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Valizadeh P, Jannatdoust P, Tahamtan M, Soleimani Dorcheh S, Khalaj F, Ghorani H, Ayoobi Yazdi N, Salahshour F. Differentiating malignant from benign splenic lesions: a meta-analysis and pictorial review of imaging features. Abdom Radiol (NY) 2024; 49:2833-2857. [PMID: 38900328 DOI: 10.1007/s00261-024-04447-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/30/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVES Splenic lesions might exhibit overlapping imaging features, varying from benign entities like cysts and hemangiomas to malignancies such as lymphoma and angiosarcoma. This meta-analysis aims to delineate imaging characteristics that distinguish malignant from benign splenic lesions. METHODS Adhering to PRISMA guidelines, we searched PubMed, Scopus, and Web of Science for studies on imaging features differentiating malignant from benign splenic lesions. We extracted data on splenic pathology and imaging characteristics and assessed the methodological quality via QUADAS-2. Odds ratio meta-analyses were performed using STATA (Version 17.0, Stata Corp, College Station, TX). RESULTS Portal phase hypoenhancement, hypovascular enhancement pattern, diffusion restriction, and late phase hypoenhancement, with odds ratios above 10, highly indicate malignancy. Other features suggestive of malignancy include solid morphology, lymphadenopathy, presence of perisplenic fluid, arterial hypoenhancement, hypoechogenicity on ultrasound, splenomegaly, and presence of multiple lesions. In contrast, cystic morphology, hypervascular-washout and hypervascular-persistent pattern of enhancement, late phase hyperenhancement, anechogenicity on ultrasound, portal phase hyperenhancement, well-defined borders, and calcification are in favour of benign pathology. CONCLUSION The study underscores the critical role of contrast-enhanced and diffusion-weighted imaging in distinguishing malignant from benign splenic lesions, emphasizing the role of features like portal phase hypoenhancement and restricted diffusion in diagnosing malignancies. Additionally, the study emphasizes the value of contrast-enhanced ultrasound, which allows for the visualization of key contrast-enhancement patterns without the risk of ionizing radiation exposure.
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Affiliation(s)
- Parya Valizadeh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Jannatdoust
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Tahamtan
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Soroush Soleimani Dorcheh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Student's Scientific Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Fattaneh Khalaj
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Ghorani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Niloofar Ayoobi Yazdi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Faeze Salahshour
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran.
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Neitzel E, Stearns J, Guido J, Porter K, Whetten J, Lammers L, vanSonnenberg E. Iatrogenic vascular complications of non-vascular percutaneous abdominal procedures. Abdom Radiol (NY) 2024:10.1007/s00261-024-04381-x. [PMID: 38849536 DOI: 10.1007/s00261-024-04381-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE The purpose of this paper is to compile and present all of the reported vascular complications that resulted from common non-vascular abdominal procedures in the literature. Non-vascular procedures include, though are not limited to, percutaneous abscess/fluid collection drainage (PAD), percutaneous nephrostomy (PN), paracentesis, percutaneous transhepatic cholangiography (PTC)/percutaneous biliary drainage (PBD), percutaneous biliary stone removal, and percutaneous radiologic gastrostomy (PG)/percutaneous radiologic gastrojejunostomy (PG-J). By gathering this information, radiologists performing these procedures can be aware of the associated vascular injuries, as well as take steps to minimize risks. METHODS A literature review was conducted using the PubMed database to catalog relevant articles, published in the year 2000 onward, in which an iatrogenic vascular complication occurred from the following non-vascular abdominal procedures: PAD, PN, paracentesis, PTC/PBD, percutaneous biliary stone removal, and PG/PG-J. Biopsy and tumor ablation were deferred from this article. RESULTS 214 studies met criteria for analysis. 28 patients died as a result of vascular complications from the analyzed non-vascular abdominal procedures. Vascular complications from paracentesis were responsible for 19 patient deaths, followed by four deaths from PTC/PBD, three from biliary stone removal, and two from PG. CONCLUSION Despite non-vascular percutaneous abdominal procedures being minimally invasive, vascular complications still can arise and be quite serious, even resulting in death. Through the presentation of vascular complications associated with these procedures, interventionalists can improve patient care by understanding the steps that can be taken to minimize these risks and to reduce complication rates.
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Affiliation(s)
- Easton Neitzel
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA.
| | - Jack Stearns
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jessica Guido
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Kaiden Porter
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jed Whetten
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Luke Lammers
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Eric vanSonnenberg
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
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Aleem A, Aujla P, Purtle B, Mittal N, Ramireddy S. Safety and Efficacy of Endoscopic Ultrasound-Guided Fine-Needle Aspiration Biopsy of Littoral Cell Angioma. Cureus 2024; 16:e61800. [PMID: 38975436 PMCID: PMC11227729 DOI: 10.7759/cureus.61800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
Littoral cell angioma (LCA) is a rare vascular tumor of the spleen that often requires histopathological analysis for diagnosis due to non-specific imaging features. The current approach is either splenectomy or image-guided percutaneous biopsy which carries notable procedure-associated morbidity and limited accuracy. We present a novel case of LCA successfully diagnosed with endoscopic ultrasound fine-needle aspiration biopsy (EUS-FNAB), demonstrating its potential to reduce the morbidity associated with traditional percutaneous biopsy methods. This case highlights EUS-FNAB's advantage in minimizing complications and its effectiveness in diagnosing vascular tumors of the spleen, supporting its inclusion in the diagnostic algorithm for splenic lesions. Further cases are encouraged to explore EUS-FNAB's role in diagnosing rare vascular tumors such as LCA to establish its efficacy and safety profile.
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Affiliation(s)
- Abdullah Aleem
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, USA
| | - Parvir Aujla
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, USA
| | - Blake Purtle
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, USA
| | - Nitish Mittal
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, USA
| | - Srinivas Ramireddy
- Department of Gastroenterology and Hepatology, University of Texas Health Science Center at Houston, Houston, USA
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4
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Krähling H, Seidensticker M, Heindel WL, Gerwing M. Diagnostic approach to splenic lesions. ROFO-FORTSCHR RONTG 2024; 196:573-581. [PMID: 37967822 DOI: 10.1055/a-2193-2292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
BACKGROUND Splenic lesions are rare and mostly incidental findings on cross-sectional imaging. Most lesions are of benign nature and can be correctly identified based on imaging characteristics. Further, invasive evaluation is only necessary in cases of splenic lesions with uncertain or potentially malignant etiology. METHOD While in most cases a correct diagnosis can be made from computed tomography (CT), (additional) magnetic resonance imaging (MRI) can aid in the identification of lesions. As these lesions are rare, only a few of the differential diagnoses are regularly diagnosed in the clinical routine. RESULT AND CONCLUSION This review presents the differential diagnoses of splenic lesions, including imaging characteristics and a flowchart to determine the right diagnosis. In conjunction with laboratory results and clinical symptoms, histological workup is necessary only in a few cases, especially in incidental findings. In these cases, image-guided biopsies should be preferred over splenectomy, if possible. KEY POINTS · Splenic lesions are rare and are usually incidental findings on abdominal imaging. · CT imaging and MRI imaging are the diagnostic tools of choice for the further workup of splenic lesions. · Based on their image morphological characteristics, a large number of splenic lesions can be assigned to one entity and do not need histological analysis. CITATION FORMAT · Krähling H, Seidensticker M, Heindel WL et al. Diagnostic approach to splenic lesions. Fortschr Röntgenstr 2024; 196: 573 - 581.
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Affiliation(s)
| | - Max Seidensticker
- Department of Radiology, Ludwig-Maximilians-Universität München, Germany
| | | | - Mirjam Gerwing
- Clinic of Radiology, University of Münster, Münster, Germany
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Milickovic M, Rasic P, Cvejic S, Bozic D, Savic D, Mijovic T, Cvetinovic S, Djuricic SM. Splenic hamartomas in children. World J Clin Cases 2024; 12:1909-1917. [PMID: 38660549 PMCID: PMC11036520 DOI: 10.12998/wjcc.v12.i11.1909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/06/2024] [Accepted: 03/22/2024] [Indexed: 04/11/2024] Open
Abstract
Splenic hamartomas (SHs) are uncommon, benign vascular lesions of unclear etiology and are mostly found incidentally on abdominal images, at surgery, or at autopsy. Since the first case description, in 1861, less than 50 pediatric SH cases have been reported in the literature. In this article, we have performed an analysis of all SH cases in children published in the literature to date and presented our case of an 8-year-old male with SH. These lesions in children were shown to cause symptoms more often than in the adult population. The observed SH sizes in children ranged from a few millimeters to 18 cm, and the symptomatic lesions were mostly larger or multiple. The most common clinical finding was splenomegaly. Signs of hypersplenism were present in children with a single SH larger than 4.5 cm (diameter range: 4.5-18.0 cm) and in those with multiple hamartomas, ranging from a few millimeters to 5 cm. Eighty percent of patients with available laboratory findings had hematological abnormalities such as anemia, thrombocytopenia, or pancytopenia. Other symptoms and signs included abdominal pain, recurrent infections, fever, night sweats, lethargy, growth retardation, and weight loss. The use of multiple imaging modalities may suggest the preoperative diagnosis of a splenic mass in children and determine the therapeutic approach. However, the final diagnosis of SH relies on histopathological evaluation. Surgery, including total or partial splenectomy (PS), is the mainstay of SH management. Although total splenectomy carries a greater risk of overwhelming post-splenectomy infection than PS it has remained the most performed surgical procedure in children with SH. In the majority of pediatric patients with symptomatic SH, resolution of symptoms and resolution or improvement of cytopenias occurred after surgical treatment.
