Contrast-enhanced ultrasound guided biopsy of superficial toraco-abdominal and neck lesions. Initial experience in 20 patients

Aim: In the diagnostic workup of superficial located tumors, percutaneous biopsy plays an important role. However, a successful retrieval of an adequate tissue sample is achievable in only 80-90% of the cases, mainly due to tissue inhomogenities. Contrast-enhanced ultrasound (CEUS) was successfully used to optimize the percutaneous biopsy in several tumors. The aim of our study was to assess the feasibility of CEUS as a direct guiding method for percutaneous biopsy of superficial toraco-abdominal and neck tumors. Material and methods: Twenty patients aged 12-75 years with superficial toraco-abdominal and neck masses were studied. CEUS guided biopsy was performed using the contrast harmonic imaging technique with 9 MHz broadband linear transducer (10 cases) or 3.5MHz transducer (10 cases). The needle (18 G Bard coupled on an automatic device Bard Magnum) was directed in arterial phase into the enhanced, perfused areas. The following parameters were recorded: maximal length of the tumor, perfusion pattern, number of passages, length of the specimen, rate of complications. Results: The mean maximal length of the tumor was 6.95 cm (range 4-10.6 cm). CEUS guided biopsy was technical successful in 100% of patients. The mean number of passages needed to sample a good specimen was 1.6, range 1-3. The mean length of the specimen was 1.18 cm, range 0.8-1.4cm. The perfusion patterns of the tumors in our series were: P1-non-enhancing mass-11.1 %, P2 peripherally enhancing mass with non-enhancing central area -5.6%, P3 diffusely enhancing mass with scattered non-enhancing areas -77.7 % and P4 completely homogeneously enhancing masses -5.6% of patients. The sensitivity of CEUS guided biopsy in the diagnosis of superficial tumors was 100%. For adenopathies a sub-typing was possible in all cases. There was only one minor hematoma around the punctured tumor in one patient. Conclusions: In our series 83% of the tumors had a perfusion pattern (P2 and P3) that may lead to sampling errors in case of US guided biopsy. CEUS guided biopsy of toraco-abdominal and neck tumors is a feasible technique that improves the sensitivity of percutaneous biopsy to 100%.