| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Original Report |
1
Department of Radiology, Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJ,
United Kingdom.
2
Department of Radiology, Royal Devon and Exeter Hospital, Exeter, Devon, EX2
5DH, United Kingdom.
3
Department of Radiology, Derriford Hospital, Plymouth, Devon, PL6 8DH, United
Kingdom.
Received February 7, 2000;
accepted after revision May 8, 2000.
Address correspondence to G. F. Maskell.
Abstract
 Top Abstract IntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
CONCLUSION. Three biopsy procedures provided inadequate samples and the biopsies were repeated, giving a total of 15 biopsy procedures. A tissue diagnosis was made in all 12 patients. All procedures were well tolerated, and no immediate or delayed complications occurred. Percutaneous core biopsy of bowel wall masses is a safe technique that allows a histologic diagnosis to be obtained in difficult cases when other methods cannot provide an adequate tissue sample.
|
TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
|
TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
Three of the 12 patients required a second biopsy because the initial sample was inadequate and provided only necrotic tissue or nonspecific inflammatory cells. The sites of the mass being biopsied in these three patients were the descending colon (CT guidance), the small bowel (sonographic guidance), and the stomach (CT guidance). In all three of these patients, one core was obtained at the first biopsy session. In each patient, two cores were obtained at the second biopsy session using the same guidance technique as at the first. The mean interval between the two sessions was 15 days.
In total, 15 biopsy procedures were performed: three of gastric lesions, two of duodenal lesions, five small-bowel lesions, and five large-bowel lesions. Percutaneous biopsy of the gastric and duodenal lesions was performed after endoscopic biopsies showed negative findings. The small-bowel biopsies were performed after small-bowel studies with abnormal findings in patients considered too unwell to undergo surgery or in whom lymphoma was suspected. The large-bowel cases were selected when colonoscopy failed to reach the lesions because of either redundant sigmoid loops or diverticular disease.
Initial CT was performed to evaluate the position, character, and anatomic location of the lesion and to select a suitable biopsy path. The lesions were then biopsied using CT or sonographic guidance, depending on accessibility. All CT biopsies were performed with a Somaton DRH or Somaton Plus 4 CT scanner (Siemens, Erlangen, Germany), and all sonographically guided biopsies were performed using an Ultramark 4 unit (Advanced Technology Laboratories, Seattle, WA). Fifteen biopsy procedures were performed in all, 10 using CT guidance and five using sonographic guidance.
After written informed consent was obtained, the skin site was washed with a bactericidal skin preparation fluid, and the skin and abdominal wall were infiltrated with 1% lignocaine. No IV conscious sedation was required for any patient. An 18-gauge Temno biopsy needle (Bauer Medical International, Santo Domingo, Dominican Republic) was used. The biopsies performed using sonography were done with a freehand technique under real-time guidance. Standard axial imaging and a direct puncture technique were used for biopsies performed with CT guidance (Fig. 1A,1B). A single core was obtained in five procedures and two cores in 10 procedures. Biopsies were performed by one of two attending radiologists. All biopsies (except for the sample of the posterior gastric wall obtained through the stomach) were performed via a route that avoided traversing the bowel lumen and targeted at the thickest part of the bowel wall (Fig. 2A,2B). Because a cytopathologist was not in attendance, the samples were placed in a preservative and were sent immediately to the laboratory. After the procedure the patients were monitored in the recovery area for 4 hr according to our standard protocol; pulse and blood pressure were observed every 30 min for 2 hr and then hourly for 2 hr. The patients were discharged if the observations were satisfactory. In eight of the 15 biopsy sessions, the patients were inpatients and the monitoring was carried out on the ward.
|
|
|
|
The clinical records and any available subsequent images of all 12 patients were reviewed retrospectively for evidence of immediate or delayed complications or evidence of tumor seeding. Five patients had repeated CT, and seven patients had only clinical follow-up. In total, five patients went on to have surgery.
|
TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
The age of the patient, biopsy site, tissue diagnosis, and mode of imaging guidance are detailed in Table 1. No immediate or delayed complications followed the biopsy, and no tumor seeding was noted at surgery, clinical follow-up, or subsequent imaging. Five patients had surgery after the biopsy at an interval of 1 week to 14 months. Four of these five patients and one who received chemotherapy also had imaging follow-up with CT over a period of 2-42 months (mean, 21 months). Seven patients, including one who had surgery, had only clinical follow-up over a period of 1-6 months (mean, 4 months).
|
|
TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
Five patients were considered too frail to undergo surgery. Of these, three declined any further treatment once the diagnosis was made, and chemotherapy was not thought to be appropriate for the other two patients. Two patients had palliative chemotherapy. Five patients had surgery; of these, three had potentially curative surgery, one had palliative surgery, and the patient with fibromatosis had surgery 14 months after the biopsy after a relapse while undergoing medical treatment.
