J Korean Soc Radiol.  2017 Jun;76(6):438-441. 10.3348/jksr.2017.76.6.438.

Percutaneous Biopsy of a Metastatic Common Iliac Lymph Node Using Hydrodissection and a Semi-Automated Biopsy Gun

• Ryu SY
• Park BK

• KMID: 2379328
• DOI: http://doi.org/10.3348/jksr.2017.76.6.438

Abstract

Percutaneous biopsy is a less invasive technique for sampling the tissue than laparoscopic biopsy or exploratory laparotomy. However, it is difficult to perform biopsy of a deep-seated lesion because of the possibility of damage to the critical organs. Recently, we successfully performed CT-guided biopsy of a metastatic common iliac lymph node using hydrodissection and semi-automated biopsy devices. The purpose of this case report was to show how to perform hydrodissection and how to use a semi-automated gun for safe biopsy of a metastatic common iliac lymph node.

MeSH Terms

Biopsy*
Image-Guided Biopsy
Laparotomy
Lymph Nodes*

Figure

• 

  Fig. 1 Percutaneous biopsy of common iliac lymph nodes in a 68-year-old man. A. Contrast-enhanced CT image shows an enlarged lymph node (asterisk) which is surrounded by the right ureter (large solid arrow), the common iliac artery (blank arrow) and the common iliac vein (small solid arrows). Arrowheads indicate small or large bowel loops that are intervened between the skin and the lesion. B. Unenhanced CT image shows that the ascending colon (arrowhead) is located on the way to the lesion (asterisk) although the patient is positioned in the right anterior oblique position. The locations of the right ureter (large solid arrow), the common iliac artery (blank white arrow), and the common iliac vein (small solid arrows) did not change, either. C. An 18 gauge chiba needle (black arrowhead) is introduced to instill 5% dextrose water anterior to the ascending colon (white arrowhead). An asterisk indicates the right common iliac lymph node. D. The ascending colon (white arrowhead) is displaced away from the biopsy needle pathway to target the lymph node (asterisk) with a total of 200 cc dextrose water (arrows). E. The inner needle (white arrowheads) of a semi-automatic biopsy device is manually pushed approximately 1 cm into the lymph node. White arrows indicates the outer needle. A blank arrow and black arrows indicate the common iliac artery and vein, respectively. F. The inner needle (arrowheads) is completely introduced through the lesion before firing the outer cutting needle (white arrows). The biopsy needle does not penetrate the right ureter (solid arrow), the common iliac artery (blank arrow), and the common iliac vein (black arrows).

Reference

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