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18.05.2017 | CIRSE Standards of Practice Guidelines

CIRSE Guidelines on Percutaneous Needle Biopsy (PNB)

verfasst von: Andrea Veltri, Irene Bargellini, Luigi Giorgi, Paulo Alexandre Matos Silva Almeida, Okan Akhan

Erschienen in: CardioVascular and Interventional Radiology | Ausgabe 10/2017

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Excerpt

Image-guided percutaneous needle biopsy (PNB) has proven to be a safe and effective procedure, and it became a common procedure representing an essential step for diagnosis and treatment planning in many situations. …

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Tam AL, Lim HJ, Wistuba II, Tamrazi A, Kuo MD, Ziv E, et al. Image-guided biopsy in the era of personalized cancer care: proceedings from the society of interventional radiology research consensus panel. J Vasc Interv Radiol. 2016;27(1):8–19. doi:10.1016/j.jvir.2015.10.019.CrossRefPubMed

Solomon SB, Zakowski MF, Pao W, Thornton RH, Ladanyi M, Kris MG, et al. Core needle lung biopsy specimens: adequacy for EGFR and KRAS mutational analysis. Am J Roentgenol. 2010;194(1):266–9. doi:10.2214/AJR.09.2858.CrossRef

Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol. 2003;14:S199–202.CrossRefPubMed

Taslakian B, Georges Sebaaly M, Al-Kutoubi A. Patient evaluation and preparation in vascular and interventional radiology: what every interventional radiologist should know (part 1: patient assessment and laboratory tests). Cardiovasc Intervent Radiol. 2016;39(3):325–33.CrossRefPubMed

Lee MJ, Fanelli F, Haage P, Hausegger K, Van Lienden KP. Patient safety in interventional radiology: a CIRSE IR checklist. Cardiovasc Intervent Radiol. 2012;35(2):244–6. doi:10.1007/s00270-011-0289-5.CrossRefPubMed

Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, et al. American College of Chest Physicians. Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e326S–50S. doi:10.1378/chest.11-2298.

Patel IJ, Davidson JC, Nikolic B, Salazar GM, Schwartzberg MS, Walker TG, et al. Standards of practice committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 2012;23(6):727–36. doi:10.1016/j.jvir.2012.02.012.CrossRefPubMed

Hinojar R, Jiménez-Natcher JJ, Fernández-Golfín C, Zamorano JL. New oral anticoagulants: a practical guide for physicians. Eur Heart J Cardiovasc Pharmacother. 2015;1(2):134–45. doi:10.1093/ehjcvp/pvv002.CrossRefPubMed

Lorentzen T, Nolsøe CP, Ewertsen C, Nielsen MB, Leen E, Havre RF, et al. EFSUMB. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part I. General aspects (long version). Ultraschall Med. 2015;36(5):E1–14. doi:10.1055/s-0035-1553593.PubMed

10.

Zani EL, Clark OA, Rodrigues Netto N Jr. Antibiotic prophylaxis for transrectal prostate biopsy. Cochrane Database Syst Rev. 2011 May 11;(5):CD006576. doi:10.1002/14651858.CD006576.pub2.

11.

Cussans A, Somani BK, Basarab A, Dudderidge TJ. The role of targeted prophylactic antimicrobial therapy before transrectal ultrasonography-guided prostate biopsy in reducing infection rates: a systematic review. BJU Int. 2016;117(5):725–31. doi:10.1111/bju.13402.CrossRefPubMed

12.

McGrath A, Sabharwal T. General principles of biopsy and drainage. In: Gervais DA, Sabharwal T, editors. Interventional radiology procedures in biopsy and drainage. London: Springer-Verlag; 2011. p. 1–10.

13.

Gupta S, Krishnamurthy S, Broemeling LD, Morello FA Jr, Wallace MJ, Ahrar K, et al. Small (≤ 2-cm) subpleural pulmonary lesions: short- versus long-needle-path CT-guided biopsy—comparison of diagnostic yields and complications. Radiology. 2005;234:631–7.CrossRefPubMed

14.

Sainani NI, Arellano RS, Shyn PB, Gervais DA, Mueller PR, Silverman SG. The challenging image-guided abdominal mass biopsy: established and emerging techniques ‘if you can see it, you can biopsy it’. Abdom Imaging. 2013;38(4):672–96. doi:10.1007/s00261-013-9980-0.CrossRefPubMed

15.

Tsetis D, Uberoi R, Fanelli F, Roberston I, Krokidis M, van Delden O, et al. The provision of interventional radiology services in Europe: CIRSE recommendations. Cardiovasc Intervent Radiol. 2016;39(4):500–6. doi:10.1007/s00270-016-1299-0.CrossRefPubMed

16.

