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Möller K, Dietrich CF, Faiss S, Mutze S, Goelz L. [Alternatives of histological material collection - When and how is histological confirmation by ultrasound (US), computer tomography (CT) or endosonography (EUS) useful?]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 60:937-958. [PMID: 34781389 DOI: 10.1055/a-1482-9448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Histological classifications of tumorous lesions together with adequate staging are necessary for stage-appropriate and personalized therapies. The indications, technical possibilities, and limitations as well as potential complications of image-guided needle biopsy by ultrasound, computed tomography, and endosonography are described. Which procedure for which organ and which lesion?
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Affiliation(s)
- Kathleen Möller
- Klinik für Innere Medizin/Gastroenterologie, Berlin, Germany, SANA-Klinikum, Berlin, Germany
| | | | - Siegbert Faiss
- Klinik für Innere Medizin/Gastroenterologie, Berlin, Germany, SANA-Klinikum, Berlin, Germany
| | - Sven Mutze
- Institut für Radiologie und Neuroradiologie, BG Unfallkrankenhaus Berlin, Berlin, Germany.,Institut für Radiologie, SANA-Klinikum, Berlin, Germany.,Institut für Diagnostische Radiologie, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Leonie Goelz
- Institut für Radiologie und Neuroradiologie, BG Unfallkrankenhaus Berlin, Berlin, Germany.,Institut für Diagnostische Radiologie, Universitätsmedizin Greifswald, Greifswald, Germany
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Neal D, Robila V, Chesney A, Sayeed S. Fine needle aspiration and core needle biopsy of the spleen: A case series illustrating current practices and challenges. Diagn Cytopathol 2021; 49:1196-1206. [PMID: 34546006 DOI: 10.1002/dc.24876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 08/30/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Splenic fine needle aspiration (FNA) and core needle biopsies (CNB) are rare specimen types, potentially avoided due to clinical concern for hemorrhagic complications. The safety and utility of splenic FNA, the role of rapid onsite evaluation (ROSE), as well as the diagnostic utility of CNB versus FNA have not been recently reviewed. MATERIALS AND METHODS A 10-year retrospective review was performed of percutaneous image-guided FNA and CNB of the spleen. Clinical indications, outcomes, ROSE findings, and final diagnoses were reviewed and correlated. RESULTS Forty-four specimens from 39 patients were identified. The commonest indication for biopsy was a radiographic mass found during assessment for patient complaint (45%, 20/44), evaluation for malignancy (primary or metastatic) (39%, 17/44), and incidentally (16%, 7/44). Malignant diagnoses were rendered in 10 cases, 80% hematolymphoid and 20% nonhematolymphoid. Thirty-one cases were nonneoplastic and identified as infectious/inflammatory processes 39%, cysts 10%, vascular lesions 13%, benign splenic elements 22%, accessory or atrophic spleen 10%, and extramedullary hematopoiesis 6%. The nondiagnostic rate was 7%. Cases with subsequent splenectomy showed 100% specificity and 86% sensitivity. The concordance of ROSE and final interpretation was 90% within the neoplastic category. Finally, the significant complication rate was 6.8% with no bias to occurrence following FNA or CNB. CONCLUSIONS This series affirms the safety and efficacy of splenic FNA and CNB by complication rates comparable to prior studies and high rate of concordance. The diagnostic accuracy may be further improved by ROSE, and CNB in cases reliant on staining and tissue architecture.
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Affiliation(s)
- Daniel Neal
- Virginia Commonwealth University Health, Richmond, Virginia, USA
| | - Valentina Robila
- Virginia Commonwealth University Health, Richmond, Virginia, USA
| | - Alden Chesney
- Virginia Commonwealth University Health, Richmond, Virginia, USA
| | - Sadia Sayeed
- Virginia Commonwealth University Health, Richmond, Virginia, USA
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Sangiorgio VFI, Rizvi H, Padayatty J, Thayur N, Fujiwara T, Anyanwu FA, Calaminici M. Radiologically guided percutaneous core needle biopsy of the spleen: a reliable and safe diagnostic procedure for neoplastic and reactive conditions. Histopathology 2021; 78:1051-1055. [PMID: 33393079 DOI: 10.1111/his.14327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/02/2021] [Indexed: 01/05/2023]
Abstract
RATIONALE Percutaneous core needle biopsy (CNB) of the spleen is rarely performed, due to concerns about its complications and low diagnostic yield. However, this procedure represents a potentially useful diagnostic tool, especially in patients with splenomegaly and no definitive diagnosis after a clinical and radiological work-up. METHODS AND RESULTS We report the data on a cohort of 45 radiologically guided percutaneous core needle biopsies of the spleen from 44 patients performed at two centres. Platelet count and prothrombin time were within normal limits in all patients at the time of the procedure. The biopsy was ultrasound-guided in all cases except one, which was guided by computed tomography. An 18G needle was used in 82% of the cases, followed by 16G (10.2%) and 20G (7.8%) needles. The biopsy provided sufficient material for histological examination (including immunohistochemical studies) in 41 cases (91.1%). Haematological malignancies were most commonly diagnosed (52.3%); diffuse large B cell lymphoma (DLBCL) was the most frequent, followed by splenic marginal zone lymphoma (SMZL). For the most recent cases of DLBCL, the CNB provided sufficient material for fluorescence in-situ hybridisation to assess the status of MYC, BCL2 and BCL6. This allowed the identification of a case of high-grade B cell lymphoma with MYC and BCL2 rearrangement. Major complications were not reported; minor complications occurred in three cases (6.7%). CONCLUSIONS Our data demonstrate that radiologically guided percutaneous CNB should be considered as a valid diagnostic tool, as it provides quick and reliable histological diagnoses avoiding the complications and risks of splenectomy.