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Affiliation(s)
- Maja Milickovic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia "Dr. Vukan Cupic", Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Petar Rasic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia "Dr. Vukan Cupic", Belgrade 11000, Serbia
| | - Sofija Cvejic
- Department of Radiology, The Children’s University Hospital, Belgrade 11000, Serbia
| | - Dejana Bozic
- Department of Clinical Pathology, Mother and Child Health Care Institute of Serbia "Dr. Vukan Cupic", Belgrade 11000, Serbia
| | - Djordje Savic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia "Dr. Vukan Cupic", Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Tanja Mijovic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia "Dr. Vukan Cupic", Belgrade 11000, Serbia
| | - Sava Cvetinovic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia "Dr. Vukan Cupic", Belgrade 11000, Serbia
| | - Slavisa M Djuricic
- Faculty of Medicine, University of Banja Luka, Banja Luka 78000, Bosnia and Herzegovina
- Department of Clinical Pathology, Mother and Child Health Care Institute of Serbia "Dr. Vukan Cupic", Belgrade 11000, Serbia
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Lin G, Hsieh CY, Lai YC, Wang CC, Lin Y, Lu KY, Chai WY, Chen AP, Yen TC, Ng SH, Lai CH. Hyperpolarized [1- 13C]-pyruvate MRS evaluates immune potential and predicts response to radiotherapy in cervical cancer. Eur Radiol Exp 2024; 8:46. [PMID: 38594558 PMCID: PMC11003947 DOI: 10.1186/s41747-024-00445-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/23/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Monitoring pyruvate metabolism in the spleen is important for assessing immune activity and achieving successful radiotherapy for cervical cancer due to the significance of the abscopal effect. We aimed to explore the feasibility of utilizing hyperpolarized (HP) [1-13C]-pyruvate magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) to evaluate pyruvate metabolism in the human spleen, with the aim of identifying potential candidates for radiotherapy in cervical cancer. METHODS This prospective study recruited six female patients with cervical cancer (median age 55 years; range 39-60) evaluated using HP [1-13C]-pyruvate MRI/MRS at baseline and 2 weeks after radiotherapy. Proton (1H) diffusion-weighted MRI was performed in parallel to estimate splenic cellularity. The primary outcome was defined as tumor response to radiotherapy. The Student t-test was used for comparing 13C data between the groups. RESULTS The splenic HP [1-13C]-lactate-to-total carbon (tC) ratio was 5.6-fold lower in the responders than in the non-responders at baseline (p = 0.009). The splenic [1-13C]-lactate-to-tC ratio revealed a 1.7-fold increase (p = 0.415) and the splenic [1-13C]-alanine-to-tC ratio revealed a 1.8-fold increase after radiotherapy (p = 0.482). The blood leukocyte differential count revealed an increased proportion of neutrophils two weeks following treatment, indicating enhanced immune activity (p = 0.013). The splenic apparent diffusion coefficient values between the groups were not significantly different. CONCLUSIONS This exploratory study revealed the feasibility of HP [1-13C]-pyruvate MRS of the spleen for evaluating baseline immune potential, which was associated with clinical outcomes of cervical cancer after radiotherapy. TRIAL REGISTRATION ClinicalTrials.gov NCT04951921 , registered 7 July 2021. RELEVANCE STATEMENT This prospective study revealed the feasibility of using HP 13C MRI/MRS for assessing pyruvate metabolism of the spleen to evaluate the patients' immune potential that is associated with radiotherapeutic clinical outcomes in cervical cancer. KEY POINTS • Effective radiotherapy induces abscopal effect via altering immune metabolism. • Hyperpolarized 13C MRS evaluates patients' immune potential non-invasively. • Pyruvate-to-lactate conversion in the spleen is elevated following radiotherapy.
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Affiliation(s)
- Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St, Guishan, 33382, Taoyuan, Taiwan.
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan.
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
- Research Center for Radiation Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ching-Yi Hsieh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St, Guishan, 33382, Taoyuan, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Research Center for Radiation Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Chieh Lai
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St, Guishan, 33382, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chun-Chieh Wang
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
- Research Center for Radiation Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yenpo Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St, Guishan, 33382, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Kuan-Ying Lu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St, Guishan, 33382, Taoyuan, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Wen-Yen Chai
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St, Guishan, 33382, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | | | - Tzu-Chen Yen
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shu-Hang Ng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St, Guishan, 33382, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Division of Gynecologic Oncology, Gynecologic Oncology Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Gómez Rubio M, Monasterios Maestra P, Camacho Castañeda FI, Castillo-López G, Esteban FJ, Phares L, Sevilla S. Sclerosing angiomatoid nodular transformation (SANT) of the spleen can be safely diagnosed by a core percutaneous ultrasound-guided biopsy. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024. [PMID: 38591625 DOI: 10.17235/reed.2024.10373/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Sclerosing angiomatoid nodular transformation (SANT) is a rare benign lesion of the spleen. SANT cannot be distinguished from other benign or malignant splenic tumors based on imaging findings. So, diagnosis relies on histopathologic examination. Although splenectomy is frequently considered as an option, core needle biopsy tissue analysis is safe and accurate to avoid surgery.
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Affiliation(s)
- Mariano Gómez Rubio
- Digestive Diseases, Hospital Universitario de Getafe. Universidad Europea de Madrid, España
| | | | | | | | | | - Lucía Phares
- Digestive Diseases, Hospital Universitario de Getafe, España
| | - Sergio Sevilla
- Digestive Diseases, Hospital Universitario de Getafe, España
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8
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Doi S, Adachi T, Watanabe A, Katsukura N, Tsujikawa T. Current perspectives on the diversification of endoscopic ultrasound-guided fine-needle aspiration and biopsy. J Med Ultrason (2001) 2024; 51:235-243. [PMID: 38108995 DOI: 10.1007/s10396-023-01393-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/23/2023] [Indexed: 12/19/2023]
Abstract
Endoscopic ultrasound-guided tissue acquisition (EUS-TA) has undergone significant advancements since it was first reported in 1992. Initially focused on the pancreas, EUS-guided fine-needle aspiration (FNA) has now been extended to encompass all organs proximal to the gastrointestinal system. Recently, a novel fine-needle biopsy (FNB) needle with an end-cut tip was developed, allowing for the collection of specimens suitable for histological assessment, a feat hard to achieve with traditional needles. The FNB needle holds promise for applications in immunohistochemistry staining and genetics evaluation, and it has the potential to yield specimens of comparable quality to core needle biopsy during percutaneous puncture, especially for lesions beyond the pancreas, such as lymph nodes. This review focuses on the efficacy of EUS-FNA/FNB for extended target regions, specifically lymph nodes, spleen, adrenal gland, and ascites. The indications for EUS-FNA have greatly expanded beyond the pancreas over the years, and future improvements and innovations in puncture needles will allow for the collection of higher-quality specimens, which is expected to play a significant part in personalized cancer treatment.
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Affiliation(s)
- Shinpei Doi
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago, Takatsu-Ku, Kawasaki, Kanagawa, 213-8507, Japan.
| | - Takako Adachi
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago, Takatsu-Ku, Kawasaki, Kanagawa, 213-8507, Japan
| | - Ayako Watanabe
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago, Takatsu-Ku, Kawasaki, Kanagawa, 213-8507, Japan
| | - Nobuhiro Katsukura
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago, Takatsu-Ku, Kawasaki, Kanagawa, 213-8507, Japan
| | - Takayuki Tsujikawa
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago, Takatsu-Ku, Kawasaki, Kanagawa, 213-8507, Japan
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9
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Pu SH, Bao WYG, Jiang ZP, Yang R, Lu Q. Percutaneous ultrasound-guided coaxial core needle biopsy for the diagnosis of multiple splenic lesions: A case report. World J Gastrointest Surg 2024; 16:616-621. [PMID: 38463358 PMCID: PMC10921196 DOI: 10.4240/wjgs.v16.i2.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/18/2023] [Accepted: 01/25/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The overlap of imaging manifestations among distinct splenic lesions gives rise to a diagnostic dilemma. Consequently, a definitive diagnosis primarily relies on histological results. The ultrasound (US)-guided coaxial core needle biopsy (CNB) not only procures sufficient tissue to help clarify the diagnosis, but reduces the incidence of puncture-related complications. CASE SUMMARY A 41-year-old female, with a history of pulmonary tuberculosis, was admitted to our hospital with multiple indeterminate splenic lesions. Gray-scale ultrasonography demonstrated splenomegaly with numerous well-defined hypoechoic masses. Abdominal contrast-enhanced computed tomography (CT) showed an enlarged spleen with multiple irregular-shaped, peripherally enhancing, hypodense lesions. Positron emission CT revealed numerous abnormal hyperglycemia foci. These imaging findings strongly indicated the possibility of infectious disease as the primary concern, with neoplastic lesions requiring exclusion. To obtain the precise pathological diagnosis, the US-guided coaxial CNB of the spleen was carried out. The patient did not express any discomfort during the procedure. CONCLUSION Percutaneous US-guided coaxial CNB is an excellent and safe option for obtaining precise splenic tissue samples, as it significantly enhances sample yield for exact pathological analysis with minimum trauma to the spleen parenchyma and surrounding tissue.
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Affiliation(s)
- Sha-Hong Pu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wu-Yong-Ga Bao
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Zhen-Peng Jiang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Rui Yang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Qiang Lu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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10
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Segger L, Lerchbaumer MH, Collettini F, Hamm B, Fleckenstein FN, Fehrenbach U, Gebauer B, Auer TA. Percutaneous Computed Tomography (CT) Fluoroscopy-Guided Biopsy of the Spleen Using Fibrin Glue as a Sealant. Diagnostics (Basel) 2024; 14:162. [PMID: 38248038 PMCID: PMC10814976 DOI: 10.3390/diagnostics14020162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Some authors consider the risk of bleeding an absolute contraindication to percutaneous image-guided splenic puncture. While splenic punctures are mainly performed at specialized centers, no technique for the closure of the puncture tract has been broadly established. The aim of this study was to investigate the effectiveness and safety of a percutaneous image-guided biopsy of the spleen using fibrin glue to plug the tract. A total of 27 requests for splenic image-guided interventions were identified between 2010 and 2021 and considered for inclusion in our retrospective single-center study. Seven patients needed to be excluded, which left twenty patients who underwent a percutaneous computed tomography (CT) fluoroscopy-guided biopsy of a splenic lesion during this period. In all patients, a 17G coaxial needle with an 18G core biopsy needle was used. Diagnostic adequacy and accuracy were evaluated, and complications were classified using the CIRSE classification system for adverse events. Diagnostic adequacy was 100% (20/20), and a median of four samples were collected. Diagnostic accuracy was 80% (16/20). The four off-target samples included one inconclusive finding and three samples of regular spleen tissue. The overall complication rate was 5% (1/20). No mild (grade 1-2) or moderate (grade 3-4) complications occurred. One severe (grade 5-6) complication occurred. Although controversial and potentially high-risk, diagnostic percutaneous biopsies of the spleen appear to be relatively safe with the use of fibrin glue to seal the tract.
