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Percutaneous Biopsy (percutaneou + biopsy)
Selected AbstractsMRI-guided procedures in various regions of the body using a robotic assistance system in a closed-bore scanner: Preliminary clinical experience and limitations,JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 4 2010Michael Moche MD Abstract Purpose: To present the clinical setup and workflow of a robotic assistance system for image-guided interventions in a conventional magnetic resonance imaging (MRI) environment and to report our preliminary clinical experience with percutaneous biopsies in various body regions. Materials and Methods: The MR-compatible, servo-pneumatically driven, robotic device (Innomotion) fits into the 60-cm bore of a standard MR scanner. The needle placement (n = 25) accuracy was estimated by measuring the 3D deviation between needle tip and prescribed target point in a phantom. Percutaneous biopsies in six patients and different body regions were planned by graphically selecting entry and target points on intraoperatively acquired roadmap MR data. Results: For insertion depths between 29 and 95 mm, the average 3D needle deviation was 2.2 ± 0.7 mm (range 0.9,3.8 mm). Patients with a body mass index of up to ,30 kg/m2 fitted into the bore with the device. Clinical work steps and limitations are reported for the various applications. All biopsies were diagnostic and could be completed without any major complications. Median planning and intervention times were 25 (range 20,36) and 44 (36,68) minutes, respectively. Conclusion: Preliminary clinical results in a standard MRI environment suggest that the presented robotic device provides accurate guidance for percutaneous procedures in various body regions. Shorter procedure times may be achievable by optimizing technical and workflow aspects. J. Magn. Reson. Imaging 2010;31:964,974. ©2010 Wiley-Liss, Inc. [source] Preoperative staging and evaluation of resectability in pancreatic ductal adenocarcinomaHPB, Issue 1 2004R Andersson Background Cancer of the pancreas is a common disease, but the large majority of patients have tumours that are irresectable at the time of diagnosis. Moreover, patients whose tumours are clearly beyond surgical cure are best treated non-operatively, if possible, by relief of biliary obstruction and percutaneous biopsy to confirm the diagnosis and then consideration of oncological treatment, notably chemotherapy. These facts underline the importance of a standard protocol for the preoperative determination of operability (is it worth operating?) and resectability (is there a chance that the tumour can be removed?). Recent years have seen the advent of many new techniques, both radiological and endoscopic, for the diagnosis and staging of pancreatic cancer. It would be impracticable in time and cost to submit every patient to every test. This review will evaluate the available techniques and offer a possible algorithm for use in routine clinical practice. Discussion In deciding whether to operate with a view to resecting a pancreatic cancer, the surgeon must take into account factors related to the patient, the tumour and the institution and team entrusted with the patient's care. Patient-related factors include age, general health, pain and the presence or absence of malnutrition and an acute phase inflammatory response. Tumour-related factors include tumour size and evidence of spread, whether to adjacent organs (notably major blood vessels) or further afield. Hospital-related factors chiefly concern the volume of pancreatic cancer treated and thus the experience of the whole team. Determination of resectability is heavily dependent upon detailed imaging. Nowadays conventional ultrasonography can be supplemented by endoscopic, laparoscopic and intra-operative techniques. Computed tomography (CT) remains the single most useful staging modality, but MRI continues to improve. PET scanning may demonstrate unsuspected metastases and likewise laparoscopy. Diagnostic cholangiography can be performed more easily by MR techniques than by endoscopy, but ERCP is still valuable for preoperative biliary decompression in appropriate patients. The role of angiography has declined. Percutaneous biopsy and peritoneal cytology are not usually required in patients with an apparently resectable tumour. The prognostic value of tumour marker levels and bone marrow biopsy is yet to be established. Preoperative chemotherapy or chemoradiation may have a role in down-staging an irresectable tumour sufficiently to render it resectable. Selective use of diagnostic laparoscopy staging is potentially helpful in determination of resectability. Laparotomy remains the definitive method for determining the resectability of pancreatic cancer, with or without portal vein resection, and should be undertaken in suitable patients without clear-cut evidence of irresectability. [source] Intra-abdominal sequestration of the lung and elevated serum levels of CA 19-9: a diagnostic pitfallHPB, Issue 