Biopsy of Deep Pelvic and Abdominal Targets With Ultrasound Guidance: Efficacy of Compression

[Renal Biopsy]

The extent of renal biopsy indication is being widened because of the increasing incidence of incidental renal masses; the increasing treatment options for renal cell carcinoma, including ablation therapy and novel targeted treatment; and the increasing incidence of kidney transplantation. However, percutaneous renal biopsy is technically difficult, particularly for beginners, because the skin-to-organ distance is relatively longer than those associated with other organs. In the present review, we will discuss the indications, technical considerations, efficacy, and complications of renal biopsy. Furthermore, we share practical tips of renal biopsy through many examples to help radiologists perform renal biopsy safely and effectively in various situations.

Ultrasound evaluation of intraluminal magnets in an ex vivo model

PURPOSE

The management of foreign body ingestion proves to be a challenge. Magnets pose a unique set of risks when ingested due to their attractive forces and subsequent risk of adherence, pressure necrosis, and perforation complications. Radiographs only provide a limited snapshot in the setting of multiple magnet ingestion when the risk of complication is highest. We hypothesize that abdominal ultrasound (US) has the potential to supplement radiographs in assessing ingested magnets by determining the presence of bowel loop entrapment and of any extraluminal fluid.

METHODS

We recreated various scenarios of magnet configurations using animal cadaveric bowel models. X-ray and US images were obtained in various bowel-magnet orientations.

RESULTS

We identified several key US features to suggest bowel wall tethering. These include direct visualization of bowel wall entrapment between magnets (what we term the "dangerous V sign"), anti-dependent positions of the magnets, and inability to separate loops of bowel with compression.

CONCLUSION

These findings could potentially provide valuable information when directing the urgency of intervention in foreign body ingestion. Ultrasound may supplement and improve the current guidelines in management of magnet ingestion.

Ultrasound-guided transvaginal biopsies of pelvic lesions: diagnostic yield, safety profile, and technical considerations over a 20-year experience

PURPOSE

To evaluate diagnostic yield, safety profile, and specific technical considerations of transvaginal ultrasound (TVUS) guided biopsy/aspiration.

MATERIALS/METHODS

TVUS guided biopsy (core, FNA) procedures with pre-procedure CT/MRI imaging at a single institution between 2001 and 2021 were reviewed. Relevant patient demographic data was extracted via the Electronic Health Record (EMR), technical details of the biopsy procedure were collected, and distance to target via transvaginal and transabdominal biopsy approach was measured on pre-procedure imaging. Surgical pathology was reviewed and assessed for concordance. Complications were assessed. Statistical analysis was performed using SPSS.

RESULTS

96 TVUS procedures (mean age, 58.7 ± 15.2 years; mean BMI, 27.4) were reviewed. TVUS guided approach decreased the distance to target (mean, 1.1 cm vs 8.6 cm transabdominal; p < 0.0001) and created a safe path not otherwise available in two patients. Average lesion size was 4.0 ± 2.1 cm (IQR 2.5, 5.2 cm) and targets at or above the vaginal cuff (0.9 ± 1.5 cm) and up to 0.5 ± 1.0 cm above the acetabular roof were accessible. 75 (78%) cases were core biopsies (18G; median, 2 passes) and 21 were FNA. Conscious sedation was used in 84.4% (n = 81) of cases and local anesthetic was also used in 84.4% (n = 81) of cases. Overall diagnostic yield was 98.9% (n = 94) with 94.7% (n = 89) cases confirmed as concordant diagnoses, including 57.4% (n = 54) malignant. Complications occurred in eight patients (8.3%), all minor. No post-biopsy infections were encountered regardless of administration of pre-procedure antibiotics (n = 14, 14.6%,), documentation of sterile prep (n = 92, 95.8%), or speculum use (n = 19, 19.8%). 50% (n = 48) had a prior hysterectomy, with no association with adequacy or complications (p = 0.9).

CONCLUSION

Transvaginal biopsy of pelvic lesions offers excellent diagnostic yield and favorable safety profile, and can dramatically decrease distance to target.

CLINICAL RELEVANCE

Ultrasound-guided transvaginal approach offers a safe and effective way to biopsy pelvic lesions in women.

Diagnostic Value of Combined Detection of Pelvic Ultrasound and Serum LH, FSH, and E2 Levels in Children with Idiopathic Central Precocious Puberty

Objective

To study the diagnostic value of combined detection of pelvic ultrasound and serum LH, FSH, and E2 levels in children with idiopathic central precocious puberty (ICPP).