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Affiliation(s)
- Laura Segger
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
| | | | - Federico Collettini
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
| | - Florian Nima Fleckenstein
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - Uli Fehrenbach
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
| | - Bernhard Gebauer
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
| | - Timo A. Auer
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
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Kavandi H, Itani M, Strnad B, Martin S, Ebrahimzadeh SA, Lubner MG, Noe-Kim V, Hinshaw JL, Bansal M, Karam AR, Khanna K, Hadied MO, Planz V, Glazer DI, Burgan CM, Galgano S, Brook A, Brook OR. A Multicenter Study of Needle Size and Safety for Splenic Biopsy. Radiology 2024; 310:e230453. [PMID: 38259204 DOI: 10.1148/radiol.230453] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background Splenic biopsy is rarely performed because of the perceived risk of hemorrhagic complications. Purpose To evaluate the safety of large bore (≥18 gauge) image-guided splenic biopsy. Materials and Methods This retrospective study included consecutive adult patients who underwent US- or CT-guided splenic biopsy between March 2001 and March 2022 at eight academic institutions in the United States. Biopsies were performed with needles that were 18 gauge or larger, with a comparison group of biopsies with needles smaller than 18 gauge. The primary outcome was significant bleeding after the procedure, defined by the presence of bleeding at CT performed within 30 days or angiography and/or surgery performed to manage the bleeding. Categorical variables were compared using the χ2 test and medians were compared using the Mann-Whitney test. Results A total of 239 patients (median age, 63 years; IQR, 50-71 years; 116 of 239 [48.5%] female patients) underwent splenic biopsy with an 18-gauge or smaller needle and 139 patients (median age, 58 years [IQR, 49-69 years]; 66 of 139 [47.5%] female patients) underwent biopsy with a needle larger than 18 gauge. Bleeding was detected in 20 of 239 (8.4%) patients in the 18-gauge or smaller group and 11 of 139 (7.9%) in the larger than 18-gauge group. Bleeding was treated in five of 239 (2.1%) patients in the 18-gauge or smaller group and one of 139 (1%) in the larger than 18-gauge group. No deaths related to the biopsy procedure were recorded during the study period. Patients with bleeding after biopsy had smaller lesions compared with patients without bleeding (median, 2.1 cm [IQR, 1.6-5.4 cm] vs 3.5 cm [IQR, 2-6.8 cm], respectively; P = .03). Patients with a history of lymphoma or leukemia showed a lower incidence of bleeding than patients without this history (three of 90 [3%] vs 28 of 288 [9.7%], respectively; P = .05). Conclusion Bleeding after splenic biopsy with a needle 18 gauge or larger was similar to biopsy with a needle smaller than 18 gauge and seen in 8% of procedures overall, with 2% overall requiring treatment. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Grant in this issue.
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Affiliation(s)
- Hadiseh Kavandi
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Malak Itani
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Benjamin Strnad
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Sooyoung Martin
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Seyed Amir Ebrahimzadeh
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Meghan G Lubner
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Victoria Noe-Kim
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - J Louis Hinshaw
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Mohit Bansal
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Adib R Karam
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Kanika Khanna
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Mohamad Omar Hadied
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Virginia Planz
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Daniel I Glazer
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Constantine M Burgan
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Samuel Galgano
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Alexander Brook
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Olga R Brook
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
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12
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Grant EG. Image-guided Core Splenic Biopsy: A Safe Option. Radiology 2024; 310:e233281. [PMID: 38259213 DOI: 10.1148/radiol.233281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Affiliation(s)
- Edward G Grant
- From the Department of Radiology, University of Southern California Keck School of Medicine, 1500 San Pablo St, Los Angeles, CA 90033
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13
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Cheng JA, Lin YC, Lin Y, Wu RC, Lu HY, Yang LY, Chiang HJ, Juan YH, Lai YC, Lin G. Machine Learning Radiomics Signature for Differentiating Lymphoma versus Benign Splenomegaly on CT. Diagnostics (Basel) 2023; 13:3632. [PMID: 38132216 PMCID: PMC10742777 DOI: 10.3390/diagnostics13243632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND We aimed to develop and validate a preoperative CT-based radiomics signature for differentiating lymphoma versus benign splenomegaly. METHODS We retrospectively analyzed CT studies from 139 patients (age range 26-93 years, 43% female) between 2011 and 2019 with histopathological diagnosis of the spleen (19 lymphoma, 120 benign) and divided them into developing (n = 79) and testing (n = 60) datasets. The volumetric radiomic features were extracted from manual segmentation of the whole spleen on venous-phase CT imaging using PyRadiomics package. LASSO regression was applied for feature selection and development of the radiomic signature, which was interrogated with the complete blood cell count and differential count. All p values < 0.05 were considered to be significant. RESULTS Seven features were selected for constructing the radiomic signature after feature selection, including first-order statistics (10th percentile and Robust Mean Absolute Deviation), shape-based (Surface Area), and texture features (Correlation, MCC, Small Area Low Gray-level Emphasis and Low Gray-level Zone Emphasis). The radiomic signature achieved an excellent diagnostic accuracy of 97%, sensitivity of 89%, and specificity of 98%, distinguishing lymphoma versus benign splenomegaly in the testing dataset. The radiomic signature significantly correlated with the platelet and segmented neutrophil percentage. CONCLUSIONS CT-based radiomics signature can be useful in distinguishing lymphoma versus benign splenomegaly and can reflect the changes in underlying blood profiles.
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Affiliation(s)
- Jih-An Cheng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan; (J.-A.C.); (Y.-C.L.); (H.-Y.L.); (H.-J.C.); (Y.-H.J.); (Y.-C.L.)
| | - Yu-Chun Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan; (J.-A.C.); (Y.-C.L.); (H.-Y.L.); (H.-J.C.); (Y.-H.J.); (Y.-C.L.)
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 333, Taiwan
- Clinical Metabolomics Core and Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan
| | - Yenpo Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan; (J.-A.C.); (Y.-C.L.); (H.-Y.L.); (H.-J.C.); (Y.-H.J.); (Y.-C.L.)
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 333, Taiwan
- Clinical Metabolomics Core and Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan;
| | - Hsin-Ying Lu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan; (J.-A.C.); (Y.-C.L.); (H.-Y.L.); (H.-J.C.); (Y.-H.J.); (Y.-C.L.)
- Clinical Metabolomics Core and Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan
| | - Lan-Yan Yang
- Clinical Trial Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan;
| | - Hsin-Ju Chiang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan; (J.-A.C.); (Y.-C.L.); (H.-Y.L.); (H.-J.C.); (Y.-H.J.); (Y.-C.L.)
- Clinical Metabolomics Core and Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan
| | - Yu-Hsiang Juan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan; (J.-A.C.); (Y.-C.L.); (H.-Y.L.); (H.-J.C.); (Y.-H.J.); (Y.-C.L.)
| | - Ying-Chieh Lai
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan; (J.-A.C.); (Y.-C.L.); (H.-Y.L.); (H.-J.C.); (Y.-H.J.); (Y.-C.L.)
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 333, Taiwan
- Clinical Metabolomics Core and Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan; (J.-A.C.); (Y.-C.L.); (H.-Y.L.); (H.-J.C.); (Y.-H.J.); (Y.-C.L.)
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 333, Taiwan
- Clinical Metabolomics Core and Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan
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Bellisario F, Attili F, Campana F, Borrelli de Andreis F, Bellesi S, Maiolo E, Alma E, Malafronte R, Macis G, Larocca LM, Annunziata S, D’Alò F, Hohaus S. Endoscopic Ultrasound-Guided Fine Needle Biopsy in the Diagnostic Work-Up of Deep-Seated Lymphadenopathies and Spleen Lesions: A Monocentric Experience. Diagnostics (Basel) 2023; 13:2839. [PMID: 37685377 PMCID: PMC10487140 DOI: 10.3390/diagnostics13172839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 09/10/2023] Open
Abstract
EUS-FNB has been introduced in clinical practice as a less invasive diagnostic approach with respect to surgery. We performed a single-center retrospective study on the diagnostic efficacy of EUS-guided FNB, including 171 patients with lymph nodes, splenic, and extranodal lesions that underwent EUS for FNB at our institution. Excluding 12 patients who did not undergo FNB and 25 patients with a previous diagnosis of a solid tumor, we included 134 patients with clinical/radiological suspect of a lymphoproliferative disease, including 20 patients with a previous history of lymphoma. Out of the 134 biopsies, material of diagnostic quality was obtained in 111 procedures (84.3%). Histological examination of the EUS-FNB samples produced an actionable diagnosis in 100 cases (74.6%). Among the patients without an actionable diagnosis, a second, different diagnostic procedure produced a further eight diagnoses of lymphoma. Therefore, the sensitivity of EUS-FNB for diagnosing lymphomas was calculated to be 86.4% (51/59). Assignment of lymphomas to WHO classification subtypes was possible in 47/51 (92%) of the cases. In conclusion, EUS-FNB is an effective procedure for the histological characterization of lesions that are suspected to be lymphoproliferative disease, allowing for an actionable diagnosis in 75% of cases.
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Affiliation(s)
- Flaminia Bellisario
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.B.); (S.B.); (E.M.); (E.A.); (R.M.); (G.M.); (S.A.); (S.H.)
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Fabia Attili
- Endoscopia Digestiva, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.A.); (F.B.d.A.)
| | - Fabrizia Campana
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Federica Borrelli de Andreis
- Endoscopia Digestiva, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.A.); (F.B.d.A.)
| | - Silvia Bellesi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.B.); (S.B.); (E.M.); (E.A.); (R.M.); (G.M.); (S.A.); (S.H.)
| | - Elena Maiolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.B.); (S.B.); (E.M.); (E.A.); (R.M.); (G.M.); (S.A.); (S.H.)
| | - Eleonora Alma
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.B.); (S.B.); (E.M.); (E.A.); (R.M.); (G.M.); (S.A.); (S.H.)
| | - Rosalia Malafronte
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.B.); (S.B.); (E.M.); (E.A.); (R.M.); (G.M.); (S.A.); (S.H.)