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Affiliation(s)
| | - Hasan Rizvi
- Department of Cellular Pathology, the Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Joseph Padayatty
- Department of Haematology, Colchester General Hospital, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Nagendra Thayur
- Department of Radiology, Colchester General Hospital, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Taiki Fujiwara
- Department of Cellular Pathology, the Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Francis A Anyanwu
- Department of Haematology, Colchester General Hospital, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Maria Calaminici
- Department of Cellular Pathology, the Royal London Hospital, Barts Health NHS Trust, London, UK
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Mosquera-Klinger G, de la Serna Higuera C, Bazaga S, García-Alonso FJ, Sánchez Ocaña R, Antolín Melero B, de Benito Sanz M, Madrigal B, Torres Á, Pérez-Miranda M. Endoscopic ultrasound-guided fine-needle aspiration for splenomegaly and focal splenic lesion: is it safe, effective and necessary? REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS 2020; 112. [DOI: 10.17235/reed.2020.6667/2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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5
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Hanlon K, Wilson MR, Kay D, Jackson B, Leach M. Safety and diagnostic yield of splenic core biopsy; a methodical approach using combined Haematology/Radiology assessment in a tertiary referral centre. Br J Haematol 2019; 186:371-373. [PMID: 30873597 DOI: 10.1111/bjh.15867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Katharine Hanlon
- Department of Haematology Beatson West of Scotland Cancer Centre GlasgowUK
| | - Matthew R. Wilson
- Department of Haematology Beatson West of Scotland Cancer Centre GlasgowUK
| | - David Kay
- Department of Radiology Queen Elizabeth University Hospital GlasgowUK
| | - Bob Jackson
- Department of Pathology Queen Elizabeth University Hospital Glasgow UK
| | - Mike Leach
- Department of Haematology Beatson West of Scotland Cancer Centre GlasgowUK
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Patel N, Dawe G, Tung K. Ultrasound-guided percutaneous splenic biopsy using an 18-G core biopsy needle: our experience with 52 cases. Br J Radiol 2015; 88:20150400. [PMID: 26337505 DOI: 10.1259/bjr.20150400] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The spleen is more commonly affected in multiorgan disease, but alternative sites are selected for biopsy owing to perceived haemorrhage risk. If these sites are inaccessible or, less commonly, the spleen is the only disease site, then splenic biopsy is considered, with most studies using a 20- to 22-G needle. The primary aim of biopsy is to exclude underlying malignancy or to obtain histological analysis in known malignancy, usually lymphoma, when reclassification is required for therapy. We present, to our knowledge, the largest series of 18-G ultrasound-guided splenic core needle biopsy assessing diagnostic and complication rates. METHODS All ultrasound-guided splenic biopsy cases from May 1990 to May 2015 were identified on the radiology information system. Histological diagnosis and complications were identified from laboratory reports, case notes and discharge summaries to assess diagnostic positive and complication rates. Haemorrhages requiring transfusion, embolization or splenectomy, pneumothorax, other significant intra-abdominal injury or death are classified as major complications, whilst conservative haemorrhage management is considered a minor complication. RESULTS A total of 52 splenic biopsies were performed in 47 patients. A positive diagnostic yield for all biopsies was 90.4%. The major and minor complication rates were 0% and 1.9% (1/52), respectively. CONCLUSION Ultrasound-guided 18-G splenic biopsy is a safe and accurate procedure with no added risk of complications when compared with smaller needles or biopsy of other abdominal organs. ADVANCES IN KNOWLEDGE This is the largest case series of ultrasound-guided splenic biopsy with an 18-G needle, and our experience confirms a high diagnostic yield and a complication rate which compares favourably with the biopsy of other abdominal organs.
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Affiliation(s)
- Nirav Patel
- Department of Radiology, Southampton General Hospital, Southampton, UK
| | - Gemma Dawe
- Department of Radiology, Southampton General Hospital, Southampton, UK
| | - Ken Tung
- Department of Radiology, Southampton General Hospital, Southampton, UK
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Tokue H, Hirasawa S, Morita H, Koyma Y, Miyazaki M, Shibuya K, Tokue A, Nakano S, Tsushima Y. Percutaneous image-guided biopsy for non-mass-forming isolated splenomegaly and suspected malignant lymphoma. PLoS One 2014; 9:e111657. [PMID: 25365519 PMCID: PMC4218790 DOI: 10.1371/journal.pone.0111657] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 10/06/2014] [Indexed: 11/30/2022] Open
Abstract
Background The aim of this study was to evaluate the accuracy, safety, and role of splenic biopsy in the management of patients with non-mass-forming isolated splenomegaly and suspected malignant lymphoma. Methods Between 2001 and 2013, 137 biopsies were performed under computed tomography (CT) fluoroscopic guidance in 39 patients. All patients had splenomegaly based on the CT findings and a suspected diagnosis of malignant lymphoma based on their clinical symptoms. The spleen was the only accessible site to perform a biopsy, and no mass lesions could be identified in the spleen. Results The overall sensitivity, specificity, and diagnostic accuracy of image-guided biopsy for malignant lymphoma were 88%, 100% and 92%, respectively. Major complications occurred in 3 patients. In 1 patient, transcatheter arterial embolization was performed due to hemorrhage, and two patients needed blood transfusion because of hematoma development, without the need for further treatment. Conclusions Image-guided splenic core-needle biopsy is a safe and accurate technique with a high diagnostic accuracy in most patients who with non-mass-forming isolated splenomegaly and suspected underlying malignant lymphoma.
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Affiliation(s)
- Hiroyuki Tokue
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Gunma, Japan
- Department of Radiology, Maebashi Red Cross Hospital, Gunma, Japan
- * E-mail:
| | - Satoshi Hirasawa
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Gunma, Japan
| | - Hideo Morita
- Department of Radiology, Maebashi Red Cross Hospital, Gunma, Japan
| | - Yoshinori Koyma
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Gunma, Japan
| | - Masaya Miyazaki
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Gunma, Japan
| | - Kei Shibuya
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Gunma, Japan
| | - Azusa Tokue
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Gunma, Japan
| | - Sachiko Nakano
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Gunma, Japan
| | - Yoshito Tsushima
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Gunma, Japan
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Cavanna L, Mordenti P, Bertè R, Palladino MA, Biasini C, Anselmi E, Seghini P, Vecchia S, Civardi G, Di Nunzio C. Ultrasound guidance reduces pneumothorax rate and improves safety of thoracentesis in malignant pleural effusion: report on 445 consecutive patients with advanced cancer. World J Surg Oncol 2014; 12:139. [PMID: 24886486 PMCID: PMC4016786 DOI: 10.1186/1477-7819-12-139] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malignant pleural effusion (MPE) is an extremely common problem affecting cancer patients, and thoracentesis is an essential procedure in an attempt to delineate the etiology of the fluid collections and to relieve symptoms in affected patients. One of the most common complications of thoracentesis is pneumothorax, which has been reported to occur in 20% to 39% of thoracenteses, with 15% to 50% of patients with pneumothorax requiring tube thoracostomy.The present study was carried out to assess whether thoracenteses in cancer patients performed with ultrasound (US) guidance are associated with a lower rates of pneumothorax and tube thoracostomy than those performed without US guidance. METHODS A total of 445 patients were recruited in this retrospective study. The medical records of 445 consecutive patients with cancer and MPE evaluable for this study, undergoing thoracentesis at the Oncology-Hematology and Internal Medicine Departments, Piacenza Hospital (Italy) were reviewed. RESULTS From January 2005 to December 2011, in 310 patients (69.66%) thoracentesis was performed with US guidance and in 135 (30.34%) without it. On post-thoracentesis imaging performed in all these cases, 15 pneumothoraces (3.37%) were found; three of them (20%) required tube thoracostomy. Pneumothorax occurred in three out of 310 procedures (0.97%) performed with US guidance and in 12 of 135 procedures (8.89%) performed without it (P<0.0001). It must be emphasized that in all three patients with pneumothorax requiring tube thoracostomy, thoracentesis was performed without US guidance. CONCLUSIONS The routine use of US guidance during thoracentesis drastically reduces the rate of pneumothorax and tube thoracostomy in oncological patients, thus improving safety as demonstrated in this study.
