J Korean Soc Radiol.  2018 Apr;78(4):225-234. 10.3348/jksr.2018.78.4.225.

The Diagnostic Usefulness of Ultrasound-Guided Peritoneal Biopsy for the Solitary Peritoneal Thickening of an Unknown Cause Visualized as Only Infiltrated Fat Tissue on a CT Scan

• Chu YJ
• Ryeom H
• Lee SY
• Kim GC
• Cho SH
• Lee J
• Kim TH
• Song JH

• KMID: 2407927
• DOI: http://doi.org/10.3348/jksr.2018.78.4.225

Abstract

PURPOSE
To assess the usefulness of an ultrasound (US)-guided peritoneal biopsy for the solitary peritoneal thickening visualized as only infiltrated fat on a computed tomography (CT) scan.
MATERIALS AND METHODS
This retrospective study included 36 patients (16 males, 20 females; mean age, 51.7 years) who underwent a US-guided biopsy for the solitary peritoneal thickening of unknown cause visualized as only infiltrated fat without an apparent mass formation on a CT scan. The rate of the specific histopathological diagnosis and accuracy for the diagnosis of malignant disease was assessed.
RESULTS
The procedure was technically successful with the acquisition of an adequate amount of the specimen for microscopic examination from all patients. A specific histopathological diagnosis was made in 31/36 patients (86.1%): peritoneal carcinomatosis in 15/31 (48.4%), tuberculous peritonitis in 15/31 (48.4%) and panniculitis in 1/31 (3.2%). A non-specific histopathological diagnosis was made in 5/36 (13.9%): chronic inflammation in 4/5 (80%) and mesothelial hyperplasia in 1/5 (20%). The procedure showed sensitivity of 83.3%, with a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 85.7%, and an accuracy rate of 86.1% for the diagnosis of malignant diseases.
CONCLUSION
The US-guided peritoneal biopsy is a fairly accurate diagnostic procedure for the peritoneal thickening visualized as only infiltrated fat on a CT scan, and it can be used before performing laparoscopic or an open biopsy.

MeSH Terms

Biopsy*
Carcinoma
Diagnosis
Female
Humans
Hyperplasia
Inflammation
Male
Panniculitis
Peritoneum
Peritonitis, Tuberculous
Retrospective Studies
Sensitivity and Specificity
Tomography, X-Ray Computed*
Ultrasonography

Figure

• 

  Fig. 1. A 59-year-old man with peritoneal carcinomatosis with unknown primary site. A. CT of the abdomen shows mild thickening of the greater omentum (arrows) with moderate amount of ascites. B. Transverse ultrasonogram (5 MHz convex-array transducer) shows minimally thickened greater omentum (arrows) and small amount of ascites. On color Doppler examination, no prominent vessels can be found. Note the bowel loops (asterisks) posterior aspect of thickened greater omentum. C. Transverse ultrasonogram obtained during the biopsy reveals the thickened omentum (arrows) with well-visualized and well-placed biopsy needle (arrowheads). Note the adjacent bowel loops (asterisks) near the biopsy needle and ascites around the targeted omentum. The histopathological diagnosis by ultrasound-guided biopsy was the peritoneal carcinomatosis. D. Follow-up CT of the abdomen 9months after chemotherapy shows aggravated peritoneal thickening which is ‘omental cake' formation (arrows). CT = computed tomography

• 

  Fig. 2. A 17-year-old woman with tuberculous peritonitis. A. CT of the abdomen shows small amount of ascites and mild thickening of the greater omentum with only fatty infiltration (asterisks) and parietal peritoneum (arrows) with contrast enhancement. B. Transverse ultrasonogram (12 MHz linear-array transducer) shows thickened greater omentum with 2.08 cm thickness (arrows). C. Transverse ultrasonogram during the biopsy shows well placed biopsy needle (arrowheads) which is slightly angulated pathway to obtain as much sample as possible. The histopathological diagnosis by ultrasound-guided biopsy was the tuberculous peritonitis. D. Follow-up CT of the abdomen shows resolution of peritoneal thickening and ascites after anti-tuberculosis medication. CT = computed tomography

• 

  Fig. 3. A 39-year-old man with peritoneal carcinomatosis. A. CT scan of the abdomen shows thickening of the greater omentum with fatty infiltration (arrows) and small amount of ascites. B, C. Transverse ultrasonogram (5 MHz convex-array transducer) shows thickened greater omentum (arrows) that corresponded to the lesion selected as biopsy site on CT. There is ascites (asterisks) around echogenic omentum (arrows). Transverse ultrasonogram obtained immediately after the biopsy shows tiny moving echogenic dots emerged from the biopsy site (echogenic dots and tubules within the circle), which represent active bleeding. This bleeding was stopped within 5 minutes without specific management. CT = computed tomography

Reference

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