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Giuseppe Macis
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.B.); (S.B.); (E.M.); (E.A.); (R.M.); (G.M.); (S.A.); (S.H.)
| | - Luigi Maria Larocca
- Patologia Oncoematologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Salvatore Annunziata
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.B.); (S.B.); (E.M.); (E.A.); (R.M.); (G.M.); (S.A.); (S.H.)
| | - Francesco D’Alò
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.B.); (S.B.); (E.M.); (E.A.); (R.M.); (G.M.); (S.A.); (S.H.)
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Stefan Hohaus
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.B.); (S.B.); (E.M.); (E.A.); (R.M.); (G.M.); (S.A.); (S.H.)
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
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15
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Galal M, Fawzy NA, Shafqat A, Rana HT, Aljabr A. Multimodality imaging workup of classical Hodgkin lymphoma in an 8-month-old child. Radiol Case Rep 2023; 18:1431-1436. [PMID: 36798067 PMCID: PMC9925834 DOI: 10.1016/j.radcr.2023.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 02/04/2023] Open
Abstract
The incidence of Hodgkin lymphoma (HL) varies by age, most commonly affecting 15-19-year-olds. Cases in children less than 3 years old are exceedingly rare. We report a case of classical HL in an 8-month-old male; the youngest case reported thus far in the literature to our knowledge. Furthermore, while lymphadenopathy is a salient feature of HL, it was absent in our patient, who presented with immunodeficiency and delays in achieving neurologic milestones. A thorough radiologic workup demonstrated bilateral paravertebral masses, collapse of the T3 vertebrae, and severe spinal cord compression. Involvement of the lung, liver, and spleen was also noted. Histopathological evaluation of the paravertebral mass revealed a diagnosis of classical HL. Various non-neoplastic and malignant disorders, such as tuberculosis, Langerhans cell histiocytosis, leukemia, and neuroblastoma, amongst others, could be included in the differential diagnosis of our patient. Using an Illustrative case report, we review the multimodality imaging workup of Hodgkin lymphoma.
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Affiliation(s)
- Maad Galal
- College of Medicine, Alfaisal University, Al Takhassousi, Al Zahrawi Street interconnecting with, Riyadh 11533, Saudi Arabia
| | - Nader Ashraf Fawzy
- College of Medicine, Alfaisal University, Al Takhassousi, Al Zahrawi Street interconnecting with, Riyadh 11533, Saudi Arabia
| | - Areez Shafqat
- College of Medicine, Alfaisal University, Al Takhassousi, Al Zahrawi Street interconnecting with, Riyadh 11533, Saudi Arabia,Corresponding author.
| | - Hirdah Tauqir Rana
- College of Medicine, Alfaisal University, Al Takhassousi, Al Zahrawi Street interconnecting with, Riyadh 11533, Saudi Arabia
| | - Aljohara Aljabr
- Department of Radiology, King Fahad Medical City, Riyadh, Saudi Arabia
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16
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Tomioka A, Asakuma M, Kawaguchi N, Komeda K, Shimizu T, Uchiyama K, Lee SW. Long-term disease-free survival of an undifferentiated pleomorphic sarcoma of the spleen: A case report and literature review. Medicine (Baltimore) 2022; 101:e31642. [PMID: 36451413 PMCID: PMC9704966 DOI: 10.1097/md.0000000000031642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Undifferentiated pleomorphic sarcoma (UPS) primarily occurs in the soft tissues of the extremities, trunk, and retroperitoneum. As the primary UPS of the spleen (splenic UPS) is extremely rare, to the best of our knowledge, only 19 cases have been reported in English literature. No cases of long-term survival without a local or distant recurrence have been reported. PATIENT CONCERNS We report the case of a 37-year-old man who was referred to our hospital for a splenic tumor. He had no past medical or relevant familial history. On abdominal computed tomography (CT), a low attenuation solid mass and cystic component with mural calcifications were present at the lower pole of his spleen. The fluorodeoxyglucose-positron emission tomography (CT) indicated it as malignant tumor of the spleen. DIAGNOSES The patient's provisional diagnosis was deduced to be angiosarcoma, which was the most common malignant tumor of the spleen. INTERVENTIONS An elective laparoscopic splenectomy was performed, and the histology of the tumor was consistent with UPS (pT1, pN0, cM0, and AJCC8th). No adjuvant therapy was administered. OUTCOMES Ten years have passed since the patient's splenectomy, and he continues to do well, without evidence of local or distant recurrence. LESSONS To the best of our knowledge, this is the first case of long-term recurrence-free survival after surgical management of a splenic UPS. It is probable that radical splenectomy during the disease played the most important role in the patient's long-term survival. Understanding the characteristic findings of a splenic UPS in an abdominal CT may help to diagnose properly.
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Affiliation(s)
- Atsushi Tomioka
- General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
- * Correspondence: Atsushi Tomioka, General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-cho, Takatsuki City, Osaka 569-8686, Japan. (e-mail: )
| | - Mitsuhiro Asakuma
- General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Nao Kawaguchi
- General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Koji Komeda
- General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Tetsunosuke Shimizu
- General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Kazuhisa Uchiyama
- General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Sang-Woong Lee
- General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
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17
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Endoscopic ultrasound-guided tissue acquisition for splenic lesions: A systematic review and meta-analysis of diagnostic test accuracy. PLoS One 2022; 17:e0276529. [PMID: 36264978 PMCID: PMC9584539 DOI: 10.1371/journal.pone.0276529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND AIMS At present, it is difficult and risky to diagnose splenic lesions by conventional needle biopsy using computed tomography (CT) or ultrasound (US). Endoscopic ultrasound (EUS)-guided tissue acquisition is increasingly being used as a new technique to determine the tissue diagnosis of splenic lesions. Therefore, our goal was to determine the efficacy and safety of EUS-guided tissue acquisition for splenic lesions. METHODS We performed a systematic review and meta-analysis to evaluate the pooled sensitivity and specificity of EUS-guided tissue acquisition for the diagnosis of splenic lesions using Metadisc. The Quality Assessment of Diagnostic Accuracy Studies Questionnaire, a quality assessment tool, was used to scrutinize the quality of the studies. RESULTS Six eligible studies between January 2000 and June 2022 were identified, and a total number of 62 patients (aged range from 19 to 84) were enrolled. One patient was excluded because of insufficient specimens. The pooled sensitivity and specificity of included studies were 0.85 [95% confidence interval (CI), 0.73-0.93] and 0.77 (95% CI, 0.46-0.95), respectively. The pooled positive likelihood ratio (LR) was 2.38 (95% CI, 1.24-4.57), the pooled negative LR was 0.31 (95% CI, 0.17-0.55), the pooled diagnostic odds ratio (DOR) was 8.67 (95% CI, 2.80-26.82), the area under the summary receiver operating characteristic (SROC) curve was 0.8100 (Standard Error 0.0813). CONCLUSION EUS-guided tissue acquisition is a safe technique with high sensitivity in the diagnosis of splenic lesions. However, because of the small sample sizes, more studies with more cases are needed to further validate these results.
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18
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Strnad BS, Itani M, Middleton WD. Detection and management of bleeding in the setting of image-guided percutaneous needle biopsy. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2681-2696. [PMID: 34882270 DOI: 10.1007/s00261-021-03357-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 01/18/2023]
Abstract
Image-guided percutaneous needle biopsy (PNB) is an important and increasingly utilized method of minimally invasive tissue sampling for a broad variety of disease processes. While infrequent, major bleeding is a potential complication of PNB and can be life-threatening, especially when unrecognized. On the other hand, prompt recognition and treatment of major bleeding in this setting can prevent significant morbidity or mortality. It is therefore crucial for anyone performing PNB to be familiar with the diagnosis and management of bleeding complications. This article reviews the risk factors for major bleeding in the setting of PNB, the presentation and imaging findings of a spectrum of bleeding complications encountered during and following PNB, and the management of those findings based on experience at a single, high volume, biopsy center.
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Affiliation(s)
- Benjamin S Strnad
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, Box 8131, Saint Louis, MO, 63110, USA.
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, Box 8131, Saint Louis, MO, 63110, USA
| | - William D Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, Box 8131, Saint Louis, MO, 63110, USA
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19
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Riller Q, Cohen-Aubart F, Roos-Weil D. [Splenic lymphoma, diagnosis and treatment]. Rev Med Interne 2022; 43:608-616. [PMID: 35691756 DOI: 10.1016/j.revmed.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022]
Abstract
Some common clinical situations, such as splenomegaly or lymphocytosis, or less common, such as autoimmune hemolytic anemia, cold agglutinin disease, or cryoglobulinemia can lead to the diagnosis of splenic lymphoma. Splenic lymphoma is rare, mainly of non-hodgkinian origin, encompassing very different hematological entities in their clinical and biological presentation from an aggressive form such as hepato-splenic lymphoma to indolent B-cell lymphoma not requiring treatment such as marginal zone lymphoma, the most frequent form of splenic lymphoma. These entities can be challenging to diagnose and differentiate. This review presents different clinical and biological manifestations suspicious of splenic lymphoma and proposes a diagnosis work-up. We extended the strict definition of splenic lymphoma (lymphoma exclusively involving the spleen) to lymphoma thant can be revealed by a splenomegaly and we discuss the differential diagnosis of splenomegaly.
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Affiliation(s)
- Q Riller
- Service de médecine interne 2, Centre national de référence maladies systémiques rares, hôpital Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France.
| | - F Cohen-Aubart
- Service de médecine interne 2, Centre national de référence maladies systémiques rares, hôpital Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - D Roos-Weil
- Service d'hématologie clinique, hôpital Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
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20
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Lisotti A, Crinò SF, Mangiavillano B, Cominardi A, Ofosu A, Brighi N, Metelli F, Zagari RM, Facciorusso A, Fusaroli P. Diagnostic performance of endoscopic ultrasound-guided tissue acquisition of splenic lesions: systematic review with pooled analysis. Gastroenterol Rep (Oxf) 2022; 10:goac022. [PMID: 35663151 PMCID: PMC9154069 DOI: 10.1093/gastro/goac022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/09/2022] [Accepted: 05/10/2022] [Indexed: 11/27/2022] Open
Abstract
Background Focal splenic lesions are usually incidentally discovered on radiological assessments. Although percutaneous tissue acquisition (TA) under trans-abdominal ultrasound guidance is a well-established technique for obtaining cyto-histological diagnosis of focal splenic lesions, endoscopic ultrasound (EUS)-guided TA has been described in several studies, reporting different safety and outcomes. The aim was to assess the pooled safety, adequacy, and accuracy of EUS-TA of splenic lesions. Methods A comprehensive review of available evidence was conducted at the end of November 2021. All studies including more than five patients and reporting about the safety, adequacy, and accuracy of EUS-TA of the spleen were included. Results Six studies (62 patients) were identified; all studies have been conducted using fine-needle aspiration (FNA) needles. Pooled specimen adequacy and accuracy of EUS-TA for spleen characterization were 92.8% [95% confidence interval (CI), 86.3%–99.3%] and 88.2% (95% CI, 79.3%–97.1%), respectively. The pooled incidence of adverse events (six studies, 62 patients) was 4.7% (95% CI, 0.4%–9.7%). Conclusion EUS-FNA of the spleen is a safe technique with high diagnostic adequacy and accuracy. The EUS-guided approach could be considered a valid alternative to the percutaneous approach for spleen TA.
