old man with history of total gastrectomy for ADK. CT-guided CNB on supine patient for histological evaluation of epigastric solid lesion

Figure 2.

A 64 years old man with outcome of pulmonary lobectomy for primitive lung cancer. CT-guided CNB on prone position of retroperitoneal node: the sample permitted to confirm the metastatic nature

Figure 3.

54 years old woman with previous cervical and endometrial squamous cells carcinoma, with indeterminate right adrenal solid lesion having elevated metabolic activity at PET examination. CT guided CNB on prone position in axial view (a) and parasagittal reconstruction (b), permitted the histological diagnosis of adenoma

Figure 4.

An 81 years old woman with outcome of anterior resection of the rectum for ADK with focal thickening of posterior wall. CT-guided FNAB on prone position of the lesion confirmed recurrence of the tumor

Figure 5.

A 65 years old woman with abdominal pain; the abdominal CT demonstrate a pancreatic tail lesion. CT-guided PNB on prone position of pancreatic tail lesion showed a neuroendocrine tumor

Figure 6.

A 75 years old woman with solid exophytic lesion of left kidney. CT-guided CNB on prone position showed a renal cell carcinoma