Liver transplant biopsies with a biopsy gun

The authors evaluated the safety and efficacy of a biopsy gun for performance of image-guided percutaneous biopsy of hepatic allografts in liver transplant recipients. Two hundred fifty-two liver biopsies were performed in 58 transplant recipients over a 27-month period by using this instrument with an 18-gauge needle. Major complications occurred in two of the 252 biopsies (0.8%): One hemopneumothorax necessitated drainage with a chest tube, and one hemorrhage necessitated transfusion. No patient required surgical exploration because of a complication of the biopsy. Specimens were adequate for accurate histopathologic diagnosis in 248 of 252 procedures (98.4%). The authors conclude that image-guided percutaneous biopsy of hepatic allografts with use of the biopsy gun is a safe and accurate method of obtaining hepatic tissue from liver transplant recipients for histopathologic analysis.     

Stereotactic breast biopsy with a biopsy gun

One hundred three patients underwent stereotactic breast biopsy with an 18-, 16-, or 14-gauge cutting needle and a biopsy gun. After biopsy, a localization wire was placed and surgical biopsy performed. There was agreement of the histologic results in 89 cases (87%) including 14 of 16 cancers (87%) (kappa = 0.806). The gun biopsy yielded the correct diagnosis in four cases involving a lesion (including one cancer) that was missed at the surgical biopsy. Nine cases in which the lesion was missed at gun biopsy can be related to insufficient needle size, the greater difficulty in using one of the two stereotactic devices, and early inexperience with the technique. A 14-gauge needle was used in the last 29 biopsies, the results of which agreed with the surgical pathologic findings in 28 cases (97%). With greater experience, stereotactic-guided large-gauge automated percutaneous biopsy may prove to be an acceptable alternative to surgical biopsy in women with breast masses suspected at mammography.     

Significance of operator experience in diagnostic accuracy of biopsy gun biopsies

A total of 175 consecutive patients who had undergone a renal biopsy with a biopsy gun were evaluated retrospectively to assess the diagnostic accuracy rate of radiologists with varying experience in biopsy procedures. No statistically significant difference was found between the different operators. If provided with detailed instruction even operators with a limited amount of experience produced biopsy results equal to those of experienced operators. The automated sampling character of the biopsy gun, with a consistently high diagnostic sampling rate (96%), is believed to be responsible for these results. In a subgroup of 27 patients diagnostic accuracy was not found to be reduced in overweight patients. Correspondence to: A. Elvin     

Transjugular liver biopsy: A review of 77 biopsies using a spring-propelled cutting needle (biopsy gun)

Seventy-seven transjugular liver biopsies were performed with a coaxial, spring-loaded, 18-gauge cutting needle, the Biopty gun (Bard Biopsy System, Covington, GA, USA) on consecutive patients between July 1993 and February 1995. Fifty men and 27 women were included in the study; the mean age was 45 years (range 15–69 years). The average number of punctures per patient was 5.2, with a range of 2–9, yielding an average of 4.8 samples per patient (range 1–7). The length of the samples varied from 10 to 22 mm with a constant diameter of 1 mm. The mean time required to complete the procedure was 48 min (43–52 min). Histological diagnoses were obtained in 74 of 77 patients (96%), with non-diagnostic specimens attributed to excessive fragmentation (3 cases). Complications occurred in 10 patients (puncture site hematoma, carotid artery puncture, abdominal pain, vasovagal reaction, hepatic capsule perforation, and hemobilia). The latter two complications were self-limited. In our experience this transjugular hepatic biopsy method is promising for performing biopsies in patients with chronic liver disease, due to its high success rate and low morbidity rate.     

CT-guided percutaneous lung biopsy using a cutting needle and an automated biopsy gun. Comparison with lung biopsy using a manual aspiration needle]

Twenty-five percutaneous lung biopsies using a 20-gauge cutting needle and automated biopsy gun (ABG) were performed under CT guidance in 25 patients with thoracic lesions. This procedure was compared with that using a 21-gauge manual aspiration needle in 36 patients (40 examinations, 37 lesions) in terms of success rate, rate of correct diagnosis, mean examination time and rate of complications. Specimens obtained from lung biopsy were graded by a histopathologist according to quality and quantity from 0 to 4 (pathological score). There were no statistically significant differences between the two procedures in terms of success rate, rate of correct diagnosis and rate of complications; only the time required was significantly different. However, sufficient biopsy material and a mean pathological score of G-II 2.8 (that of G-I was 1.9, p less than 0.05) could be obtained by the biopsy procedure using the cutting needle. The above results indicated that aspiration needle biopsy was adequate for lung biopsy, but that a cutting needle and ABG should be used when a good biopsy specimen is needed for tissue diagnosis.     

Needle holder for use with a biopsy gun

The authors designed and constructed a simple needle holder device for maintaining the position of the trocar and cannula before performance of computed tomography (CT)- and ultrasonography-guided biopsies with a biopsy gun. The holder can be removed before attachment of the biopsy gun and routine obtaining of tissue. Use of the holder facilitated quicker and easier CT-guided biopsies of the liver (n = 3), pancreas (n = 1), and adrenal gland (n = 1) and of a chest wall tumor.     

