Accuracy and diagnostic yield of CT-guided stereotactic liver biopsy of primary and secondary liver tumors

Abstract

Objective: CT-guided biopsy still plays a decisive role in the management of liver tumors, especially if the lesions are not visible or accessible by ultrasound. As CT-guided stereotaxy appears to be a very accurate targeting technique, the aim of this study was to evaluate the targeting accuracy, diagnostic yield, and complications of CT-guided stereotactic liver biopsy of primary and secondary liver tumors. Methods and Materials: Prior to stereotactic liver biopsy, patients under general anesthesia were immobilized using a vacuum cushion. Respiratory motion was controlled by temporary disconnections of the endotracheal tube. An opticalbased navigation system was used for 3D trajectory planning and placement of a 15-G coaxial needle via a stereotactic aiming device. The histological samples were obtained using a 16-G Tru-Cut TM biopsy needle system. For evaluation of targeting accuracy the control CT image with the needles in place was fused with the planning CT image. The lateral error at the tip and skin entry point and the angular error were calculated. In addition, the skin-to-liver-surface (SL) distance, the needle-to-liver-surface (NL) angle, and the presence of liver cirrhosis were evaluated. The diagnostic yield was evaluated by histological reports from the institutional pathologists. Results: The median lateral error was 2.5 mm (range: 0-6.5 mm) at the needle entry point and 3.2 mm (range: 0.01-9.4 mm) at the needle tip. The median angular error was 1.06(range: 0-6.64 ). Liver cirrhosis, NL angle and SL distance showed no significant impact on the targeting accuracy. Forty-five of the 46 liver biopsies (97.8%) were diagnostic according to the histological reports. No puncture-related complications such as bleeding or perforation of intestinal organs or lung tissue were recorded.

Minimally Invasive Locoregional Treatment of Intrahepatic Cholangiocellular Carcinoma

“…Needle placement is performed with high accuracy. A median lateral error of needle placement of 2.5 mm was reported (58). Haidu et al reported a 1-and 3-year survival rate of 91% and 71% in 11 patients after SRFA (34), with an estimated median overall survial of 60 months.…”

Projector‐based augmented reality system for interventional visualization inside MRI scanners

“…This is the reason why many needle-based interventions are nowadays carried out with the help of ultrasound (US) or computed tomography (CT) scanners. 2,3 Although US is compact, cheap, and widely available, deep structures within the body, especially underneath bones, are hardly visible. [4][5][6] In contrast, CT enables an appropriate representation of the whole operating area.…”

C-Arm Cone-Beam CT Combined with a New Electromagnetic Navigation System for Guidance of Percutaneous Needle Biopsies: Initial Clinical Experience

“…For that reason our study focused on the technical success of lesion targeting. An interesting alternative approach has been studied by Schullian et al [29] who evaluated CT-guided stereotactic liver biopsy by coupling an optical-based navigation system and a stereotactic aiming device. The authors reported high targeting accuracy data in terms of lateral and angular errors, and a diagnostic yield of 97.8 % that was even slightly higher than that in our cohort study.…”