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Affiliation(s)
- Luigi Cavanna
- Oncology-Hematology Department, Piacenza Hospital, Via Taverna, 49, 29121 Piacenza, Italy
| | - Patrizia Mordenti
- Oncology-Hematology Department, Piacenza Hospital, Via Taverna, 49, 29121 Piacenza, Italy
| | - Raffaella Bertè
- Oncology-Hematology Department, Piacenza Hospital, Via Taverna, 49, 29121 Piacenza, Italy
| | - Maria Angela Palladino
- Oncology-Hematology Department, Piacenza Hospital, Via Taverna, 49, 29121 Piacenza, Italy
| | - Claudia Biasini
- Oncology-Hematology Department, Piacenza Hospital, Via Taverna, 49, 29121 Piacenza, Italy
| | - Elisa Anselmi
- Oncology-Hematology Department, Piacenza Hospital, Via Taverna, 49, 29121 Piacenza, Italy
| | - Pietro Seghini
- Unit of Biostatistics and Epidemiology, Piacenza Hospital, Via Taverna, 49, 29121 Piacenza, Italy
| | - Stefano Vecchia
- Laboratory of Cancer Chemotherapy Unit (UFA), Piacenza Hospital, Via Taverna, 49, 29121 Piacenza, Italy
| | - Giuseppe Civardi
- Internal Medicine, Fiorenzuola Hospital, 29017 Fiorenzuola D’Arda, Italy
| | - Camilla Di Nunzio
- Oncology-Hematology Department, Piacenza Hospital, Via Taverna, 49, 29121 Piacenza, Italy
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Sammon J, Twomey M, Crush L, Maher MM, O'Connor OJ. Image-guided percutaneous splenic biopsy and drainage. Semin Intervent Radiol 2013; 29:301-10. [PMID: 24293803 DOI: 10.1055/s-0032-1330064] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Percutaneous splenic biopsy and drainage are relatively safe and accurate procedures. The risk of major complication (1.3%) following percutaneous splenic biopsy does not exceed that of other solid intra-abdominal organ biopsies, and it has less morbidity and mortality than splenectomy. Both computed tomography and ultrasound can be used to provide image guidance for biopsy and drainage. The safety profile of fine-needle aspiration cytology is better than core needle biopsy, but core biopsy has superior diagnostic accuracy.
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Affiliation(s)
- Jennifer Sammon
- Department of Radiology, Cork University Hospital and University College Cork, Wilton, Cork, Ireland
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10
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Hu Q, Naushad H, Xie Q, Al-Howaidi I, Wang M, Fu K. Needle-core biopsy in the pathologic diagnosis of malignant lymphoma showing high reproducibility among pathologists. Am J Clin Pathol 2013; 140:238-47. [PMID: 23897261 DOI: 10.1309/ajcp9zagkvj8pdax] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To evaluate the role of needle-core biopsy in the pathologic diagnosis of lymphoma. METHODS One hundred and five cases with clinical suspicion for lymphoma were studied by 3 hematopathologists mimicking daily diagnostic service. The diagnostic result sheets were analyzed for diagnostic accuracy and reproducibility. The histologic pattern recognition by the 3 hematopathologists was also analyzed. RESULTS The overall diagnostic accuracy, based on the consensus diagnosis, was 85% to 87%. High reproducibility of diagnosis in lymphoma was observed among pathologists. The tissue size was associated with the percentage of definitive diagnosis. Histologic patterns were well recognized on core tissues. CONCLUSIONS Needle-core biopsy is an effective technique for the diagnosis of lymphoma and should be considered the first-line procedure for cases with suspicion for lymphoma.
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Affiliation(s)
- Qinglong Hu
- Department of Pathology, Alegent Creighton Health, Omaha, NE
| | - Hina Naushad
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha
| | | | - Islam Al-Howaidi
- Department of Internal Medicine, Creighton University Medical Center, Omaha, NE
| | - Minghua Wang
- Department of Pathology, Hainan Medical University Affiliated Hospital, Haikou, China
| | - Kai Fu
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha
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Radhakrishnan A, Mayhew PD. Laparoscopic Splenic Biopsy in Dogs and Cats: 15 Cases (2006–2008). J Am Anim Hosp Assoc 2013; 49:41-5. [DOI: 10.5326/jaaha-ms-5823] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This retrospective study describes a technique and evaluates outcome associated with laparoscopic splenic biopsy in dogs and cats. Medical records of dogs (n = 10) and cats (n = 5) that had a laparoscopic splenic biopsy performed as part of their diagnostic evaluation for systemic disease were evaluated. Splenic biopsies were performed with the patient in dorsal recumbency using a two-portal approach. In some cases, concurrent organ biopsy was also performed. A pair of 5 mm cup biopsy forceps was used for biopsy collection, and an absorbable gelatin hemostatic sponge was placed at the biopsy site to aid in hemostasis. All patients recovered without major complications. Conversion to an open surgical approach was not required. Median survival time was 180 days, and nine patients were alive at the time of manuscript preparation. Four patients were diagnosed with neoplasia; however, only one had neoplasia involving the spleen. Median survival time for the nonneoplasia group (n = 11) was 300 days. Eight of those patients were alive at time of manuscript preparation. Minimal morbidity was observed in this cohort of clinical patients. Histopathology may be preferred over cytology in some clinical situations, and laparoscopic splenic biopsy provides a minimally invasive diagnostic option.
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Affiliation(s)
- Anant Radhakrishnan
- Bluegrass Veterinary Specialists, Lexington, KY (A.R.); and Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA (P.M.)
| | - Philipp D. Mayhew
- Bluegrass Veterinary Specialists, Lexington, KY (A.R.); and Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA (P.M.)
