Lawrence AJ, Abstract Co-Author: Nothing to Disclose

Naveen Kalra MBBS, MD, Presenter: Nothing to Disclose

Srinivasan Radhika, Abstract Co-Author: Nothing to Disclose

Ajay Gulati MD, Abstract Co-Author: Nothing to Disclose

Rakesh Kapoor MD, Abstract Co-Author: Nothing to Disclose

Yogesh Chawla, Abstract Co-Author: Nothing to Disclose

Niranjan Khandelwal MD, Abstract Co-Author: Nothing to Disclose

To compare the diagnostic adequacy of CT-ultrasound fusion image-guided fine needle aspiration (FNA) with ultrasound-guided FNA in patients with suspected hepatic metastases which were conspicuous on ultrasound.

Prospective study of 30 patients who had suspected hepatic metastases on ultrasound and triphasic CT imaging (64- or 128-slice CT). CT-ultrasound fusion image-guided FNA of the largest hepatic lesion was done with 20G needle using electromagnetic tracking. Two passes were obtained using coaxial system. Free hand ultrasound-guided FNA of the same lesion was done in the same sitting using 20G needle and two passes were obtained. The sequence of the methods was determined using computer-generated random table. Diagnostic adequacy of the smears was objectively assessed by a scoring system based on the cellular material, background blood or clot, degree of cellular degeneration or trauma and retention of architecture. The cytologist was blinded to the method of aspiration.

Multiple lesions were seen in 28 patients and single lesion was seen in 2 patients. The size of the lesions sampled ranged from 1-10 cm (mean 4.12 cm, median 4.1 cm). The depth of location of the lesions ranged from 1.4-9.3 cm (mean 5.35 cm, median 5.35 cm). The fusion fitness values ranged from 1.2-10 mm. Technical success of needle placement was achieved in all patients using both methods. The scores of the smears did not correlate with lesion size, depth of location and fusion fitness value. Diagnostic adequacy was seen in 90% lesions sampled by fusion image guidance and in 93.3% lesions sampled by ultrasound guidance. This difference was not statistically significant. All the lesions which yielded inadequate smears using fusion guidance were deep seated lesions (> 5cm). All the lesions which yielded inadequate smears using ultrasound guidance were small lesions (<3cm). No serious complications were seen in any of the patients.

Fusion image-guided FNA is a safe procedure with a high diagnostic adequacy rate. It is not better than ultrasound-guided FNA in patients with hepatic metastases which are conspicuous on ultrasound.

CT-ultrasound fusion image-guided FNA is a safe procedure with a high diagnostic adequacy rate but is not better than ultrasound-guided FNA for conspicuous hepatic lesions. 

AJ, L, Kalra, N, Radhika, S, Gulati, A, Kapoor, R, Chawla, Y, Khandelwal, N, Fusion Image-guided and Ultrasound-guided Fine Needle Aspiration in Patients with Suspected Hepatic Metastases.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014319.html