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Affiliation(s)
- Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Stefano Francesco Crinò
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | | | - Anna Cominardi
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Andrew Ofosu
- Gastroenterology and Hepatology, Stanford University, Stanford, CA, USA
| | - Nicole Brighi
- Department of Medical Oncology, IRCSS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Medola, Italy
| | - Flavio Metelli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Rocco Maurizio Zagari
- Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Bologna, Italy
| | - Antonio Facciorusso
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy.,Department of Surgical and Medical Sciences, Section of Gastroenterology, University of Foggia, Foggia, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
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21
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Kim N, Auerbach A, Manning MA. Algorithmic Approach to the Splenic Lesion Based on Radiologic-Pathologic Correlation. Radiographics 2022; 42:683-701. [PMID: 35302864 DOI: 10.1148/rg.210071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Splenic lesions are commonly discovered incidentally at imaging, without clinical signs or symptoms that may aid in diagnosis. As such, the differential diagnosis and subsequent management are based primarily on imaging characteristics. Much has been written about the myriad pathologic conditions that can occur in the spleen; however, there is little guidance on the approach to an incidental splenic mass. Applying an approach frequently used in imaging to the splenic mass-based on the number and consistency of lesions and refined by supplementary imaging features-allows formulation of a useful differential diagnosis. Solitary cystic masses include true cysts, pseudocysts, and parasitic cysts. When multiple cystic lesions are present, the differential diagnosis expands to include infectious lesions (abscess or microabscesses) and lymphangioma (a benign cystic neoplasm). Hemangioma is the most common solitary solid mass, although other vascular lesions (hamartoma, sclerosing angiomatoid nodular transformation) and nonvascular lesions (inflammatory pseudotumor, lymphoma) manifest as solitary and solid. When multiple solid masses are present, diffuse inflammatory disease (sarcoidosis), littoral cell angioma, and lymphoma should be considered. Malignancies, such as angiosarcoma or metastasis, can manifest as solitary or multiple and solid or cystic masses but are typically associated with symptoms or widespread primary malignancy. Careful assessment of the multimodality imaging characteristics of splenic lesions based on this approach aids the radiologist faced with the incidental splenic lesion. Online supplemental material is available for this article. Work of the U.S. Government published under an exclusive license with the RSNA.
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Affiliation(s)
- Nancy Kim
- From the Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, CCC Building Ground Floor, CG 201, Washington, DC 20007 (N.K., M.A.M.); the Joint Pathology Center, Silver Spring, Md (A.A.); and the American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.)
| | - Aaron Auerbach
- From the Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, CCC Building Ground Floor, CG 201, Washington, DC 20007 (N.K., M.A.M.); the Joint Pathology Center, Silver Spring, Md (A.A.); and the American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.)
| | - Maria A Manning
- From the Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, CCC Building Ground Floor, CG 201, Washington, DC 20007 (N.K., M.A.M.); the Joint Pathology Center, Silver Spring, Md (A.A.); and the American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.)
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22
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Sclerosing Angiomatoid Nodular Transformation of the Spleen: A Diagnostic Conundrum. J Belg Soc Radiol 2022; 106:12. [PMID: 35480339 PMCID: PMC8992766 DOI: 10.5334/jbsr.2689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
A splenic lesion often represents a diagnostic challenge due to relative scarcity and the broad differential diagnosis. Sclerosing Angiomatoid Nodular Transformation (SANT) of the spleen is usually encountered only incidentally. Although benign, patients with SANT often receive splenectomy, due to its rarity, diagnostic uncertainty and sometimes intimidating imaging morphology and size. Imaging features on computed tomography, magnetic resonance and positron emission tomography have a high diagnostic value for SANT and help differentiate this entity from other splenic lesions. When the imaging parameters are matched with core needle biopsy tissue analysis, further watchful waiting can be recommended in order to avoid splenectomy.
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23
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Hiyama K, Kirino I, Fukui Y, Terashima H. Two cases of splenic neoplasms with differing imaging findings that required laparoscopic resection for a definitive diagnosis. Int J Surg Case Rep 2022; 93:107023. [PMID: 35477212 PMCID: PMC9052252 DOI: 10.1016/j.ijscr.2022.107023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction and importance Splenic tumors are rare and are sometimes found incidentally. In such cases, laboratory tests and imaging studies should be performed based on the diagnostic algorithm to determine whether the tumor is benign or malignant. However, we clinicians sometimes encounter challenging cases. Herein we experienced two challenging cases of splenic tumor which we could not correctly diagnosis preoperatively. Case presentation Case 1: A female in her 80s presented to our surgical department to undergo follow-up examinations for Stage IIIa ascending colon cancer. A follow-up CT scan showed marked enlargement of the splenic tumor which suggested metastatic cancer. We performed laparoscopic splenectomy. Case 2: A healthy female in her 50s presented to our internal medicine department to undergo a workup after multiple splenic tumors. A follow-up CT scan showed that the tumors had grown slightly. We could not completely rule out a malignant tumor. She rejected further follow-up study and chose splenectomy. Clinical discussion We experienced two cases of splenic hemangioma with different clinical presentations and imaging findings. Although some studies have reported that biopsying a splenic tumor is a safe and effective way of distinguishing among splenic tumors, in our country splenic biopsies are seldom performed due to fears of causing intraabdominal bleeding or tumor dissemination. Clinicians should consider whether it would be better to perform follow up with a biopsy or splenectomy as a definitive treatment on a case-by-case basis. Conclusion Laparoscopic splenectomy can be used for definitive management in cases involving malignancy or an uncertain etiology. Splenic tumors are sometimes challenging to be correctly diagnosed. We should recognize a diagnostic algorithm, but not always applicable. Clinicians should choose follow-up or splenectomy on a case-by-case basis. Splenectomy is the definitive management of malignancy or an uncertain etiology.
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Affiliation(s)
| | - Izumi Kirino
- Department of Surgery, Atago Hospital, Kochi, Japan
| | - Yasuo Fukui
- Department of Surgery, Atago Hospital, Kochi, Japan
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24
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Malgras B, Najah H, Dohan A, Barat M, Soyer P. Diagnosis and treatment of focal splenic lesions. J Visc Surg 2022; 159:121-135. [DOI: 10.1016/j.jviscsurg.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Habibi HA, Cevener M, Yilmaz S. Image-guided percutaneous cutting needle biopsy in difficult locations. Jpn J Radiol 2022; 40:560-567. [DOI: 10.1007/s11604-021-01238-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/09/2021] [Indexed: 12/01/2022]
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26
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Rajendran T, Kini JR, Abna A, Prasad K. Clinical benefit of R-CHOP without splenectomy in stage I primary splenic diffuse large B-cell lymphoma. BMJ Case Rep 2022; 15:e246610. [PMID: 34983812 PMCID: PMC8728438 DOI: 10.1136/bcr-2021-246610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/04/2022] Open
Abstract
Primary splenic diffuse large B-cell lymphoma (PS-DLBCL) is a relatively rare malignancy, and there are no optimal approaches for diagnosis and management. There are less invasive splenic biopsies that effectively obviate diagnostic and elective splenectomies. We report a man in his 50s with 2-day history of pain in the abdomen and who was found to have a splenic mass on PET-CT. A CT-guided core needle splenic biopsy confirmed the diagnosis of PS-DLBCL. He was managed with six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) alone, without splenectomy. The patient attained complete remission, and he is disease free at 6 years of follow-up.
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Affiliation(s)
- Tara Rajendran
- Division of Medical Oncology, Department of General Medicine, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Mangalore, Karnataka, India
| | - Jyoti Ramanath Kini
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Mangalore, Karnataka, India
| | - Aysha Abna
- Department of Radio-diagnosis and Imaging, Father Muller Medical College, Mangalore, Karnataka, India
| | - Krishna Prasad
- Division of Medical Oncology, Department of General Medicine, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Mangalore, Karnataka, India
- Department of Medical Oncology, Mangalore Institute of Oncology, Mangalore, Karnataka, India
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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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Smith TA, Gage D, Quencer KB. Narrative review of vascular iatrogenic trauma and endovascular treatment. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1199. [PMID: 34430640 PMCID: PMC8350708 DOI: 10.21037/atm-20-4332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022]
Abstract
Iatrogenic injury is unfortunately a leading cause of morbidity and mortality for patients worldwide. The etiology of iatrogenic injury is broad, and can be seen with both diagnostic and therapeutic interventions. While steps can be taken to reduce the occurrence of iatrogenic injury, it is often not completely avoidable. Once iatrogenic injury has occurred, prompt recognition and appropriate management can help reduce further harm. The objective of this narrative review it to help reader better understand the risk factors associated with, and treatment options for a broad range of potential iatrogenic injuries by presenting a series of iatrogenic injury cases. This review also discusses rates, risk factors, as well as imaging and clinical signs of iatrogenic injury with an emphasis on endovascular and minimally invasive treatments. While iatrogenic vascular injury once required surgical intervention, now minimally invasive endovascular treatment is a potential option for certain patients. Further research is needed to help identify patients that are at the highest risk for iatrogenic injury, allowing patients and providers to reconsider or avoid interventions where the risk of iatrogenic injury may outweigh the benefit. Further research is also needed to better define outcomes for patients with iatrogenic vascular injury treated with minimally invasive endovascular techniques verses conservative management or surgical intervention.