Biopsy of the pancreas with a biopsy gun

Cutting-needle biopsy under ultrasonic guidance was performed in 47 patients with suspected pancreatic carcinoma. The final diagnosis as revealed by autopsy, surgery, or radiologic/clinical follow-up was pancreatic malignancy in 39 patients and benign disease in eight. A correct diagnosis with the aid of biopsy findings was obtained in 44 of the 47 patients (94%). In three patients with carcinoma of the pancreas, the correct diagnosis was not obtained with use of results from the first biopsy. In two of these three patients, simultaneous biopsy of a liver metastasis revealed the presence of a malignant tumor growth. After the biopsy, two patients had a vasovagal reaction, and two experienced mild pain. No case of biopsy-induced pancreatitis occurred, although in one patient a transient rise in the serum amylase level was seen. The present results show that cut biopsy of the pancreas is a useful, reliable, and nontraumatic method in the diagnosis of pancreatic malignancy.     

Technical note: Adaptation of the Bard prostate biopsy gun for CT-guided abdominal biopsies

The Bard prostate biopsy gun under ultrasonic guidance provides consistent, high quality prostatic core samples for histopathologic diagnosis. This device can be adapted for biopsy of abdominal organs using computed tomographic guidance. We demonstrate how these technical modifications can be made. Having used this modified device in conjunction with the 18-gauge prostate biopsy needle in 25 patients, we have had excellent results and no complications. Disclaimer: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.     

Renal biopsy in diffuse renal disease--experience with a 14-gauge automated biopsy gun.

The diagnostic and complication rates of 104 percutaneous renal biopsies performed for diffuse renal disease in native kidneys were retrospectively reviewed. Biopsies were performed by one radiologist using continuous ultrasound guidance and a 14-gauge biopsy needle in an automated gun (Biopty TM, Radiplast TM, Uppsala). 103 of 104 (99%) biopsies resulted in adequate tissue for a definitive histological diagnosis which improves on previously published diagnostic rates. Four patients (3.8%) experienced transient macroscopic haematuria. There were two symptomatic peri-renal haematomas, both of whom required transfusion, and one arteriovenous fistula which was successfully embolized (total 2.9% significant complications). Our results compare favourably with results using more conventional techniques. We suggest that use of real-time ultrasound with the 14-gauge Biopty needle should be the method of choice for percutaneous renal biopsy in adults.     

CT-guided percutaneous biopsies

The number of biopsy requests continuously increases over the years. Similarly, lesions that are not amenable to CT-guided biopsy are exceptional due to improved imaging guidance and technical advances. The needle tract should preferably go through fat, which is less painful and safer. The biopsy should be painless with the use of local anesthetics complemented by intravenous sedation. Blunt introducers and hydrodissection techniques create access to lesions without injury to vessels, bowel loops and fascias. The biopsy samples should be processed in accordance with the suspected diagnosis.     

Primary bone tumors: percutaneous needle biopsy. Radiologic-pathologic study of 222 biopsies

Findings of 222 needle biopsies were evaluated to determine the accuracy of the procedure in diagnosis, the role of the biopsy in limb-salvage procedures, the contribution of needle biopsy in the assessment of tumor effect in patients receiving chemotherapy or radiotherapy, and reasons for failure to obtain diagnostic tissue. The overall accuracy of needle biopsy in diagnosis of benign and malignant tumors was 78.6%. The major tumor categories included osteosarcoma (50 patients), giant-cell tumor (33 patients), Ewing sarcoma (22 patients), and spindle-cell sarcoma (15 patients). The accuracy of needle biopsy in diagnosis for these tumors was 78%, 88%, 95%, and 87%, respectively. The results of follow-up needle biopsy were encouraging, with roughly a 70% adequacy in the patients who had osteosarcoma and 50% in the patients who had Ewing sarcoma. The major reason for failure to obtain tissue for diagnosis in 17 of 35 patients was the presence of blastic tumors. The presence of cystic lesions and faulty technique were other reasons for failure. Percutaneous needle biopsy in patients who have primary bone tumors is a helpful diagnostic tool, forms an important part of the limb-salvage procedure, and contributes to the assessment of tumor effects in patients receiving chemotherapy or radiotherapy. To minimize failure in obtaining adequate tissue for diagnosis, biopsy specimens of blastic tumors should be obtained from their soft tissue components, lytic areas, or the least dense areas, while a smear of aspirate from cystic lesions should be prepared for cytologic examination and the clot embedded in paraffin for histologic study.     