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Singh AK, Shankar S, Gervais DA, Hahn PF, Mueller PR. Image-guided percutaneous splenic interventions. Radiographics 2012; 32:523-34. [PMID: 22411947 DOI: 10.1148/rg.322115135] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In the spleen, image-guided interventional procedures such as biopsy and catheter drainage have not been widely performed because of the perceived increased risk of complications. The ability of image-guided biopsy to allow tissue diagnosis of a focal splenic mass without the need for splenectomy is the driving force behind use of this procedure in oncology patients. The literature on image-guided splenic biopsy suggests that the highest biopsy yield is achieved with core biopsy and the lowest complication rate is achieved with fine-needle aspiration. Image-guided catheter drainage is an effective alternative to splenectomy for management of infected splenic collections. In clinical practice, image-guided splenic biopsy, fluid aspiration, and catheter drainage have high success rates. Image-guided alcohol ablation is effective in treatment of splenic cysts. The literature on splenic radiofrequency ablation (RFA) is sparse; therefore, further studies are needed to determine the role of RFA in management of splenic neoplasms and hypersplenism. Image-guided percutaneous thrombin injection can be used to treat splenic artery pseudoaneurysms. Awareness of the correct interventional techniques and their limitations is important for safe performance of image-guided percutaneous splenic interventions.
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Affiliation(s)
- Ajay K Singh
- Department of Radiology, Division of Emergency Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114, USA.
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13
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Effectiveness and safety of minilaparoscopy-guided spleen biopsy: a retrospective series of 57 cases. Surg Endosc 2012; 26:2416-22. [DOI: 10.1007/s00464-012-2190-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 01/23/2012] [Indexed: 10/28/2022]
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Cavanna L, Cordani MR, Biasini C, Di Nunzio C, Monfredo M, Stroppa E, Muroni M, Ambroggi M, Muroni L, Di Cicilia R, Cremona G, Nobili E, Zaffignani E, Civardi G. Ultrasound-guided Central Venous Catheterization for Home Parenteral Nutrition and Hydratation in Advanced Incurable Cancer Patients: Results of A Prospective Observational Study. World J Oncol 2011; 2:238-244. [PMID: 29147254 PMCID: PMC5649685 DOI: 10.4021/wjon390e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2011] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Most patients with advanced cancer are frequently malnourished and frequently they develop decreased oral fluid intake and dehidratation. Home parenteral nutrition (HPN) is an increasingly used therapy for patients with advanced cancer. A central venous access device is often an essential component allowing parenteral nutrition and hidratation. However central venous catheter (CVC) insertion represents a risk for pneumothorax or other mechanical complications. This study aimed to determine the reduction of risks related to central venous catheter positionement in the setting of cancer patients with palliative programm. METHODS Consecutive patients with a variety of cancer in advanced phase requiring palliative care who were undergoing placement of central venous catheter for parenteral nutrition or hydratation have been prospectively studied in a program of ultrasound-guided CVC placement. Four types of possible complications were defined:mechanical, thrombotic, infection and malfunctioning. After sterilization, local anesthesia is applied and a 7.5 MHZ puncturing US probe is placed in the supraclavicular site and a 16-gauge needle is advanced under real-time US guidance, into the last portion of internal jugular vein by experienced physicians. The Seldinger tecnique is used to place the catheter that is advanced into the superior vena cava until insertion to right atrium. Two hours after each procedure a chest X-ray and US scanning are carried out to confirm CVC position and rule out a pneumotorax. RESULTS From 30 October 2000 to 31 October 2008: 209 CVC insertional procedure were applied in 207 patients with cancer in the palliative phase only. There were 101 women and 106 men with a mean age of 67.68 year (range 22-86). A single needle puncture of the vein was performed on 206 of 209 procedures (98.6%), the technique was efficacious at the first attempt in 98.6% of cases, in 2 patients (0.96%) the CVC was positioned at the second attempt. The procedure failed only one case (0.44%). No cases of pneumothorax, of major bleeding or nerve punctured were reported. Symptomatic vein thrombosis developed in one patient (0.44%). Infection episodes were reported in two cases. Mean time for CVC permanence was 92.5±9.1 days (range 8-158). CONCLUSION This study indicates that US-guided CVC insertion is a safe, cheap procedure for cancer patients in advanced phase and with palliative program, allowing parenteral nutrition and hydratation.
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Affiliation(s)
- Luigi Cavanna
- Azienda Ospedaliera “Guglielmo da Saliceto”, Oncology and Hematology Department, Oncology Unit, Via Taverna 49, 29100 Piacenza, Italy
| | - Maria Rosa Cordani
- Azienda Ospedaliera “Guglielmo da Saliceto”, Oncology and Hematology Department, Oncology Unit, Via Taverna 49, 29100 Piacenza, Italy
| | - Claudia Biasini
- Azienda Ospedaliera “Guglielmo da Saliceto”, Oncology and Hematology Department, Oncology Unit, Via Taverna 49, 29100 Piacenza, Italy
| | - Camilla Di Nunzio
- Azienda Ospedaliera “Guglielmo da Saliceto”, Oncology and Hematology Department, Oncology Unit, Via Taverna 49, 29100 Piacenza, Italy
| | - Michela Monfredo
- Azienda Ospedaliera “Guglielmo da Saliceto”, Oncology and Hematology Department, Oncology Unit, Via Taverna 49, 29100 Piacenza, Italy
| | - Elisa Stroppa
- Azienda Ospedaliera “Guglielmo da Saliceto”, Oncology and Hematology Department, Oncology Unit, Via Taverna 49, 29100 Piacenza, Italy
| | - Monica Muroni
- Azienda Ospedaliera “Guglielmo da Saliceto”, Oncology and Hematology Department, Oncology Unit, Via Taverna 49, 29100 Piacenza, Italy
| | - Massimo Ambroggi
- Azienda Ospedaliera “Guglielmo da Saliceto”, Oncology and Hematology Department, Oncology Unit, Via Taverna 49, 29100 Piacenza, Italy
| | - Lara Muroni
- Azienda Ospedaliera “Guglielmo da Saliceto”, Oncology and Hematology Department, Oncology Unit, Via Taverna 49, 29100 Piacenza, Italy
| | - Roberto Di Cicilia
- Azienda Ospedaliera “Guglielmo da Saliceto”, Oncology and Hematology Department, Oncology Unit, Via Taverna 49, 29100 Piacenza, Italy
| | - Gabriele Cremona
- Azienda Ospedaliera “Guglielmo da Saliceto”, Oncology and Hematology Department, Oncology Unit, Via Taverna 49, 29100 Piacenza, Italy
| | - Elisabetta Nobili
- Azienda Ospedaliera “Guglielmo da Saliceto”, Oncology and Hematology Department, Oncology Unit, Via Taverna 49, 29100 Piacenza, Italy