ACR–SIR–SPR Practice parameter for the performance of image-guided percutaneous needle biopsy (PNB) Res. 35 – 2013, Amended 2014 (Res. 39). Available from http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/PNB.pdf.

17.

Tam AL, Kim ES, Lee JJ, Ensor JE, Hicks ME, Tang X, et al. Feasibility of image-guided transthoracic core-needle biopsy in the BATTLE lung trial. J Thorac Oncol. 2013;8(4):436–42. doi:10.1097/JTO.0b013e318287c91e.CrossRefPubMed

18.

Gupta S. New techniques in image-guided percutaneous biopsy. Cardiovasc Intervent Radiol. 2004;27(2):91–104.CrossRefPubMed

19.

Abi-Jaoudeh N, Kruecker J, Kadoury S, Kobeiter H, Venkatesan AM, Levy E, et al. Multimodality image fusion-guided procedures: technique, accuracy, and applications. Cardiovasc Intervent Radiol. 2012;35(5):986–98.CrossRefPubMedPubMedCentral

20.

Chehab MA, Brinjikji W, Copelan A, Venkatesan AM. navigational tools for interventional radiology and interventional oncology applications. Semin Intervent Radiol. 2015;32(4):416–27. doi:10.1055/s-0035-1564705.CrossRefPubMedPubMedCentral

21.

Aviram G, Greif J, Man A, Schwarz Y, Marmor S, Graif M, Blachar A. Diagnosis of intrathoracic lesions: are sequential fine-needle aspiration (FNA) and core needle biopsy (CNB) combined better than either investigation alone? Clin Radiol. 2007;62(3):221–6.CrossRefPubMed

22.

Shabana W, Kielar A, Vermani V, Fernandes DD, Antoniscu R, Schweitzer M. Accuracy of sonographically guided biopsy using a freehand versus needle-guided technique: computed tomographic correlation study. J Ultrasound Med. 2013;32(3):535–40.CrossRefPubMed

23.

Kim GR, Hur J, Lee SM, Lee HJ, Hong YJ, Nam JE, et al. CT fluoroscopy-guided lung biopsy versus conventional CT-guided lung biopsy: a prospective controlled study to assess radiation doses and diagnostic performance. Eur Radiol. 2011;21(2):232–9.CrossRefPubMed

24.

Heck SL, Blom P, Berstad A. Accuracy and complications in computed tomography fluoroscopy-guided needle biopsies of lung masses. Eur Radiol. 2006;16(6):1387–92.CrossRefPubMed

25.

Prosch H, Stadler A, Schilling M, Bürklin S, Eisenhuber E, Schober E, et al. CT fluoroscopy-guided vs. multislice CT biopsy mode-guided lung biopsies: accuracy, complications and radiation dose. Eur J Radiol. 2012;81(5):1029–33.CrossRefPubMed

26.

Mammarappallil JG, Hiatt KD, Ge Q, Clark HP. Computed tomography fluoroscopy versus conventional computed tomography guidance for biopsy of intrathoracic lesions: a retrospective review of 1143 consecutive procedures. J Thorac Imaging. 2014;29(6):340–3. doi:10.1097/RTI.0000000000000109.CrossRefPubMed

27.

Lü Y, Fritz J, Li C, Liu M, Lee P, Wu L, et al. Magnetic resonance imaging-guided percutaneous biopsy of mediastinal masses: diagnostic performance and safety. Invest Radiol. 2013;48(6):452–7. doi:10.1097/RLI.0b013e31827a4a17.CrossRefPubMed

28.

Verheyden C, Pages-Bouic E, Balleyguier C, Cherel P, Lepori D, Laffargue G, et al. Underestimation rate at MR imaging-guided vacuum-assisted breast biopsy: a multi-institutional retrospective study of 1509 breast biopsies. Radiology. 2016;29:151947.

29.

Woodrum DA, Gorny KR, Greenwood B, Mynderse LA. MRI-guided prostate biopsy of native and recurrent prostate cancer. Semin Intervent Radiol. 2016;33(3):196–205. doi:10.1055/s-0036-1586151.CrossRefPubMedPubMedCentral

30.

Weiss CR, Nour SG, Lewin JS. MR-guided biopsy: a review of current techniques and applications. J Magn Reson Imaging. 2008;27(2):311–25.CrossRefPubMed

31.

Muthigi A, George AK, Sidana A, Kongnyuy M, Simon R, Moreno V, et al. Missing the mark: prostate cancer upgrading by systematic biopsy over MRI/TRUS fusion biopsy. J Urol. 2016;. doi:10.1016/j.juro.2016.08.097.

32.

El-Haddad G. PET-based percutaneous needle biopsy. PET Clin. 2016;11(3):333–49. doi:10.1016/j.cpet.2016.02.009.CrossRefPubMed

33.