1 2004C Armbruster Background Extralobar pulmonary sequestration is an uncommon congenital abnormality that is rarely diagnosed after the age of 40 years. We describe a 64-year-old woman with an intra-abdominal sequestration of the lung and elevated carbohydrate antigen (CA) 19-9 serum levels. Case outline On abdominal ultrasound a semi-solid cystic tumour was demonstrated that showed tight connection to the tail of the pancreas according to computed tomography. Cytological examination of the percutaneous biopsy did not lead to a definitive diagnosis. CA 19-9 serum levels were repeatedly elevated >250 IU/ml. With a tentative diagnosis of a tumour of the tail of pancreas the semi-solid cystic mass was resected. Frozen section histology suggested the diagnosis of pulmonary sequestration, which was confirmed by definitive histological examination. Immunohistochemical staining of the specimen with a specific monoclonal antibody against CA 19-9 showed strong immunoreactivity. Three months later the elevated CA 19-9 serum levels returned to normal. Discussion Elevated CA 19-9 serum levels have been described in benign pulmonary and mediastinal cystic lesions and in one case of extralobar intrathoracic lung sequestration. Although there is evidence that malignancies may arise in congenital lung cysts, CA 19-9 serum levels have not been investigated in such cases. Based on our results elevated serum values of CA 19-9 in combination with a cystic semi-solid mass in the left subphrenic space should include the differential diagnosis of extralobar pulmonary sequestration. [source] Gray-scale sonography of solid breast masses: Diagnosis of probably benign masses and reduction of the number of biopsiesJOURNAL OF CLINICAL ULTRASOUND, Issue 1 2007Luciano Chala MD Abstract Purpose. To identify probably benign breast masses using gray-scale sonography and to see if this strategy could reduce the number of biopsies of breast masses. Methods. This retrospective study included 229 masses in 203 women who underwent sonographically guided percutaneous biopsy. Masses with a negative predictive value for malignancy >98% were retrospectively considered probably benign, and the potential impact of gray-scale sonography in reducing the number of biopsies if these masses were not biopsied was assessed. Assessments were performed considering all masses as a group as well as various subgroups. Results. Round, ellipsoid, or lobulated masses with 3 or fewer lobulations, circumscribed margins, a longitudinal,anteroposterior diameter ratio ,1.0 and no marked hypoechogenicity, posterior acoustic shad owing, internal microcalcifications, or altered surrounding breast tissue were considered probably benign. The sensitivity of gray-scale sonography to identify this subgroup was 98%, with a negative predictive value of 99%. If these masses were not biopsied, there would be a 42% reduction in the number of biopsies considering all masses, a 36% reduction for masses classified as Breast Imaging Reporting and Data System category 4, and a 59% reduction for masses exclusively analyzed with sonography. Conclusions. It is possible to identify probably benign breast masses using gray-scale sonography, and thereby to reduce the number of biopsies performed. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 2007 [source] Posttransplant lymphoproliferative disorder: A pictorial reviewJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 5 2006K Burney Summary Posttransplant lymphoproliferative disorder (PTLD) is a serious and potentially fatal complication after solid organ and haemopoietic stem cell transplantation. The frequency of PTLD varies with the type of organ transplant but overall it affects 2,10% of all solid organ transplant recipients. Most cases develop within 1 year after the transplant, although occasional cases present 5,10 years later. Posttransplant lymphoproliferative disorder is clinically and pathologically heterogeneous , the majority are of the non,Hodgkin's lymphoma type, whereas Hodgkin's lymphoma arising after transplantation is rare. We have retrospectively reviewed patients with a histological diagnosis of PTLD after a solid organ transplant. We present the imaging features and a clinical review of this condition. Early diagnosis of PTLD may alter the management and outcome of the disease. The radiologist can play a vital role in establishing the diagnosis by imaging features supplemented with percutaneous biopsy and also in monitoring the disease response to treatment. [source] Computed tomography for the diagnosis of a lumbosacral nerve sheath tumour and management by hemipelvectomyJOURNAL OF SMALL ANIMAL PRACTICE, Issue 5 2001J. D. Niles Computed tomography was used to define the gross extent of a lumbosacral plexus nerve sheath tumour in a 10-year-old crossbred dog. The tumour was also visualised ultrasonographically, which enabled a percutaneous biopsy to be taken. Hemipelvectomy was performed to achieve a clean margin of surgical excision. [source] | ||||||||||