| | - Elena Zaffignani
- Azienda Ospedaliera “Guglielmo da Saliceto”, Oncology and Hematology Department, Oncology Unit, Via Taverna 49, 29100 Piacenza, Italy
| | - Giuseppe Civardi
- Azienda Ospedaliera “Guglielmo da Saliceto”, Oncology and Hematology Department, Oncology Unit, Via Taverna 49, 29100 Piacenza, Italy
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15
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McInnes MDF, Kielar AZ, Macdonald DB. Percutaneous Image-guided Biopsy of the Spleen: Systematic Review and Meta-Analysis of the Complication Rate and Diagnostic Accuracy. Radiology 2011; 260:699-708. [DOI: 10.1148/radiol.11110333] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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16
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Cavanna L, Civardi G, Vallisa D, Di Nunzio C, Cappucciati L, Bertè R, Cordani MR, Lazzaro A, Cremona G, Biasini C, Muroni M, Mordenti P, Gorgni S, Zaffignani E, Ambroggi M, Bidin L, Palladino MA, Rodinò C, Tibaldi L. Ultrasound-guided central venous catheterization in cancer patients improves the success rate of cannulation and reduces mechanical complications: a prospective observational study of 1,978 consecutive catheterizations. World J Surg Oncol 2010; 8:91. [PMID: 20958986 PMCID: PMC2984400 DOI: 10.1186/1477-7819-8-91] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 10/19/2010] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A central venous catheter (CVC) currently represents the most frequently adopted intravenous line for patients undergoing infusional chemotherapy and/or high-dose chemotherapy with hematopoietic stem-cell transplantation and parenteral nutrition. CVC insertion represents a risk for pneumothorax, nerve or arterial punctures. The aim of this prospective observational study was to explore the safety and efficacy of CVC insertion under ultrasound (US) guidance and to confirm its utility in clinical practice in cancer patients. METHODS Consecutive adult patients attending the oncology-hematology department were eligible if they had solid or hematologic malignancies and required CVC insertion. Four types of possible complication were defined a priore: mechanical, thrombotic, infection and malfunctioning. The patient was placed in Trendelenburg's position, a 7.5 MHZ puncturing US probe was placed in the supraclavicular site and a 16-gauge needle was advanced under real-time US guidance into the last portion of internal jugular vein. The Seldinger technique was used to place the catheter, which was advanced into the superior vena cava until insertion into right atrium. Within two hours after each procedure, an upright chest X-ray and ultrasound scanning were carried out to confirm the CVC position and to rule out a pneumotorax. CVC-related infections, symptomatic vein thrombosis and malfunctioning were recorded. RESULTS From December 2000 to January 2009, 1,978 CVC insertional procedures were applied to 1,660 consecutive patients. The procedure was performed 580 times in patients with hematologic malignancies and 1,398 times those with solid tumors. A single-needle puncture of the vein was performed on 1,948 of 1,978 procedures (98.48%); only eighteen attempts among 1,978 failed (0.9%). No pneumotorax, no major bleeding, and no nerve puncture were reported; four cases (0.2%) showed self-limiting hematomas. The mean lifespan of CVC was 189.7 +/- 18.6 days (range 7-701). Symptomatic deep-vein thrombosis of the upper limbs developed in 48 patients (2.42%). Catheter-related infections occurred in 197 (9.96%) of the catheters inserted. They were successfully treated with antibiotics and only in 48 (2.9%) patients definitive CVC removal was required for infection and/or thrombosis or malfunctioning. CONCLUSIONS This study represents the largest published series of consecutive patients with cancer undergoing CVC insertion under US guidance; this procedure allowed the completion of the therapeutic program for 1,930/1,978 (97.6%) of the catheters inserted. The absence of pneumotorax and other major complications indicates that US guidance should be mandatory for CVC insertion in patients with cancer.
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Affiliation(s)
- Luigi Cavanna
- Oncology-Hematology Department, Hospital of Piacenza, Piacenza, Italy
| | | | - Daniele Vallisa
- Oncology-Hematology Department, Hospital of Piacenza, Piacenza, Italy
| | - Camilla Di Nunzio
- Oncology-Hematology Department, Hospital of Piacenza, Piacenza, Italy
| | | | - Raffaella Bertè
- Oncology-Hematology Department, Hospital of Piacenza, Piacenza, Italy
| | | | - Antonio Lazzaro
- Oncology-Hematology Department, Hospital of Piacenza, Piacenza, Italy
| | - Gabriele Cremona
- Oncology-Hematology Department, Hospital of Piacenza, Piacenza, Italy
| | - Claudia Biasini
- Oncology-Hematology Department, Hospital of Piacenza, Piacenza, Italy
| | - Monica Muroni
- Oncology-Hematology Department, Hospital of Piacenza, Piacenza, Italy
| | - Patrizia Mordenti
- Oncology-Hematology Department, Hospital of Piacenza, Piacenza, Italy
| | - Silvia Gorgni
- Oncology-Hematology Department, Hospital of Piacenza, Piacenza, Italy
| | - Elena Zaffignani
- Oncology-Hematology Department, Hospital of Piacenza, Piacenza, Italy
| | - Massimo Ambroggi
- Oncology-Hematology Department, Hospital of Piacenza, Piacenza, Italy
| | - Livia Bidin
- Oncology-Hematology Department, Hospital of Piacenza, Piacenza, Italy
| | | | - Carmelina Rodinò
- Oncology-Hematology Department, Hospital of Piacenza, Piacenza, Italy
| | - Laura Tibaldi
- Teaching and management Department of Nursing Staff, AUSL of Piacenza, Italy
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Gómez-Rubio M, López-Cano A, Rendón P, Muñoz-Benvenuty A, Macías M, Garre C, Segura-Cabral JM. Safety and diagnostic accuracy of percutaneous ultrasound-guided biopsy of the spleen: a multicenter study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:445-450. [PMID: 19582827 DOI: 10.1002/jcu.20608] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To analyze the safety and accuracy of ultrasound-guided (USG) percutaneous needle biopsy of the spleen. METHODS Sixty-two USG needle biopsies performed in 52 patients were retrospectively analyzed: there were 53 biopsies of local lesions and 9 biopsies of diffuse lesions. Fine-needle aspiration (FNA) was performed in 37 cases and core-needle biopsy (CNB) in 25 cases. The complications and diagnostic accuracy of the 2 types of biopsy were compared. RESULTS Two patients (3.8%) had postprocedural hemorrhage after CNB; one was minor, and the other severe, requiring splenectomy. No bleeding occurred with FNA. The diagnostic accuracy was similar with FNA (86.5%) and CNB (92%), whereas in patients with lymphoma, accuracy of FNA (80%) tended to be lower than that of CNB (100%), although the difference was not statistically significant. CONCLUSION USG needle biopsy is safe and effective for diagnosing both focal and diffuse splenic lesions. The risk of bleeding may be lower with FNA than with CNB.
