Soon Ho Yoon MD, Presenter: Nothing to Disclose

Kyoung Ho Lee MD, Abstract Co-Author: Nothing to Disclose

So Yeon Kim, Abstract Co-Author: Nothing to Disclose

Young Hoon Kim, Abstract Co-Author: Nothing to Disclose

Tae Kyoung Kim MD, Abstract Co-Author: Advisory Board, Lantheus Medical Imaging, Inc

To prospectively evaluate the technical feasibility of real-time contrast-enhanced ultrasonography (CEUS)-guided percutaneous biopsy of focal hepatic lesions that are not confidently localized at B-mode US.

The study enrolled 29 consecutive patients (17 men, 12 women; mean age, 61.4 years; mean body mass index, 22.3) who were referred for US-guided biopsy of a hepatic focal lesion but the biopsy target could not be confidently localized at preprocedural planning B-mode US by two independent radiologists. The size of the target lesions was 2.66 ± 2.07 cm (mean ± SD). One of three radiologists attempted biopsy with an 18-gauge automated gun under the real-time guidance of CEUS displayed in a split-screen mode following intravenous injection of sulphur hexaflouride microbubbles (Sonovue; Bracco, Milan, Italy). Final diagnosis for the biopsy target was established based on the pathologic exanimation of the biopsy specimen and clinical follow-up including CT and MR imaging. A technical success was defined as that the pathologic diagnosis of the specimen adequately represented of the final diagnosis.

No major complications were observed. In 26 patients, the pathologic diagnosis of the biopsy specimen was consistent with the final diagnosis: malignant neoplasm (n=21), eosionophilic infiltration (n=2), hepatic adenoma (n=1), organizing abscess (n=1), and bile sludge (n=1). In one patients with malignancy, CEUS-guided biopsy was performed but failed to prove metastasis. In the remaining two patients, biopsy could not be performed because the target lesion was still not localized on CEUS confidently. The technical success rate was 90% (95% CI : 73%, 98%; 26/29). The sensitivity and negative predictive value in the diagnosis of malignancy were 95% (77%, 99%; 21/22) and 83% (36%, 99%; 5/6), respectively.

Real-time CEUS-guided biopsy is technically feasible for hepatic focal lesions that are not confidently localized at B-mode US.

If a biopsy target is invisible or indistinct at B-mode US, real-time CEUS can be used to enhance the visualization of the biopsy target, increasing overall technical success rate of the biopsy.

Yoon, S, Lee, K, Kim, S, Kim, Y, Kim, T, Real-Time Contrast-enhanced Ultrasonography-guided Biopsy of Focal Hepatic Lesions Not Localized at B-mode Ultrasonography.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8009643.html