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Affiliation(s)
- Tyler Andrew Smith
- Department of Interventional Radiology, University of Utah, Salt Lake City, UT, USA
| | - David Gage
- Department of Medicine, Intermountain Healthcare, Murray, UT, USA
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30
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Trenker C, Görg C, Freeman S, Jenssen C, Dong Y, Caraiani C, Ioanițescu ES, Dietrich CF. WFUMB Position Paper-Incidental Findings, How to Manage: Spleen. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2017-2032. [PMID: 34052061 DOI: 10.1016/j.ultrasmedbio.2021.03.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled "Incidental Imaging Findings-The Role of Medical Ultrasound." IFs are less commonly encountered in the spleen than in many other abdominal organs but remain a frequent dilemma in clinical practice. A histological diagnosis is rarely necessary for patient management. Many IFs, such as secondary spleens and splenic cysts, are harmless and do not require any further investigation. The diagnosis of many other focal splenic lesions is, however, often problematic. The following overview is intended to illustrate a variety of incidentally detected spleen pathologies such as size variants, shape variants, secondary spleens, focal splenic lesions and splenic calcifications. It should aid the examiner in establishing the diagnosis. Moreover, it should help the ultrasound practitioner decide which pathologies need no further investigation, those requiring interval imaging and cases in which immediate further diagnostic procedures are required.
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Affiliation(s)
- Corinna Trenker
- Department of Hematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstrasse, Marburg, Germany
| | - Christian Görg
- Department of gastroenterology, Interdisciplinary Center of Ultrasound, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstrasse Marburg, Germany
| | - Simon Freeman
- University Hospitals Plymouth, Imaging Directorate, Derriford Hospital, Plymouth, United Kingdom
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch Oderland GmbH Strausberg/Wriezen, Akademisches Lehrkrankenhaus Medizinische Hochschule Brandenburg "Theodor Fontane", Germany; Brandenburg Institute for Clinical Ultrasound at Medical University Brandenburg "Theodor Fontane", Neuruppin, Germany
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cosmin Caraiani
- Department of Medical Imaging, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Elena Simona Ioanițescu
- Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Center of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland.
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Safai Zadeh E, Dietrich CF, Görg C, Bleyl T, Alhyari A, Ignee A, Jenssen C, Trenker C. [Spleen biopsy: "pros and cons" or better "when and when not?"]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:879-885. [PMID: 33752245 DOI: 10.1055/a-1404-3926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Due to the relatively high complication rate, the necessity of a spleen biopsy is controversially discussed. In establishing its indication, the clinical background and performed diagnostics must be considered. Based on the medical history, imaging procedures and sonographic course, different clinical scenarios are conceivable. The aim of this review is to describe the indications of splenic biopsy considering various clinical scenarios.
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Affiliation(s)
- Ehsan Safai Zadeh
- Interdisziplinäres Ultraschallzentrum, UKGM Marburg und Philipps-Universität Marburg
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, Bern, Schweiz
| | - Christian Görg
- Interdisziplinäres Ultraschallzentrum, UKGM Marburg und Philipps-Universität Marburg
| | - Tobias Bleyl
- Klinik für Gastroenterologie, Endokrinologie, Stoffwechsel und klinische Infektiologie, UKGM Marburg und Philipps-Universität Marburg
| | - Amjad Alhyari
- Klinik für Gastroenterologie, Endokrinologie, Stoffwechsel und klinische Infektiologie, UKGM Marburg und Philipps-Universität Marburg
| | - Andre Ignee
- Department für Innere Medizin, Caritas Hospital, Bad Mergentheim, Germany
| | - Christian Jenssen
- Department für Innere Medizin, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Brandenburg Institute for Clinical Ultrasound at Medical Universitäy Brandenburg, Neuruppin, Germany
| | - Corinna Trenker
- Klinik für Hämatologie, Onkologie und Immunologie, UKGM Marburg und Philipps-Universität Marburg
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Niiya F, Takano Y, Azami T, Kobayashi T, Maruoka N, Kabasawa N, Harada H, Norose T, Ohike N, Nagahama M. Usefulness of endoscopic ultrasound-guided fine needle aspiration for splenic parenchyma in patients suspected of having primary splenic malignant lymphoma. Endosc Int Open 2021; 9:E96-E101. [PMID: 33403241 PMCID: PMC7775802 DOI: 10.1055/a-1287-9577] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background and study aims The diagnosis of malignant lymphoma (ML) is sometimes difficult, especially in patients with primary splenic malignant lymphomas (psML) which have no lymph nodes capable of acting as the biopsy target. We carried out endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for "splenic parenchyma" in patients suspected of having a psML, even without any obvious neoplastic lesions in the spleen. Patients and methods A retrospective study using medical records was conducted of eight patients suspected of having a psML that received EUS-FNA for the splenic parenchyma between January 2016 and January 2019. Data analyzed included clinical background, EUS-FNA procedure (puncture needle/route), diagnostic ability (pathological/flow cytometry [FCM]), and complications. Results EUS-FNA was performed from the stomach in all eight cases, and no patients had complications. As a result of splenic parenchymal biopsy found on EUS-FNA, 75 % of patients (6/8) were histologically diagnosed with MLs, monoclonality of B-cells was identified in all cases (8/8) with FCM, and all patients (8/8) were definitively diagnosed with psMLs. Conclusion EUS-FNA for "splenic parenchyma" is useful for patients with spML, even if they have no obvious neoplastic lesions in the spleen.
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Affiliation(s)
- Fumitaka Niiya
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Yuichi Takano
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Tetsushi Azami
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Takahiro Kobayashi
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Naotaka Maruoka
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Nobuyuki Kabasawa
- Department of Hematology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Hiroshi Harada
- Department of Hematology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Tomoko Norose
- Department of Diagnostic Pathology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa Japan
| | - Nobuyuki Ohike
- Department of Diagnostic Pathology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa Japan
| | - Masatsugu Nagahama
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
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Sheth RA, Baerlocher MO, Connolly BL, Dariushnia SR, Shyn PB, Vatsky S, Tam AL, Gupta S. Society of Interventional Radiology Quality Improvement Standards on Percutaneous Needle Biopsy in Adult and Pediatric Patients. J Vasc Interv Radiol 2020; 31:1840-1848. [DOI: 10.1016/j.jvir.2020.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022] Open
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Gómez Rubio M, López Cano A, Rendón Unceta P. Percutaneous and endoscopic ultrasound-guided splenic biopsies are both safe procedures with a high diagnostic accuracy. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:817. [PMID: 32954779 DOI: 10.17235/reed.2020.7390/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Splenic biopsy is a necessary diagnostic procedure. It has been proved that it is a safe procedure with a high diagnostic accuracy. However, the decision of percutaneous or endoscopic ultrasound-guided approach should be assessed taking into consideration patients' characteristics and the experience of each center.
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Affiliation(s)
| | | | - Paloma Rendón Unceta
- Unidad Clínica de Aparato Digestivo, Hospital Universitario Puerta del Mar, España
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35
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Balekuduru AB, Kapali AS, Kurella SP, Subbaraj SB. Endoscopic Ultrasound-Guided Transgastric Fine Needle Aspiration of Splenic Metastasis. JOURNAL OF DIGESTIVE ENDOSCOPY 2020. [DOI: 10.1055/s-0040-1713832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AbstractSplenic metastasis is extremely rare and is part of diffuse carcinomatosis. We present a case of a 60-year-old woman with transitional cell ovarian carcinoma who had hysterectomy with bilateral salpingo-oophorectomy in the past. She now presented with solitary splenic metastasis, confirmed by endoscopic ultrasound-guided transgastric fine needle aspiration biopsy.
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Affiliation(s)
- Avinash Bhat Balekuduru
- Department of Gastroenterology, M.S. Ramaiah Memorial Hospitals, Bangalore, Karnataka, India
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36
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A Rare Case of Splenic Pneumocystis jirovecii in a HIV-Positive Patient. Case Rep Gastrointest Med 2020; 2020:8509591. [PMID: 32566330 PMCID: PMC7303748 DOI: 10.1155/2020/8509591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/02/2020] [Accepted: 03/18/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Human immunodeficiency virus (HIV) positive individuals with the CD4 count less than 200 cells/mm3 are at risk for opportunistic infections. Pneumocystis jirovecii, a fungal pathogen, is a common cause of opportunistic infections with predominantly pulmonary involvement. Disseminated P. jiroveciii infection presenting with hepatosplenic lesion is extremely rare. Case Summary. A 31-year-old male with HIV with and acquired immunodeficiency syndrome (AIDS) presented with diarrhea for 3 weeks. He had splenomegaly and inguinal lymphadenopathy on physical examination. Laboratory parameters revealed anemia and hypoalbuminemia, while stool studies for infectious etiology and fecal leucocyte were negative. Computed tomography (CT) of the chest and abdomen depicted consolidation of the lungs and a large splenic mass. He underwent fiberoptic bronchoscopy with transbronchial biopsy which was consistent with P. jirovecii pneumonia. He also had a ultrasound-guided core biopsy of the splenic mass which revealed necrotizing granulomas with Pneumocystis jirovecii infection on Grocott-Gomori's methenamine silver (GMS) stain and was initiated on treatment for P. jirovecii with sulfamethoxazole with trimethoprim. Conclusion Malignancy and atypical infection are key differentials in patients presenting with hepatosplenic lesions. HIV positive patients are at increased risk of AIDS-related lymphoma. Tissue diagnosis is often required for further evaluation. Disseminated P. jirovecii presenting with splenic mass and liver lesion is extremely rare.
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37
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John S, Shabana W, Salameh JP, McInnes MDF. Percutaneous Image-Guided Biopsy of the Spleen: Experience at a Single Tertiary Care Center. Can Assoc Radiol J 2020; 72:311-316. [PMID: 32157895 DOI: 10.1177/0846537120903692] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this study is to assess the complication rate of percutaneous image-guided biopsy of the spleen at our institution and to evaluate for variables associated with complication rate. METHODS This is a Research Ethics Board approved retrospective study of consecutive patients who underwent image-guided biopsy of the spleen at our institution from January 2010 to November 2019. Complications, imaging findings, and pathologic diagnosis were reviewed. Complications (major and minor) were classified per Society of Interventional Radiology Guidelines, and complication rate was calculated. Logistic regression was applied to determine factors associated with complications. Diagnostic yield was calculated. RESULTS In all, 55 patients (28 female) underwent splenic biopsy using ultrasound guidance. The most common indication was possible lymphoma in 41 (71.7%) patients followed by query metastasis 18 (31.5%) patients. Core biopsies (18 g/20 g) were done in 53 (92%) cases, and fine-needle aspiration (22 g) was performed in 4 (8%). The median number of samples collected was 4 (range: 2-9). The results were diagnostic in 54 cases (94.7%, 95% confidence interval [CI]: 88.7-100.0). There were 12 (21%, 95% CI: 10.1-31.9) patients with minor complications and 2 (3.5%, 95% CI: 0.0-8.4) with major complications (2 splenic bleeds requiring embolization, no splenectomy, or deaths). No variables (needle size, lesion size, and number of passes) were associated with complication rate. CONCLUSION Percutaneous image-guided biopsy of the spleen at a single tertiary care institution demonstrates major complication rate comparable to that in the literature with no variables associated with complication rate; there were no cases of splenectomy or death.