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18
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Delaney CR, Johnston SM, White B, Otridge B, Fitzpatrick JM, Gorey TF. Laparoscopic-assisted splenectomy using a hand-access port. MINIM INVASIV THER 2009. [DOI: 10.3109/13645709809152880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Legrand MJ, Honore P, Joris J, Jacquet N. Techniques of laparoscopic morcellation of the spleen. MINIM INVASIV THER 2009. [DOI: 10.3109/13645709609153254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Chen WL, Tsai WC, Tsao YT, Hsu YJ. An Unusual Case of Febrile Neutropenia: Acute Myeloid Leukemia Presenting as Myeloid Sarcoma of the Spleen. J Natl Med Assoc 2008; 100:957-9. [DOI: 10.1016/s0027-9684(15)31412-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Cavanna L, Lazzaro A, Vallisa D, Civardi G, Artioli F. Role of image-guided fine-needle aspiration biopsy in the management of patients with splenic metastasis. World J Surg Oncol 2007; 5:13. [PMID: 17274814 PMCID: PMC1800304 DOI: 10.1186/1477-7819-5-13] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 02/02/2007] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Splenic metastases are very rare and are mostly diagnosed at the terminal phase of the disease or at the time of autopsy. The cytohistological diagnosis, when done, is made prevalently by splenectomy. Reports on splenic percutaneous biopsies in the diagnosis of splenic metastasis are fragmentary and very poor. The aims of this study are to analyse retrospectively the accuracy, safety and the clinical impact of ultrasound (US)-guided fine-needle aspiration biopsy (UG-FNAB) in patients with suspected splenic metastasis. METHODS A retrospective analysis of 1800 percutaneous abdominal biopsies performed at our institute during the period from 1993 to 2003 was done and 160 patients that underwent splenic biopsy were found. Among these 160 patients, 12 cases with the final diagnosis of solitary splenic metastases were encountered and they form the basis of this report. The biopsies were performed under US guidance using a 22-gauge Chiba needle. All the patients underwent laboratory tests, CT examination of the abdomen and chest, US examination of abdomen and pelvis. RESULTS There were 5 women and 7 men, median age 65 years (range 48-80). Eight patients had a known primary cancer at the time of the diagnosis of splenic metastasis: 3 had breast adenocarcinoma, 2 colon adenocarcinoma, 2 melanoma and 1 lung adenocarcinoma. Four patients were undiagnosed at the time of the appearance of splenic metastasis and subsequent investigations showed adenocarcinoma of the lung in 2 patients and colon adenocarcinoma in the remaining 2. There was a complete correspondence between the US and Computed Tomography (CT) in detecting focal lesions of the spleen. The splenic biopsies allowed a cytological diagnosis of splenic metastasis in all the 12 patients and changed clinical management in all cases. Reviewing the 160 patients that underwent UG-FNAB of the spleen we found no complications related to the biopsies. CONCLUSION These results indicate that UG-FNAB is a successful technique for diagnosis of splenic metastasis allowing an adequate treatment of the affected patients.
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Affiliation(s)
- Luigi Cavanna
- Medical Oncology and Hematology Department, Hospital of Piacenza, 29100 Piacenza, Italy
| | - Antonio Lazzaro
- Medical Oncology and Hematology Department, Hospital of Piacenza, 29100 Piacenza, Italy
| | - Daniele Vallisa
- Medical Oncology and Hematology Department, Hospital of Piacenza, 29100 Piacenza, Italy
| | - Giuseppe Civardi
- Internal Medicine Division, Hospital of Fiorenzuola, 29017 Fiorenzuola (Piacenza), Italy
| | - Fabrizio Artioli
- Medical Oncology Unit, Hospital of Carpi, 41012 Carpi (Modena), Italy
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Lieberman S, Libson E, Sella T, Lebensart P, Sosna J. Percutaneous Image-Guided Splenic Procedures: Update on Indications, Technique, Complications, and Outcomes. Semin Ultrasound CT MR 2007; 28:57-63. [PMID: 17366709 DOI: 10.1053/j.sult.2006.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Percutaneous image-guided splenic procedures are seldom performed due to fear of complications, mainly hemorrhage. Percutaneous splenic invasive procedures are, however, safe, and in most cases, the complication rates are similar to those of other abdominal organs. In most patients, biopsy of a focal splenic lesion establishes the diagnosis. Aspiration and drainage of splenic collections are performed obviating the need for splenectomy. In this review we describe the indications, technique, complications, and outcomes of percutaneous splenic biopsy, aspiration, and drainage.
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Affiliation(s)
- Sivan Lieberman
- Department of Radiology, Hadassah-Hebrew University Hospital, P.O.B. 12000, Jerusalem, Israel 91120.
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Abstract
Solitary splenic lesions are unusual. A differential diagnosis can be organized around their basic imaging appearance as either predominantly cystic or solid. Other imaging characteristics, including vascular enhancement and activity on Tc-99m sulfur colloid scan, as well as clinical history may narrow the diagnostic possibilities. Cystic lesions include post-traumatic, inflammatory and infectious pseudocysts, congenital cysts, lymphangiomas and cystic metastasis. Solid lesions include both nonneoplastic lesions such as splenic hamartoma, benign tumors such as hemangioma and malignant masses including lymphoma and angiosarcoma. Percutaneous biopsy may be used for histologic diagnosis when required.
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Affiliation(s)
- David M Warshauer
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7510, USA.
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López JI, Del Cura JL, De Larrinoa AF, Gorriño O, Zabala R, Bilbao FJ. Role of ultrasound-guided core biopsy in the evaluation of spleen pathology. APMIS 2006; 114:492-9. [PMID: 16907854 DOI: 10.1111/j.1600-0463.2006.apm_378.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Core biopsy has not traditionally been recommended in the study of spleen nodules due to the supposed fragility of this organ leading to a high risk of post-core biopsy complications. A total of 13 patients who presented solid spleen nodules, diffuse splenomegaly, or both on imaging studies (CT, MR, US) were biopsied under ultrasound control with 18G BioPince needles. Cytological (imprints and cytocentrifugates) and histological material were obtained for diagnosis in every case. Malignant lymphomas were the most commonly found pathology (four diffuse large B-cell lymphomas, two follicular lymphomas, one Hodgkin's disease, one B-cell lymphoma, NOS). In addition, there was one littoral-cell angioma, one well-differentiated neuroendocrine carcinoma, metastatic, and one haemangioma. The remaining two cases showed congestive features, and supposed spleen involvement by lymphoma in one of them was ruled out. On follow up, there were no complications related to the core biopsy. Splenectomy was performed in six cases, two diagnostic and four therapeutic. We conclude that core biopsy is a safe and efficient method in the diagnosis of spleen nodules that could be considered in the routine diagnostic algorithm of these lesions.