Methods

30 cases of children with ICPP admitted to our hospital from January 2019 to January 2021 were selected as the experimental group, and 30 healthy people during the same period were selected as the control group. Both groups received pelvic ultrasound and serum LH, FSH, and E2 detection; the two groups were compared in terms of serum indicators, combined diagnosis, specificity, and sensitivity.

Results

There were statistical differences in height, leptin, bone age, and areola diameter between the two groups (p < 0.05). The length of the uterus, the volume of the uterus, the area of the ovary, the volume of the ovary, and the maximum diameter of the follicle in the experimental group were larger than those in the control group (p < 0.05). The endometrial thickness of the experimental group was significantly greater than that of the control group (p < 0.05). The levels of serum LH, FSH, and E2 in the experimental group were significantly higher than those in the control group (p < 0.05). The area of the combined detection was significantly larger than that of the single detection. The combined detection was superior to the single detection with respect to the area, standard error a, asymptotic Sig. B, and asymptotic 95% confidence interval (p < 0.05). The sensitivity of the combined detection was significantly higher than that of the single detection.

Conclusion

The combined detection of pelvic ultrasound and serum LH, FSH, and E2 levels may be a preferred technique for the diagnosis of children with ICPP due to its benefits of high sensitivity and accuracy. It is worthy of clinical promotion and application.

Ultrasound-guided biopsy of challenging abdominopelvic targets

Percutaneous ultrasound-guided biopsies have become the standard of practice for tissue diagnosis in the abdomen and pelvis for many sites including liver, kidney, abdominal wall, and peripheral nodal stations. Additional targets may appear difficult or impossible to safely biopsy by ultrasound due to interposed bowel loops/vasculature, deep positioning, association with the bowel, or concern for poor visibility; however, by optimizing technique, it is often possible to safely and efficiently use real-time ultrasound guidance for sampling targets that normally would be considered only appropriate for CT guided or surgical/endoscopic biopsy.

Ultrasound-Guided Omental Biopsy: Diagnostic Yield and Association With CT Features Based on a Single-Institution 18-Year Series

BACKGROUND. The greater omentum can serve as a useful target for percutaneous biopsy; in clinical practice, CT is commonly used for biopsy guidance. OBJECTIVE. The purpose of this study was to evaluate the diagnostic yield of percutaneous ultrasound (US)-guided omental biopsy and to explore the association of the diagnostic yield with prebiopsy diagnostic CT findings. METHODS. This retrospective study included 163 patients (120 women and 43 men; mean age, 65 ± 12 [SD] years; mean body mass index [BMI], 28.9 ± 7.9) who underwent US-guided omental biopsy between 2002 and 2020 at a single institution at which US served as the first-line modality for omental biopsy guidance. Biopsies were performed by abdominal radiologists without dedicated interventional radiology fellowship training. Postbiopsy clinical follow-up and imaging follow-up were reviewed to establish the ultimate diagnosis for each patient. Omental biopsies were characterized as diagnostic or nondiagnostic relative to the ultimate diagnosis. Associations were explored between diagnostic yield and findings on prebiopsy CT and biopsy US. RESULTS. US-guided omental biopsy was performed using an 18-gauge core needle biopsy technique in 156 patients and fine-needle aspiration in seven patients. The mean number of biopsy passes was 2.5 ± 1.0, and mean omental thickness near the biopsy site on CT was 2.6 ± 1.2 cm. On prebiopsy diagnostic CT, omental disease appeared infiltrative in 127 (78%) patients versus mass-forming in 36 (22%) and appeared hypoechoic in 105 (64%) patients versus iso- to hyperechoic in 58 (36%). The ultimate diagnosis was malignant tumor in 154 (95%) patients (most commonly, gynecologic tumors in 82 patients [high-grade serous adenocarcinoma in 56] and gastrointestinal tumors in 45 patients) and a benign finding in nine (6%) patients. The omental biopsy was diagnostic relative to the ultimate diagnosis in 155 (95%) patients. A diagnostic versus nondiagnostic biopsy was not associated (p > .05) with age, BMI, number of biopsy passes, or omental target thickness or attenuation. A total of 94% (120/127) of US-guided omental biopsies of infiltrative cases and 97% (35/36) of biopsies of mass-forming cases were diagnostic (p = .50). A total of 96% (102/106) of US-guided omental biopsies of hypoechoic cases and 93% (53/57) of biopsies of iso- to hyperechoic cases were diagnostic (p = .36). No complications occurred. CONCLUSION. US-guided biopsy of omental disease suspected on CT is safe and effective for tissue diagnosis. Although omental disease commonly appears on US as diffuse infiltrative thickening without a discrete target, sampling based on prebiopsy CT landmarks is diagnostic in most cases. CLINICAL IMPACT. US should be considered the first-line modality for omental biopsy guidance when feasible.