Percutaneous Image-Guided Biopsy for Non-Mass-Forming Isolated Splenomegaly and Suspected Malignant Lymphoma

Abstract

BackgroundThe aim of this study was to evaluate the accuracy, safety, and role of splenic biopsy in the management of patients with non-mass-forming isolated splenomegaly and suspected malignant lymphoma.MethodsBetween 2001 and 2013, 137 biopsies were performed under computed tomography (CT) fluoroscopic guidance in 39 patients. All patients had splenomegaly based on the CT findings and a suspected diagnosis of malignant lymphoma based on their clinical symptoms. The spleen was the only accessible site to perform a biopsy, and no mass lesions could be identified in the spleen.ResultsThe overall sensitivity, specificity, and diagnostic accuracy of image-guided biopsy for malignant lymphoma were 88%, 100% and 92%, respectively. Major complications occurred in 3 patients. In 1 patient, transcatheter arterial embolization was performed due to hemorrhage, and two patients needed blood transfusion because of hematoma development, without the need for further treatment.ConclusionsImage-guided splenic core-needle biopsy is a safe and accurate technique with a high diagnostic accuracy in most patients who with non-mass-forming isolated splenomegaly and suspected underlying malignant lymphoma.

Splenomegaly in the returning traveller: a diagnostic workup

“…In cases of isolated splenomegaly, detailed history, examination and appropriate investigations are essential to exclude a systemic illness 2. The most common causes of isolated splenomegaly are haematological: 25–66%, hepatic: 12–46%, infective: 13–25%, primary splenic: 25% and others: 8–21% 1…”

“…The spleen is a common site of lymphoma dissemination and may be involved with any lymphoid malignancy. However, primary splenic lymphoma represents a rare diagnosis 2. According to some authors it accounts for <1% of incidences, as it is strictly defined by involvement of only the spleen and splenic hilar lymph nodes, in the absence of any other localised tumours 7.…”

“…This has a dual role in establishing the diagnosis and providing therapeutic benefit 8. However, for patients with macroscopic splenic nodules in the absence of liver disease and portal hypertension there is increasing evidence for the use of core needle biopsies to obtain the diagnosis 2 7 12 13. Historically there has been reluctance in performing splenic biopsy given the perceived risks of major bleeding involved 2.…”

“…However, for patients with macroscopic splenic nodules in the absence of liver disease and portal hypertension there is increasing evidence for the use of core needle biopsies to obtain the diagnosis 2 7 12 13. Historically there has been reluctance in performing splenic biopsy given the perceived risks of major bleeding involved 2. However, studies show that the complication rates are significantly reduced when 20–22 Gauge needles are used 2 7.…”

Splenic biopsies are underutilized due to overestimation of bleeding risks

“…Additionally, in a study completed after the meta-analysis, which looked at 137 patients with isolated splenomegaly undergoing CTguided fine-needle biopsy, Tokue et al reported only three adverse events 4 . This study is particularly valuable because it may be more relevant to modern biopsy techniques, helping to confirm the results from the meta-analysis and older studies 1,5 .…”