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Affiliation(s)
- José I López
- Department of Pathology, Hospital de Basurto, Basque Country University, Bilbao, Spain.
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25
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Ambulkar I, Kulkarni B, Borges A, Jagannath P, Advani SH. Primary non-Hodgkin's lymphoma of the spleen presenting as space occupying lesion: a case report and review of literature. Leuk Lymphoma 2006; 47:135-9. [PMID: 16321838 DOI: 10.1080/10428190500277142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Primary splenic lymphoma (PSL) is rare with a reported incidence of less than 1%. Diffuse large cell pathology has been reported in 22-23% of the cases and is felt to have poor outcome. This study reports a 50 year old male who presented with fever and weakness. He was found to have a mass lesion in the spleen documented by CT scan. A splenectomy was performed which showed non-Hodgkin's lymphoma. Immunohistological studies showed a positivity for CD20 and CD30.
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Affiliation(s)
- Indumati Ambulkar
- Asian Institute of Oncology, S. L. Raheja Hospital, Raheja Rugnalaya Road, Mahim, Mumbai, 400 016, India.
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26
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Choi SH, Lee JM, Lee KH, Kim SH, Lee JY, Han JK, Choi BI. Postbiopsy splenic bleeding in a dog model: comparison of cauterization, embolization, and plugging of the needle tract. AJR Am J Roentgenol 2005; 185:878-84. [PMID: 16177404 DOI: 10.2214/ajr.04.1395] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of our study was to compare radiofrequency cauterization, embolization using an absorbable gelatin sponge, and a Histoacryl-Lipiodol mixture plugging as postbiopsy bleeding reduction methods after splenic core needle biopsy in a dog model. MATERIALS AND METHODS Eleven mongrel dogs were randomly separated into nonheparinized (n = 5) and heparinized (n = 6) groups. Eight splenic biopsies per animal were performed using an 18-gauge automated core biopsy needle: two as controls, two ablated by radiofrequency, two embolized using an absorbable gelatin sponge, and two plugged using a Histoacryl-Lipiodol mixture. Procedure times and postbiopsy bleeding amounts were assessed. Statistically significant differences were determined by repeated measures analysis of variance; the Tukey-Kramer test for multiple comparisons was used for post hoc comparisons. Three-day follow-up CT scans were obtained to check for procedure-related complications or delayed bleeding. RESULTS The postbiopsy bleeding reduction groups showed significantly less blood loss than the control group for both the nonheparinized (p < 0.0001) and heparinized groups (p < 0.0001). In the heparinized group, both radiofrequency cauterization (p < 0.01) and gelatin sponge embolization (p < 0.05) significantly reduced bleeding compared with Histoacryl-Lipiodol mixture plugging. Gelatin sponge embolization was the longest procedure (p < 0.001). On follow-up CT, no delayed bleeding was observed. However, multiple Histoacryl-Lipiodol emboli were observed in the splenic and portal veins in all the dogs we treated. CONCLUSION Radiofrequency cauterization was found to be the most useful postbiopsy bleeding reduction method in terms of the amount of bleeding and the procedure time.
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Affiliation(s)
- Seung Hong Choi
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744
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27
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Lieberman S, Libson E, Maly B, Lebensart P, Ben-Yehuda D, Bloom AI. Imaging-guided percutaneous splenic biopsy using a 20- or 22-gauge cutting-edge core biopsy needle for the diagnosis of malignant lymphoma. AJR Am J Roentgenol 2003; 181:1025-7. [PMID: 14500223 DOI: 10.2214/ajr.181.4.1811025] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We estimated the accuracy and safety of imaging-guided needle biopsy for the diagnosis of suspected malignant lymphoma in patients with a splenic lesion. CONCLUSION Imaging-guided small-bore cutting-edge needle biopsy of splenic lesions is a safe procedure. In most patients with primary or recurrent lymphoma, the disease subtype can be diagnosed reliably.
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Affiliation(s)
- Sivan Lieberman
- Department of Radiology, Hadassah University Hospital, Ein-Kerem, P.O.B. 12000, Jerusalem, Israel
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28
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Ultrasound-guided Fine Needle Biopsy of Splenic Lymphoma. J Med Ultrasound 2003. [DOI: 10.1016/s0929-6441(09)60045-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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29
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Civardi G, Vallisa D, Bertè R, Giorgio A, Filice C, Caremani M, Caturelli E, Pompili M, De Sio I, Buscarini E, Cavanna L. Ultrasound-guided fine needle biopsy of the spleen: high clinical efficacy and low risk in a multicenter Italian study. Am J Hematol 2001; 67:93-9. [PMID: 11343380 DOI: 10.1002/ajh.1085] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aim of this study was to evaluate the clinical efficacy and safety of the ultrasound-guided fine needle biopsy (UG-FNB) of the spleen in a large population of patients. We collected retrospectively the findings concerning the application of UG-FNB of the spleen from eight Italian clinical centers that utilized this technique for at least ten years. A data schedule was sent to all centers to collect information about techniques, results, and complications of UG-FNB of the spleen. We analyzed 398 biopsy procedures both on focal lesions (257 cases) and on splenic parenchyma (141 cases). The overall accuracy was 90.9% for the series as a whole, 84.9% for cytological sampling, 88.3% for microhistological sampling, and 90.3% for both cytological and histological sampling (double biopsy). Tissue core biopsy yielded better overall accuracy in patients with suspected splenic involvement by lymphoma (90.9% vs. 68.5% for cytology). The complication rate was low (no death cases, less than 1% for major complications, and 5.2% for all complications). No predictive factors were able to detect high-risk situations. The operator's skill (higher number of performed procedures) was significantly related to better overall accuracy. Conversely, the complication rate was not affected. UG-FNB of the spleen is a very effective diagnostic procedure with low risk for the patient. Aspiration cytology and core needle biopsy showed similar diagnostic yields, except for the diagnosis of splenic lymphoma, in which core needle biopsy obtained better results.
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Affiliation(s)
- G Civardi
- Divisione di Medicina Interna-Ematologia, Ospedale Civile, Piacenza, Italy.
