Contrast-Enhanced Ultrasound Guided Biopsy of Undetermined Abdominal Lesions: A Multidisciplinary Decision-Making Approach

Abstract

Aim. To investigate the value of contrast-enhanced ultrasound (CEUS) guided biopsy of undetermined abdominal lesions in multidisciplinary treatment (MDT) decision-making approach. Methods. Between Jan 2012 and Dec 2015, 60 consecutive patients (male, 37; female, 23; mean age, 51.3 years ± 14.6) who presented with undetermined abdominal lesions were included. CEUS and core needle percutaneous biopsy was performed under real-time CEUS guidance in all lesions. Data were recorded and compared with conventional ultrasound (US) guidance group (n = 75). All CEUS findings and clinical data were evaluated in MDT. Results. CEUS enabled the delimitation of more (88.3% versus 41.3%) and larger (14.1 ± 10.7 mm versus 32.3 ± 18.5 mm) nonenhanced necrotic areas. More inner (20.0% versus 6.7%) and surrounding (18.3% versus 2.7%) major vessels were visualized and avoided during biopsies. CEUS-guided biopsy increased the diagnostic accuracy from 93.3% to 98.3%, with correct diagnosis in 57 of 60 lesions (95.0%). The therapeutic plan was influenced by CEUS guided biopsies findings in the majority of patients (98.3%). Conclusion. The combination of CEUS guided biopsy and MDT decision-making approach is useful in the diagnostic work-up and therapeutic management.

Use of Ultrasound Contrast Agents in Relation to Percutaneous Interventional Procedures: A Systematic Review and Pictorial Essay

“…In this systematic review, potential indications for CEUS‐guided biopsy were divided into 3 main categories: (1) biopsy from perfused areas to avoid necrosis; (2) biopsy of poorly visualized or downright “invisible” lesions; and (3) additional benefits from CEUS in relation to US‐guided biopsy. A total of 19 articles were identified …”

“…By directing the biopsy needle toward contrast‐enhanced areas within the target lesion, inadvertent sampling from necrotic parts of the tumor can be reduced. This strategy resulted in a 10% to 15% increase in diagnostic accuracy by a decrease in the false‐negative rate . The principle of this technique was first described in 2000 by Bang et al, in a small feasibility study using Levovist (Schering AG, Berlin, Germany) and real‐time sampling from enhancing areas.…”

“…Noteworthy, in the liver study, 10 of 15 patients in the non‐CEUS arm with negative pathologic results were rebiopsied with CEUS guidance, and in all cases, a malignant diagnosis was reached . The same concept of targeting contrast‐enhanced tissue, assuming viability, has been applied in settings for biopsy of various liver, lung, mediastinum, neck, musculoskeletal, undetermined abdominal, and other tumors with encouraging results and reported feasibility of 94% to 100% …”

Rates of success and failure of biopsies of hollow abdominal organs: descriptive analysis

“…The use of CEUS plays an important role in the evaluation of suspicious lesions because it helps physicians determine whether a biopsy is necessary, identify the most viable area within the lesion, and choose the best lesion to biopsy (6) . The diagnostic performance of CEUS has been shown to be better than that of conventional ultrasound (4,6,7,12) . However, in our study, there were no records of lesions excluded for biopsy after CEUS had been performed, which could account for the fact that there was no significant difference between the CEUS and non-CEUS groups in terms of diagnostic performance (89% versus 85%).…”

“…It improves the detection and characterization of multiple lesions (4,5) , as well as increasing the accuracy of percutaneous biopsies (6,7) and reducing the rate of complications (6,(8)(9)(10)(11) . Through the use of CEUS, it is possible to perform real-time evaluation of the perfusion of focal lesions in the arterial, portal, and delayed contrast phases, in order to characterize focal lesions with high diagnostic accuracy (5)(6)(7)12) . In comparison with conventional ultrasound-guided biopsy, CEUS-guided biopsy has been shown to increase diagnostic accuracy by 5% (from 93.3% to 98.3%) and to decrease the false-negative rate in those large undetermined abdominal lesions (6) .…”