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Affiliation(s)
- Susan John
- Department of Medical Imaging, the Ottawa Hospital, Ontario, Canada.,The Ottawa Hospital Research Institute Clinical Epidemiology Program, Ontario, Canada
| | - Wael Shabana
- Department of Medical Imaging, the Ottawa Hospital, Ontario, Canada.,Department of Radiology, 6363University of Ottawa, Ontario, Canada
| | - Jean-Paul Salameh
- The Ottawa Hospital Research Institute Clinical Epidemiology Program, Ontario, Canada
| | - Matthew D F McInnes
- Department of Medical Imaging, the Ottawa Hospital, Ontario, Canada.,The Ottawa Hospital Research Institute Clinical Epidemiology Program, Ontario, Canada.,Department of Radiology, 6363University of Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, 6363University of Ottawa, Ontario, Canada
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Leenknegt B, Moore S, Fang C, Kibriya N, Gregory S, Cancuri O, Sidhu PS, Yusuf G. Using contrast-enhanced ultrasound to guide a successful biopsy of a splenic sarcomatoid carcinoma. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2019; 28:58-61. [PMID: 32063997 DOI: 10.1177/1742271x19876088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/15/2019] [Indexed: 12/12/2022]
Abstract
Introduction Splenic lesions are uncommon and frequently cause a diagnostic dilemma, often with non-specific findings on both ultrasound and cross-sectional imaging with histological confirmation necessary. To reduce patient morbidity, primarily from haemorrhage and to increase diagnostic yield, precise imaging and biopsy targeting are needed. Case We present a case of an indeterminate complex splenic lesion, with areas of necrosis which required histological diagnosis. Contrast-enhanced ultrasound-guided percutaneous core needle biopsy was undertaken to provide real-time imaging guidance, increasing viable lesion targeting and helping to avoid areas of necrosis. Conclusion Contrast-enhanced ultrasound guidance of the percutaneous core needle biopsy allowed increased operator confidence in lesional targeting accuracy and reduced the number of passes required for biopsy, simultaneously maximising histological yield and minimising patient morbidity.
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Affiliation(s)
| | - Stephen Moore
- Princess Royal University Hospital, King's College NHS Foundation Trust, UK
| | - Cheng Fang
- Department of Radiology, King's College Hospital NHS Foundation Trust
| | - Nabil Kibriya
- Department of Radiology, King's College Hospital NHS Foundation Trust
| | - Stephen Gregory
- Department of Radiology, King's College Hospital NHS Foundation Trust
| | - Osman Cancuri
- Princess Royal University Hospital, King's College NHS Foundation Trust, UK
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital NHS Foundation Trust
| | - Gibran Yusuf
- Department of Radiology, King's College Hospital NHS Foundation Trust
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Alonazi B, Alfuhaid T, Mahmoud MZ. Are CT and US imaging-guided percutaneous FNAs and/or spleen and focal splenic lesion tissue core biopsies safe and effective? JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2019. [DOI: 10.1080/16878507.2019.1660076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Batil Alonazi
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Turki Alfuhaid
- Diagnostic Radiology Department, Alberta Children’s Hospital, Calgary, Canada
| | - Mustafa Z. Mahmoud
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
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[Echo-guided splenic biopsy: An effective diagnostic tool in sarcoidosis?]. Rev Med Interne 2019; 40:609-612. [PMID: 31221453 DOI: 10.1016/j.revmed.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/31/2019] [Accepted: 06/06/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Histological diagnosis of systemic granulomatosis may be difficult. The question of the best histological target remains unanswered. CASE We report here the observation of a patient admitted in intensive care unit for severe hypercalcemia in the context of polylymphadenopathy and constitutional symptoms. Assessment of this hypercalcemia was suggestive of systemic granulomatosis. The CT (computed tomodensitometry) revealed lymphadenopathies of the mediastinum and the hepatic hilus, hepatomegaly and heterogeneous splenomegaly. At this stage, our main hypotheses were: lymphoid hematopathy, sarcoidosis, tuberculosis. An echo-guided biopsy of the spleen allowed the histological diagnosis of systemic granulomatosis suggestive of sarcoidosis, without significant complication in the course. CONCLUSION This observation illustrates the efficiency and safety of spleen biopsy for the histological diagnosis of systemic granulomatosis.
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Piening N, Saurabh S, Munoz Abraham AS, Osei H, Fitzpatrick C, Greenspon J. Sterile necrotizing and non-necrotizing granulomas in a heart transplant patient with history of PTLD: A unique finding. Int J Surg Case Rep 2019; 60:8-12. [PMID: 31185455 PMCID: PMC6556822 DOI: 10.1016/j.ijscr.2019.05.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/07/2019] [Accepted: 05/27/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Posttransplant lymphoproliferative disease (PTLD) is a known complication in patients with solid organ transplant. It can present as localized or disseminated tumor. The cornerstone of management consists of reduced immunosuppression (RI). In select cases, localized disease can potentially be curative with surgical excision. PRESENTATION OF CASE Here we present a case of a 19-year-old female with orthotopic heart transplant with two episodes of recurrent PTLD. After the second episode she was found to have asymptomatic splenic lesions which were refractory to RI and chemotherapy. She subsequently underwent splenectomy that showed sterile necrotizing and non-necrotizing granulomas with no evidence of PTLD. DISCUSSION Based on our literature search this is the first ever reported case of sterile granulomas in a patient with recurrent PTLD which could potentially be diagnosed with minimally invasive biopsy rather than diagnostic splenectomy. CONCLUSION This report is an attempt to create awareness regarding potential for presence of sterile granulomas in patients with recurrent PTLD and discuss the use of percutaneous biopsy before splenectomy.
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Affiliation(s)
| | - Saxena Saurabh
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, United States
| | | | - Hector Osei
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, United States
| | - Colleen Fitzpatrick
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, United States
| | - Jose Greenspon
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, United States
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Pirovano A, Matino E, Zecca E, Costanzo M, Croce A, Leutner M, Romito R, Pirisi M. A 28-Year-Old Woman with Ascites and Multiple Focal Spleen Lesions. Eur J Case Rep Intern Med 2019; 6:001061. [PMID: 31157180 PMCID: PMC6542493 DOI: 10.12890/2019_001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/15/2019] [Indexed: 11/12/2022] Open
Abstract
Serous effusions complicating the course of lymphomas occur commonly in the pleural space but seldom in the peritoneum, where they most often present as chylous ascites with diagnostic cytology. Almost invariably, in these rare cases, the serum to ascites albumin gradient is low. We describe a 28-year-old woman with anasarca, ascites and a serum to ascites albumin gradient of 1.1 g/dl, consistent with portal hypertension. No tumour cells were detected in the ascitic fluid. However, a CT scan of the chest and abdomen disclosed liver and spleen enlargement and multiple enlarged retroperitoneal lymph nodes, suspicious for a lymphoproliferative disorder. Bone marrow aspiration and biopsy were not diagnostic, so a decision was made to proceed with a splenectomy despite the onset of low-grade disseminated intravascular coagulation. Surgery was uneventful. Diffuse large B cell lymphoma was diagnosed. A liver biopsy taken at the time of surgery demonstrated that the liver parenchyma was massively infiltrated by reactive T lymphocytes surrounding rare large CD20+ tumour cells. This infiltrate had likely led to increased portal pressure attended by ascites formation, which resolved completely after chemotherapy. The case emphasizes the rewards of pursuing a diagnosis supported by a high prior probability even in the presence of apparently discordant laboratory findings, as well as the importance of performing a diagnostic splenectomy in case of splenomegaly with unexplained focal lesions.
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Affiliation(s)
| | - Erica Matino
- Università del Piemonte Orientale, Novara, Italy
| | - Erika Zecca
- Università del Piemonte Orientale, Novara, Italy
| | | | | | - Monica Leutner
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Raffaele Romito
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Mario Pirisi
- Università del Piemonte Orientale, Novara, Italy.,Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
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Cherukuri AR, Lubner MG, Zea R, Hinshaw JL, Lubner SJ, Matkowskyj KA, Foltz ML, Pickhardt PJ. Tissue sampling in the era of precision medicine: comparison of percutaneous biopsies performed for clinical trials or tumor genomics versus routine clinical care. Abdom Radiol (NY) 2019; 44:2074-2080. [PMID: 30032384 DOI: 10.1007/s00261-018-1702-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of the study was to determine if patients undergoing percutaneous biopsy for genetic profiling are undergoing more biopsies (procedures, passes per procedure), or experiencing more procedure-related complications. METHODS 60 patients undergoing biopsy procedures for genetic profiling were retrospectively compared with 60 consecutive control patients undergoing routine biopsies. Procedural details and related complications were collected. Results were analyzed using t-tests and logistic regression. RESULTS Biopsied organs included mainly lung (n = 31), liver (n = 50), and lymph nodes (n = 18). The average number of core biopsy passes was 3.45 in the study group and 2.18 in the control group (0.73, 1.81; p = 0.0001). The average study patient underwent 1.44 biopsy procedures by radiology from 2016 to 2017, whereas the average control patient underwent 1.08 (0.1657, 0.5010, p = 0.0002). Results were similar when looking at the subset of patients undergoing liver biopsies. In our cohort of 120 patients total, only 6 complications were noted. There were 4 complications in the control patients and 2 complications in the study patients, all of which were pneumothoraces in patients undergoing lung biopsy; only 2 of these required treatment. The odds ratio for a complication occurring from an increase in one core biopsy is 1.07 (0.601, 1.573; p = 0.775), suggesting no significant relationship among the number of biopsies taken and the probability of complication in this cohort. CONCLUSIONS Patients being biopsied for genetic profiling or clinical study enrollment are undergoing more biopsy procedures and more biopsy passes per procedure, but are not experiencing a detectable increased rate of complications in this small cohort, single-center study.