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30
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Abstract
PURPOSE To evaluate the safety, diagnostic yield, and clinical benefits of performing ultrasonography (US)-guided percutaneous splenic core biopsy in children. MATERIALS AND METHODS US-guided splenic core biopsy was performed in 30 children aged 6 months to 15.3 years (mean, 7.0 years), with focal lesions in 27 patients and homogeneous splenomegaly in three. Four patients underwent repeat biopsy to identify changes in splenic disease. Four types of biopsy needles were used in this series. General anaesthesia was used in 21 patients and conscious sedation in nine. Medical records were reviewed to assess diagnostic accuracy, influence on treatment, and biopsy-related complications. RESULTS All biopsies were performed without complication. Among the 30 biopsies, an accurate diagnosis was obtained in 25 (83%), a false-negative result was obtained in two (7%), and three (10%) were nondiagnostic. All conclusive results influenced treatment decisions. The mean number of needle passes was 2.7 per patient (range, 2-5 passes). Use of needles was 50%-100% successful in the acquisition of adequate tissue cores. Use of the 18-gauge needle was always successful in the safe acquisition of adequate tissue, with a maximum of three passes. CONCLUSION US-guided splenic core biopsy is a minimally invasive, simple, and safe procedure for use in children. It provides relatively high diagnostic accuracy while minimizing complications when compared with alternative, more invasive procedures.
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Affiliation(s)
- S Muraca
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada
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31
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Macrobiopsy of the spleen: proposal for a laparoscopic approach. MINIM INVASIV THER 2001; 10:255-8. [PMID: 16754025 DOI: 10.1080/136457001753334701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The spleen plays an important role in the immune response; however, its function is not yet fully understood. Splenectomy is still proposed for diagnosis in some patients with splenic focal lesions or splenomegaly. Often in these patients, an adequate splenic biopsy would be sufficient to obtain the correct diagnosis and address the appropriate non-surgical management. While percutaneous fine needle biopsy preserves the spleen and its functions, in some instances the tissue sample obtained is inadequate for a definitive diagnosis. We report a technique of laparoscopic macrobiopsy of the spleen, performed in two patients with splenic focal lesions. It requires, as a first step, the clipping of the splenic artery before the origin of the left gastroepiploic artery, to reduce the risk of bleeding. Macrobiopsy of the spleen, including the focal lesion, was performed using monopolar cautering scissors. This technique provided an adequate amount of tissue for diagnosis, and it was possible to preserve the spleen.
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32
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Morita K, Numata K, Tanaka K, Mitsui K, Matsumoto S, Kitamura T, Saito S, Kiba T, Sekihara H. Sonographically guided core-needle biopsy of focal splenic lesions: report of four cases. JOURNAL OF CLINICAL ULTRASOUND : JCU 2000; 28:417-424. [PMID: 10993970 DOI: 10.1002/1097-0096(200010)28:8<417::aid-jcu7>3.0.co;2-l] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
There are few published reports about the use of splenic needle biopsies in the investigation of focal splenic lesions. We report our experience with sonographically guided core-needle biopsies of splenic lesions in 4 patients. The biopsies resulted in the following diagnoses: sarcoidosis, malignant lymphoma, infarction, and scar tissue. Surgery was avoided in the 3 patients diagnosed with sarcoidosis, infarction, and scar tissue by ruling out the possibility of a malignant splenic tumor. None of the patients experienced significant complications. We conclude that splenic core-needle biopsy is a useful and safe diagnostic tool for the evaluation of focal splenic lesions.
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Affiliation(s)
- K Morita
- Third Department of Internal Medicine, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
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Abstract
OBJECTIVES To describe the imaging, clinical and pathological features of primary splenic lymphoma using a strict definition. METHODS Of 21 cases, plain films were available in nine, sonograms in 10 and CT in 16. We categorized the spleen as either normal, enlarged with no focal defects (type 1), studded with miliary masses (type 2), containing multifocal masses of varying size (1-10 cm) (type 3) or containing a solitary large mass >5 cm without (type 4A) or with (type 4B) central hypodensity/anechoic areas. RESULTS Clinical presentations were left upper quadrant pain, weight loss and/or fever. One case was found incidentally on CT. Fourteen were type 4A, three type 4B, four type 3 and none were type 1 or 2. Nine of 10 cases were hypoechoic. In 11/12 cases with enhanced scans, the lesions are hypodense relative to the splenic parenchyma, and in one case, the lesion was necrotic. Rim enhancement was seen in one case. CONCLUSION Primary splenic lymphoma usually presents as a mass or masses rather than with splenomegaly alone. Splenectomy may be required for diagnosis.
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Affiliation(s)
- A H Dachman
- Department of Radiology, The University of Chicago, IL 60637, USA
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35
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Worawattanakul S, Warshauer DM. Splenic nodules induced by phenytoin hypersensitivity reaction. J Comput Assist Tomogr 1997; 21:1013-4. [PMID: 9386302 DOI: 10.1097/00004728-199711000-00032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- S Worawattanakul
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill 27599-7510, USA
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36
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Gardner B. Surveillance in the management of the cancer patient with special reference to breast and colon cancer. Am J Surg 1997; 173:141-4. [PMID: 9074382 DOI: 10.1016/s0002-9610(96)00414-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Senior surgeons of the Society of Surgical Oncology were surveyed concerning their followup practices for patients with colon and breast cancer and compared them with the recommendations in the current literature. Intensive followup is not indicated for patients with breast cancer patients and all surgeons agree by using physical examination and mammograms predominantly. Colon cancer followup was variable and the literature indicates a small survival advantage for intensive followup.
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Affiliation(s)
- B Gardner
- UMDNJ-New Jersey Medical School, Newark 07103-2757, USA
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Bogen GL, Mancino AT, Scott-Conner CE. Laparoscopy for staging and palliation of gastrointestinal malignancy. Surg Clin North Am 1996; 76:557-69. [PMID: 8669015 DOI: 10.1016/s0039-6109(05)70462-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The use of laparoscopy in the treatment of malignant diseases is one of the great advances of surgery in the last few decades. Its roles as a diagnostic modality, a staging tool, and a therapeutic avenue for the various malignancies of the abdominal cavity continue to expand. The benefits to cancer patients with regard to reduced morbidity and shorter hospitalizations are well established. As video, optical, insufflation, and instrumentation technologies advance further, laparoscopic techniques for the treatment of cancer can only multiply in depth and breadth.
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Affiliation(s)
- G L Bogen
- Department of Surgery, University of Mississippi School of Medicine, Jackson, USA
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