J Korean Soc Radiol.  2017 May;76(5):303-309. 10.3348/jksr.2017.76.5.303.

Ultrasound-Guided Percutaneous Core Needle Biopsy of Splenic Lesions

• Park S
• Shin YM
• Won HJ
• Kim PN
• Lee MG

• KMID: 2377031
• DOI: http://doi.org/10.3348/jksr.2017.76.5.303

Abstract

PURPOSE
To evaluate the safety and efficacy of ultrasound-guided percutaneous core needle biopsy of splenic lesions.
MATERIALS AND METHODS
This retrospective study included 30 patients who underwent percutaneous core needle biopsy of their splenic lesions using 18- or 20-gauge needles between January 2001 and July 2016 in a single tertiary care center. The characteristics of the splenic lesions were determined by reviewing the ultrasound and computed tomography examinations. Acquisition rate and diagnostic accuracy were calculated, using pathologic results of the splenectomy specimen, clinical course and/or imaging follow-up as a reference standard. Post-procedure complications were identified from electronic medical records, laboratory findings and computed tomography images. Seventy-three specimens were obtained from the 30 patients and splenectomy was performed in 2 patients.
RESULTS
Twenty-nine of the 30 patients had focal splenic lesions, while the remaining patient had homogeneous splenomegaly. Acquisition rate and diagnostic accuracy were 80.0% (24/30) and 76.7% (23/30), respectively. Perisplenic hemorrhage without hemodynamic instability developed in one patient.
CONCLUSION
Ultrasound-guided percutaneous core needle biopsy of splenic lesions is a safe method for achieving a histopathologic diagnosis and can be considered as an alternative to splenectomy in patients with a high risk of splenectomy-related complications.

MeSH Terms

Biopsy, Large-Core Needle*
Diagnosis
Electronic Health Records
Follow-Up Studies
Hemangioma
Hemodynamics
Hemorrhage
Humans
Lymphoma
Methods
Needles
Retrospective Studies
Spleen
Splenectomy
Splenomegaly
Tertiary Care Centers
Tuberculosis
Ultrasonography

Figure

• 

  Fig. 1 A 66-year-old male with perisplenic hemorrhage after core needle biopsy. A. Axial computed tomography (CT) obtained for evaluation of fever shows mild splenomegaly (maximal diameter, 13 cm). B. Axial fused positron emission tomography-CT image shows mildly increased 18F-fluorodeoxyglucose uptake in the spleen (maximum standardized uptake value, 3.0). The differential diagnoses included infection and hematologic malignancy. C. Percutaneous ultrasound-guided core needle biopsy of the spleen was performed using an 18-G needle. The arrowheads indicate the tip of the biopsy needle. Histopathologic examination showed inflammatory infiltrates without evidence of malignancy. D. Follow-up CT scan obtained 1 day after the procedure to evaluate a decrease in blood hemoglobin levels (8.0 g/dL to 6.3 g/dL) shows perisplenic hemorrhage (arrowheads) and probable active extravasation of contrast media (arrow). The patient showed no hemodynamic instability and improved with supportive management.

• 

  Fig. 2 A 66-year-old female patient with known lung cancer: case with a nondiagnostic histopathologic result. A. Axial CT shows multiple low density lesions in the spleen, which were considered as possible splenic metastases. B. US examination shows a 1.4-cm hypoechoic lesion in the spleen. The index mass and other lesions were poorly visualized owing to poor sonic window. Needle approach was hindered by narrow intercostal space of the patient. The histopathologic result was nondiagnostic, and splenectomy revealed sclerosing angiomatoid nodular transformation. CT = computed tomography, US = ultrasound

• 

  Fig. 3 A 43-year-old male patient with splenic hemangiomas: case with a favorable result. A. Axial CT shows numerous hypointense lesions in the spleen. B. US examination shows multiple hyperechoic lesions in the spleen, one of which was biopsied using an 18-G core needle. The histopathologic diagnosis was hemangioma. CT = computed tomography, US = ultrasound

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