Large series have been published describing the use of FNA of solid abdominal viscera and the gastrointestinal tract. Little has been published as to the use of core biopsy of bowel-related masses [1, 6, 7]. Studies of thoracic tumors have concluded that transthoracic cutting biopsy under imaging guidance is safe and has a higher diagnostic accuracy than does FNA biopsy, especially for benign lesions or tumors with pleomorphic characteristics such as lymphomas and thymomas [8].
Tumor seeding along the instrument pathway has been reported after FNA or core biopsy of solid and hollow viscera, and also after biliary drainage, percutaneous gastrostomy, and laparoscopic surgery. The rate of tumor seeding after FNA is said to be between one in 1000 and one in 40,000 [9], but no published data compare the rate of tumor seeding after FNA and core biopsy. The increased risk of tumor seeding caused by the larger needle diameter of a core biopsy may be balanced by a reduction in the number of needle passes. Except for disease at the skin surface, CT is needed to diagnose tumor seeding, and a limitation of our data in this respect is that follow-up CT was available in only five patients. No evidence of tumor seeding was seen at subsequent surgery or follow-up examination, but the small number of patients involved in our study and the low incidence of tumor seeding means that this study does not have sufficient power to show the true seeding rate. Given the rare occurrence of seeding after percutaneous biopsy of any type, differences between FNA and core biopsy are likely to be small.
Although perforation of the bowel is rare during percutaneous abdominal biopsies, a case has been reported after FNA of a bowel wall lesion [5]. Despite the use of a larger needle, no instances of perforation after core biopsies of bowel wall lesions have been reported in the literature, perhaps because of the relatively small number of this type of biopsy performed compared with FNAs. We attempted to reduce the risk of bowel perforation by biopsying the lesions using a route that avoided traversing the bowel lumen when possible. This route was achieved in all but one patient; the leiomyosarcoma of the posterior gastric wall was biopsied through the gastric lumen with no complications. The method of biopsying the pancreas through the stomach is well documented [10]; the stomach is a thick-walled muscular organ and may be more forgiving than the rest of the bowel. Although needle passage through the bowel is avoided when possible, biopsies of both the pancreas and the abdominal lymph nodes have been described in which the needle has passed through the small bowel or colon with no complications [10, 11]. In most of these cases, the needles were 20-, 21-, or 22-gauge. Animal experimental data suggest that an 18-gauge biopsy carries little risk of bleeding or leakage and peritonitis after biopsy through the stomach [12].
In our series, the initial success rate of 75% is less than that of core biopsies of hepatic lesions, which has been reported to be 90% [2]. However, our rate is comparable to the reported success rates of FNA of bowel wall lesions (59-92%) [5, 7]. Our rate is less successful than the 100% success rate for a series of 10 patients reported by Tudor et al. [6], which may be because in that series an average of two specimens was obtained for each patient initially. When we started to perform this relatively new procedure, we were eager to limit any complications and thought that it was preferable to recall the patient if the first biopsy sample was inadequate. In our series only two of five procedures that obtained one core provided a satisfactory specimen.
We would advocate that a cytopathologist be in attendance to comment on the suitability of the first biopsy, but if that is not possible, then two passes should be performed at the first session.
Although the number of patients in our study is small, we believe that core biopsy of the hollow organs of the gastrointestinal tract is a useful method for obtaining pathology specimens for histologic examination when endoscopic methods have failed. Core biopsy provides larger tissue specimens than FNA techniques and, in our experience, can be carried out safely. Core biopsy should be considered as an alternative to FNA when obtaining tissue percutaneously from lesions of the bowel wall.
|
TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
 |
|
  S. H. Kim, J. K. Han, K. H. Lee, C. J. Yoon, Y. I. Kim, H. S. Lee, and B. I. Choi Experimentally Induced Small-Bowel Tumor in Rabbits: US-guided Percutaneous 18-gauge Core Biopsy Radiology, April 1, 2004; 231(1): 150 - 155. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. M. Ho, J. Thomas, S. A. Fine, and E. K. Paulson Usefulness of Sonographic Guidance During Percutaneous Biopsy of Mesenteric Masses Am. J. Roentgenol., June 1, 2003; 180(6): 1563 - 1566. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
