Utility of Percutaneous Image-Guided Biopsy to Diagnose Intraabdominal Lymphoma with Coaxial Core Needles,

Although pathological diagnosis is an essential component of managing malignant lymphoma and other malignancies, intraabdominal lesions are generally difficult to approach due to the invasiveness of abdominal surgery. We report here the use of percutaneous image-guided coaxial core needle biopsy to obtain intraabdominal specimens. The coaxial method is associated with a lower risk of tumor cell dissemination and allows for repeated biopsies and thus improves the accuracy of pathological or immunohistological diagnosis. To the best of our knowledge, there have been no reports on the feasibility of this technique for diagnosing intraabdominal malignant lymphomas, which typically requires flow cytometry analysis as well as histopathological evaluation.

We retrospectively reviewed consecutive cases involving percutaneous image-guided biopsy to obtain pathological specimens for intraabdominal mass lesions from April 1999 to March 2011 at Nagano Red Cross Hospital, Nagano, Japan. Liver, spleen, kidney, and inguinal node biopsies were excluded. Following local anesthesia, a certified interventional radiologist performed the procedures using a 16 coaxial guide needle (Cook) parallel to the anesthetic needle under computed tomography (CT) or ultrasonography (US). An 18 gauge core needle was inserted to obtain a pathological specimen, following aspiration with a 20 gauge needle for flow cytometry and cytological evaluation. Occlusion materials of the biopsy track were not used. Since laparotomic biopsy was performed for intraabdominal lesions when percutaneous needle biopsy was not indicated due to anatomical difficulties, we compared needle biopsies with simultaneously performed laparotomic biopsies, which led to a diagnosis of lymphoma.

During the 12-year period, we performed 66 procedures for 60 patients (32 males, 28 females; median age, 63.5; age range, 16–85). Six patients underwent second or third repeat procedures due to prior inappropriate samplings (5) or relapse (1). The overall diagnostic rate was 86.4% (57/66); there were 56 true positives, 1 true negative, 9 false negatives, and no false positives (sensitivity, 85.9%; specificity, 100%). No patients required additional surgical biopsies. CT and US were used in 51(76%) and 16 (24%) procedures, respectively. There was no statistically significant difference in accuracy between CT and US as an imaging modality. Notably, median interval between recognition of intraabdominal mass and biopsy was only one day (0–24). As for hematological malignancies, 39 patients had malignant lymphoma (diffuse large B cell lymphoma, 16; follicular lymphoma, 12; Hodgkin lymphoma, 3; peripheral T cell lymphoma, 3; small lymphocytic lymphoma, 3; Burkitt lymphoma, 1; extranodal NK/T cell lymphoma, nasal type, 1) including one case with relapse; 45 procedures were performed for these patients. Biopsies were submitted in 43 procedures, and adequate specimens were obtained for histopathological evaluation and diagnosis in 37 (86%). Flow cytometry was used in 39 procedures and detected lymphoma cells in 31 (79.5%). No major adverse events were observed. Twelve patients (9 males and 3 females; median age, 60; age range, 42–72) were eligible for laparotomic biopsy. While every postoperative course was satisfactory, median duration from lesion recognition to therapy initiation for lymphoma cases excluding those who chose watchful wait or refused therapy was significantly shorter for needle biopsies than laparotomy (14 versus 35 days, p<0.001).

This is the first report to show the clinical effectiveness of percutaneous image-guided intraabdominal needle biopsy with coaxial core needles for diagnosis of intraabdominal lymphomas. Although no difference was previously reported between coaxial and noncoaxial methods for liver or kidney biopsies (Hatfield et al. AJR 2008), they experienced seven (0.9%) major complications including one death. We identified no major complications using the Cook core needle system in the present study. This method significantly improves the collection of adequate specimens from intraabdominal lymphoma lesions and potentially helps attain immunohistological distinction, allowing for more timely therapy initiation.

No relevant conflicts of interest to declare.