Radiofrequency Cauterization with Biopsy Introducer Needle

Abstract

PURPOSE-The principal risks of needle biopsy are hemorrhage and implantation of tumor cells in the needle tract. This study compared hemorrhage after liver and kidney biopsy with and without radiofrequency (RF) ablation of the needle tract.MATERIALS AND METHODS-Biopsies of liver and kidney were performed in swine through introducer needles modified to allow RF ablation with the distal 2 cm of the needle. After each biopsy, randomization determined whether the site was to undergo RF ablation during withdrawal of the introducer needle. Temperature was measured with a thermistor stylet near the needle tip, with a target temperature of 70°C-100°C with RF ablation. Blood loss was measured as grams of blood absorbed in gauze at the puncture site for 2 minutes after needle withdrawal. Selected specimens were cut for gross examination.RESULTS-RF ablation reduced bleeding compared with absence of RF ablation in liver and kidney (P < .01), with mean blood loss reduced 63% and 97%, respectively. Mean amounts of blood loss (±SD) in the liver in the RF and no-RF groups were 2.03 g ± 4.03 (CI, 0.53-3.54 g) and 5.50 g ± 5.58 (CI,.66 g), respectively. Mean amounts of blood loss in the kidney in the RF and no-RF groups were 0.26 g ± 0.32 (CI, −0.01 to 0.53 g) and 8.79 g ± 7.72 (CI, 2.34-15.24 g), respectively. With RF ablation, thermal coagulation of the tissue surrounding the needle tract was observed.CONCLUSION-RF ablation of needle biopsy tracts reduced hemorrhage after biopsy in the liver and kidney and may reduce complications of hemorrhage as well as implantation of tumor cells in the tract.PERCUTANEOUS image-guided needle biopsy is often performed in highly vascular organs or in tumors with rich macroscopic and microscopic blood supply. The principal risks related to needle biopsy are hemorrhage and implantation of tumor cells in the needle tract. Incidences of postbiopsy hematoma in the liver have been reported in prospective studies to be 18.3% after biopsy with a 2.0-mm Tru-cut needle (1) and 23% after biopsy with a 1.6-mm Jamshidi needle (2). Patients with cirrhosis or hepatic tumors are at greater (4) and injection of fibrin (5), gelatin particles and thrombin (6), gelatin sponge pledgets (7,8), fibrinogen and thrombin (9,10), or autologous blood clot in an attempt to promote clotting and hemostasis in the needle tract. Kim et al (11) reported animal studies of radiofrequency (RF) coagulation with use of the biopsy needle itself to deliver the RF energy.Transplantation of tumor cells along the needle tract after biopsy of a malignancy is also a risk. Incidences of needle tract implantation after biopsy of hepatocellular carcinoma have been reported in two recent series as 3.9% (12) and 5.1% (13). There are also published reports of subcutaneous seeding after fine needle biopsy of metastatic colonic adenocarcinoma (14,15) and metastatic pancreatic adenocarcinoma (16). The development of an effective, inexpensive, and technically simple method of cauterizing a coaxial needle biopsy tract could provide a soluti...

A trucut biopsy needle for bipolar radiofrequency ablation of needle tract: a proof-of-concept experiment

“…3 The tan to charcoal area represents the coagulation of the tissue surrounding the puncture tract in ex vivo liver tissue tissue between the active electrode and the dispersive pad, which might lead to heating of the metallic implants or to an increase in body temperature depending on the energy applied. Pritchard and coauthors also reported a modified introducer needle for coagulation of puncture tracts [9]. They used a 14-G introducer needle as a monopolar RF device allowing the coaxial use of a 16-G biopsy gun.…”

Radiofrequency Ablation for Tumor-Related Massive Hematuria

“…September 2002-October 2003). In addition, modified RF ablation can be used on the outer needle during core biopsy to minimize bleeding after biopsy (11). The fact that RF ablation works for hematuria makes perfect sense: with coagulation necrosis, tissue does not bleed.…”

A biopsy tool with integrated piezoceramic elements for needle tract cauterization and cauterization monitoring

“…These approaches involve trans-needle placement of steel coils (Allison and Adam 1988) and injection of fibrin (Chisholm et al 1989), gelatin particles and thrombin (Zins et al 1992), gelatin sponge pledgets (Smith et al 1996;Fandrich et al 1996), and fibrinogen and thrombin (Falstrom et al 1999;Paulson et al 2000). These techniques do not provide a solution to the possibility of tumor cell deposition along the needle tract (Pritchard et al 2004). Biopsy needle tract cauterization is a therapeutic option that can simultaneously avoid post biopsy hemorrhage and needle tract seeding (Fig.…”