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Affiliation(s)
- Anjuli R Cherukuri
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - Meghan G Lubner
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA.
| | - Ryan Zea
- Biostatistics, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - J Louis Hinshaw
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - Sam J Lubner
- Internal Medicine - Division of Human Oncology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - Kristina A Matkowskyj
- Pathology and Lab Medicine, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - Marcia L Foltz
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - Perry J Pickhardt
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
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Gupta S, Rajiah P, Middlebrooks EH, Baruah D, Carter BW, Burton KR, Chatterjee AR, Miller MM. Systematic Review of the Literature: Best Practices. Acad Radiol 2018; 25:1481-1490. [PMID: 30442379 DOI: 10.1016/j.acra.2018.04.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 12/20/2022]
Abstract
Reviews of published scientific literature are a valuable resource that can underline best practices in medicine and clarify clinical controversies. Among the various types of reviews, the systematic review of the literature is ranked as the most rigorous since it is a high-level summary of existing evidence focused on answering a precise question. Systematic reviews employ a pre-defined protocol to identify relevant and trustworthy literature. Such reviews can accomplish several critical goals that are not easily achievable with typical empirical studies by allowing identification and discussion of best evidence, contradictory findings, and gaps in the literature. The Association of University Radiologists Radiology Research Alliance Systematic Review Task Force convened to explore the methodology and practical considerations involved in performing a systematic review. This article provides a detailed and practical guide for performing a systematic review and discusses its applications in radiology.
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Affiliation(s)
- Supriya Gupta
- Department of Radiology and Imaging, Rush University Medical Center, 3833, 1653 W Congress Pkwy, Chicago, IL 60612.
| | - Prabhakar Rajiah
- Cardiothoracic Imaging, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, USA
| | - Erik H Middlebrooks
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Dhiraj Baruah
- Chief, Cardiothoracic and Emergency Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brett W Carter
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1478, Houston, TX, 77030
| | - Kirsteen R Burton
- Department of Medical Imaging, University of Toronto, 263 McCaul Street, 4th Floor, Toronto, ON, M5T 1W7
| | - Arindam Rano Chatterjee
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, Department of Radiology and Radiological Sciences, Medical University of South Carolina, 96 Jonathan Lucas St. MSC 323, Charleston, SC 29425
| | - Matthew M Miller
- Department of Radiology and Medical Imaging, University of Virginia Medical Center, 1215 Lee St., Charlottesville, VA 22903
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Tri-axial Biopsy Needle Cauterization During Splenic Biopsy. Cardiovasc Intervent Radiol 2018; 41:1624-1626. [DOI: 10.1007/s00270-018-1910-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/17/2018] [Indexed: 10/17/2022]
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46
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Liu X, Jang HJ, Khalili K, Kim TK, Atri M. Successful Integration of Contrast-enhanced US into Routine Abdominal Imaging. Radiographics 2018; 38:1454-1477. [DOI: 10.1148/rg.2018170152] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Xiaoyang Liu
- From the Department of Medical Imaging, University of Toronto, University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Hyun-Jung Jang
- From the Department of Medical Imaging, University of Toronto, University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Korosh Khalili
- From the Department of Medical Imaging, University of Toronto, University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Tae Kyoung Kim
- From the Department of Medical Imaging, University of Toronto, University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Mostafa Atri
- From the Department of Medical Imaging, University of Toronto, University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
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Kitchin DR, del Rio AM, Woods M, Ludeman L, Hinshaw JL. Percutaneous liver biopsy and revised coagulation guidelines: a 9-year experience. Abdom Radiol (NY) 2018; 43:1494-1501. [PMID: 28929196 DOI: 10.1007/s00261-017-1319-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To retrospectively review revised pre-procedural coagulation guidelines for percutaneous liver biopsy to determine whether their implementation is associated with increased hemorrhagic complications on a departmental scale. Secondary endpoints were to determine the effect of this change on pre-procedural blood product (FFP and platelet) utilization, to evaluate the impact of administered blood products on hemorrhagic complications, and to determine whether bleeding complications were related to INR and platelet levels. MATERIALS AND METHODS This IRB-approved, HIPAA-compliant, retrospective study reviewed 1846 percutaneous liver biopsies in 1740 patients, comparing biopsies performed, while SIR consensus pre-procedural coagulation guidelines were in place (INR ≤ 1.5, platelets ≥50,000 µL) to those performed after departmental implementation of revised, less stringent guidelines (INR ≤ 2.0, platelets ≥25,000 µL). RESULTS On a departmental scale, there were significantly fewer hemorrhagic complications in the population of patients treated after adoption of less stringent guidelines as compared to those treated under the SIR guidelines (1.6% vs. 3.4%, p = 0.0192) despite a significant decrease in pre-procedural FFP (0.8% vs. 3.9%, p < 0.001) and platelet transfusions (0.3% vs. 1.2%, p = 0.021). Individual patient hemorrhagic complication rates significantly increased as INR increased (p = 0.006) and platelet counts decreased (p = 0.004), but pre-procedural FFP (p = 0.64) and/or platelet transfusion (p = 0.5) did not have a significant impact on hemorrhagic complication rates. CONCLUSION Implementation of less stringent pre-procedural coagulation parameter guidelines for percutaneous liver biopsy (INR ≤ 2.0, platelets ≥25,000 µL) did not result in an increase in departmental hemorrhagic complication rates but did significantly decrease pre-procedural FFP/platelet administration. An individual patient's bleeding risk does increase as INR increases and platelets decrease, but pre-procedural FFP and/or platelet transfusion did not mitigate that increased risk.
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48
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Sørensen M, Larsen LP, Villadsen GE, Aagaard NK, Grønbæk H, Keiding S, Vilstrup H. β-Blockers Improve Presinusoidal Portal Hypertension. Dig Dis Sci 2018; 63:3153-3157. [PMID: 30003386 PMCID: PMC6182445 DOI: 10.1007/s10620-018-5186-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/25/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Presinusoidal portal hypertension is a clinically important cause of gastric and gastroesophageal varices. Whereas β-blockers have an established prophylactic role against bleeding from esophageal and gastric varices in portal hypertension due to cirrhosis, the effect on presinusoidal portal hypertension is unknown. AIMS To evaluate the hemodynamic effect of β-blockers in non-cirrhotic patients with presinusoidal portal hypertension. METHODS We measured the blood pressure gradient from spleen pulp to free hepatic vein in 12 patients with presinusoidal portal hypertension by combined hepatic vein catheterization and spleen pulp puncture while on and off β-blocker treatment (random sequence). RESULTS The β-blockers reduced the gradient from a mean off-treatment value of 32 mm Hg to a on-treatment value of 26 mm Hg (P < 0.05) with a reduction of at least 20% in five patients (42%). CONCLUSIONS β-blocker treatment caused a clinically significant reduction in the pressure gradient from spleen pulp to the free hepatic vein. This finding supports the recommendation for prophylactic β-blockage in patients with presinusoidal portal hypertension.
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Affiliation(s)
- Michael Sørensen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99; C116, 8000 Aarhus, Denmark
| | - Lars P. Larsen
- Department of Radiology, Aarhus University Hospital, 8000 Aarhus, Denmark
| | - Gerda E. Villadsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99; C116, 8000 Aarhus, Denmark
| | - Niels K. Aagaard
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99; C116, 8000 Aarhus, Denmark
| | - Henning Grønbæk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99; C116, 8000 Aarhus, Denmark
| | - Susanne Keiding
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99; C116, 8000 Aarhus, Denmark
| | - Hendrik Vilstrup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99; C116, 8000 Aarhus, Denmark
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Veltri A, Bargellini I, Giorgi L, Almeida PAMS, Akhan O. CIRSE Guidelines on Percutaneous Needle Biopsy (PNB). Cardiovasc Intervent Radiol 2017; 40:1501-1513. [PMID: 28523447 DOI: 10.1007/s00270-017-1658-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/20/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Andrea Veltri
- Radiology Unit, Oncology Department, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole, 10, 10043, Orbassano, Turin, Italy.
| | - Irene Bargellini
- Department of Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56100, Pisa, Italy
| | - Luigi Giorgi
- Department of Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56100, Pisa, Italy
| | | | - Okan Akhan
- Department of Radiology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
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50
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Diagnosis of Splenic Lymphoma by Endoscopic Ultrasound Guided Fine Needle Aspiration: A Case Report and Review of the Literature. Case Rep Gastrointest Med 2017; 2017:3602910. [PMID: 28540094 PMCID: PMC5429928 DOI: 10.1155/2017/3602910] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 03/23/2017] [Accepted: 04/04/2017] [Indexed: 01/15/2023] Open
Abstract
Introduction. Splenic tumor is usually found as an incidental finding on CT of abdomen. Traditionally, ultrasound (US) or computed tomography (CT) guided biopsies were employed for the purpose of sampling; however they have been reported to have a complication rate of 5.3%. Endoscopic ultrasound-fine needle aspiration (EUS-FNA) has been recently utilized for the purpose of sampling splenic tumors. In literature there are 7 reported instances where splenic lymphoma was diagnosed using EUS-FNA. We present a case of follicular B cell lymphoma of the spleen diagnosed using EUS-FNA. Case Report. 58-year-old female presented to her primary care physician for left upper quadrant abdominal pain for one week. Physical exam was significant for left upper quadrant tenderness. Her laboratory tests were within normal limits. She underwent CT scan of abdomen which revealed approximately 5 cm × 5 cm mass in spleen. EUS-FNA of the spleen revealed a large hypoechoic, heterogeneous, well-demarcated mass measuring 54.7 mm × 43.0 mm. Fine needle aspiration was performed, and the sample was submitted for cytology and flow cytometry. Flow cytometry revealed a lambda monotypic population of B cells displaying dim CD19 and CD10. Diagnosis of B cell non-Hodgkin low grade follicular lymphoma was made. Conclusion. Endoscopic ultrasound with fine needle aspiration is a very rare but safe, reliable method of diagnosis of splenic lymphomas.
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