多层螺旋CT引导BARD活检枪经皮肺穿刺活检的临床应用

目的 探讨多层螺旋CT(MSCT)导向下,用BARD活检枪细针同轴多点多向经皮肺穿刺活检的临床应用价值.方法 MSCT引导下用BARD MAGNUM自动活检枪,对68例患者行肺穿刺活检.结果 68例患者穿刺成功率100%.以手术病理或临床随访结果 为标准,定性诊断的准确率为94.1%(64例),其中鳞癌30例,腺癌21例,转移瘤7例,炎性假瘤3例,肺脓肿2例,结核1例.假阴性率为5.9%,并发症的发生率为8.8%(6例).结论 采用MSCT引导,结合BARD活检枪同轴法多点多向肺穿活检,具有定位准确、安全可靠、穿刺成功率诊断准确率高、并发症少等优点.     

Changing role of imaging-guided percutaneous biopsy of adrenal masses: evaluation of 50 adrenal biopsies

OBJECTIVE: Prior series of percutaneous imaging-guided biopsies of adrenal masses before the advent of dedicated CT and MRI of the adrenal glands have shown that 40-57% of adrenal masses biopsied were adenomas-benign lesions requiring no further evaluation or treatment. This study was performed to assess the effect of dedicated adrenal imaging with CT and MRI on the rate of percutaneous imaging-guided biopsies of adrenal masses. MATERIALS AND METHODS: We reviewed 50 consecutive adrenal mass biopsies performed during a 48-month period. The patient demographics, technique of biopsy, pathology results, and results of any prior dedicated adrenal imaging with MRI or CT protocols were noted. RESULTS: Only six (12%) of 50 biopsies were adenomas. Five of these six cases were preceded by dedicated adrenal CT or MRI. Thirty-five cases were metastatic disease, four were adrenal cortical carcinoma, three were pheochromocytoma, and two biopsies were nondiagnostic. Overall, 20 of 50 cases were preceded by a dedicated adrenal CT or MRI examination to exclude an adenoma; in 21 of the remaining 30 cases, the imaging characteristics before biopsy were inconsistent with the potential diagnosis of an adenoma and dedicated adrenal CT or MRI was not recommended. CONCLUSION: The number of adrenal adenomas biopsied has declined markedly with the introduction of dedicated adrenal CT and MRI for adrenal adenomas. Percutaneous imaging-guided biopsy is useful in confirming the presence and nature of suspected metastatic deposits to the adrenal gland and in diagnosing or excluding adrenal adenomas in patients with equivocal imaging characteristics.     

Percutaneous transhepatic endoluminal biliary biopsy with use of a 19-gauge gun.

A technique was developed to perform endoluminal biliary biopsy with use of a commercially available 19-g gun. In 18 patients, a biopsy set consisting of an outer 7-F, 50-cm sheath, an inner curved 14-g metal cannula, and a 60-cm, 19-g biopsy gun with a 20-mm throw was employed to obtain tissue from suspicious-appearing biliary strictures via preexisting transhepatic tracts. The endoluminal biopsy was positive for neoplasm in 13 of 18 cases with three false negatives, one true negative, and one patient with insufficient follow-up. One biopsy was complicated by a hepatic artery pseudoaneurysm, which was successfully treated with coil embolization.     

Percutaneous pediatric renal biopsy: use of the biopsy gun

A recently developed biopsy gun was used in the ultrasound (US)-guided biopsy of native kidneys in seven children. The biopsy gun employs a needle (18 gauge) smaller than that usually used for renal biopsies. In all seven cases it provided a core biopsy specimen that contained enough glomeruli to make a definitive histologic diagnosis of renal parenchymal disease. Use of the biopsy gun eliminated the more complicated movements needed to obtain samples with the conventional manual biopsy techniques. No major complications occurred, and in only one case a minor complication, trace hematuria determined by means of dipstick analysis, was found. The time required to obtain the tissue samples was decreased with use of this technique. Because of the advantages of the biopsy gun, the authors now use it exclusively in percutaneous US-guided biopsy of native pediatric kidneys and recommended that this method be considered by other institutions performing similar biopsies.     

Ultrasound-guided percutaneous biopsies in 2010

Ultrasound-guidance is frequently used at the time of biopsy. Its numerous advantages include: lack of ionizing radiation, real-time visualization of the needle tip, flexibility to approach lesions from variable and complex angles, wide availability of ultrasound units. A certain level of experience is nonetheless required to ensure adequate and successful lesion targeting. New software are available to assist the operators. “Electromagnetic navigation” can assist in locating the needle tip and predicting its trajectory. Image fusion with previous cross-sectional imaging studies can assist in detecting lesions that are less conspicuous on routine ultrasound images.     

Microcalcifications around a collagen-based breast biopsy marker: complication of biopsy with a percutaneous marking system

OBJECTIVE: The purpose of this article is to present the cases of four women who underwent percutaneous breast biopsy with deployment of a titanium metallic marker embedded in a bioresorbable collagen plug. Routine follow-up mammography after benign pathologic results were obtained revealed new fine microcalcifications at the biopsy sites, requiring repeat biopsy. Pathologic examination confirmed the presence of microcalcifications associated with an acidophilic foreign material. CONCLUSION: Awareness that development of microcalcifications can complicate biopsy performed with collagen-based markers is important for correct mammographic interpretation and management.