Stewart CJ, Coldewey J, Stewart IS. Comparison of fine needle aspiration cytology and needle core biopsy in the diagnosis of radiologically detected abdominal lesions. J Clin Pathol. 2002;55(2):93–7.CrossRefPubMedPubMedCentral

34.

Maturen KE, Nghiem HV, Marrero JA, Hussain HK, Higgins EG, Fox GA, et al. Lack of tumor seeding of hepatocellular carcinoma after percutaneous needle biopsy using coaxial cutting needle technique. Am J Roentgenol. 2006;187(5):1184–7.CrossRef

35.

Robertson EG, Baxter G. Tumour seeding following percutaneous needle biopsy: the real story! Clin Radiol. 2011;66(11):1007–14. doi:10.1016/j.crad.2011.05.012.CrossRefPubMed

36.

Hatfield MK, Beres RA, Sane SS, Zaleski GX. Percutaneous imaging-guided solid organ core needle biopsy: coaxial versus noncoaxial method. Am J Roentgenol. 2008;190(2):413–7. doi:10.2214/AJR.07.2676.CrossRef

37.

Nour-Eldin NE, Alsubhi M, Emam A, Lehnert T, Beeres M, Jacobi V, et al. Pneumothorax complicating coaxial and non-coaxial CT-guided lung biopsy: comparative analysis of determining risk factors and management of pneumothorax in a retrospective review of 650 patients. Cardiovasc Intervent Radiol. 2016;39(2):261–70. doi:10.1007/s00270-015-1167-3.CrossRefPubMed

38.

Jandaghi AB, Habibzadeh H, Falahatkar S, Heidarzadeh A, Pourghorban R. Transperineal prostate core needle biopsy: a comparison of coaxial versus noncoaxial method in a randomised trial. Cardiovasc Intervent Radiol. 2016 Aug 2. [Epub ahead of print].

39.

Zins M, Vilgrain V, Gayno S, Rolland Y, Arrivé L, Denninger MH, et al. US-guided percutaneous liver biopsy with plugging of the needle track: a prospective study in 72 high-risk patients. Radiology. 1992;184(3):841–3.CrossRefPubMed

40.

Tran AA, Brown SB, Rosenberg J, Hovsepian DM. Tract embolization with gelatin sponge slurry for prevention of pneumothorax after percutaneous computed tomography-guided lung biopsy. Cardiovasc Intervent Radiol. 2014;37(6):1546–53. doi:10.1007/s00270-013-0823-8.CrossRefPubMed

41.

Baadh AS, Hoffmann JC, Fadl A, Danda D, Bhat VR, Georgiou N, et al. Utilization of the track embolization technique to improve the safety of percutaneous lung biopsy and/or fiducial marker placement. Clin Imaging. 2016;40(5):1023–8. doi:10.1016/j.clinimag.2016.06.007.CrossRefPubMed

42.

Li Y, Du Y, Luo TY, Yang HF, Yu JH, Xu XX, et al. Usefulness of normal saline for sealing the needle track after CT-guided lung biopsy. Clin Radiol. 2015;70(11):1192–7. doi:10.1016/j.crad.2015.06.081.CrossRefPubMed

43.

Lang EK, Ghavami R, Schreiner VC, Archibald S, Ramirez J. Autologous blood clot seal to prevent pneumothorax at CT-guided lung biopsy. Radiology. 2000;216(1):93–6.CrossRefPubMed

44.

Gupta S, Wallace MJ, Cardella JF, Kundu S, Miller DL, Rose SC. Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for percutaneous needle biopsy. J Vasc Interv Radiol. 2010;21(7):969–75. doi:10.1016/j.jvir.2010.01.011.CrossRefPubMed

45.

Gupta S, Henningsen JA, Wallace MJ, Madoff DC, Morello FA Jr, Ahrar K, et al. Percutaneous biopsy of head and neck lesions with CT guidance: various approaches and relevant anatomic and technical considerations. Radiographics. 2007;27(2):371–90.CrossRefPubMed

46.

Learned KO, Lev-Toaff AS, Brake BJ, Wu RI, Langer JE, Loevner LA. US-guided biopsy of neck lesions: the head and neck neuroradiologist’s perspective. Radiographics. 2016;36(1):226–43. doi:10.1148/rg.2016150087.CrossRefPubMed

47.

Zhang HF, Zeng XT, Xing F, Fan N, Liao MY. The diagnostic accuracy of CT-guided percutaneous core needle biopsy and fine needle aspiration in pulmonary lesions: a meta-analysis. Clin Radiol. 2016;71(1):e1–10. doi:10.1016/j.crad.2015.09.009.CrossRefPubMed

48.

Gupta S, Seaberg K, Wallace MJ, Madoff DC, Morello FA Jr, Ahrar K, et al. Imaging-guided percutaneous biopsy of mediastinal lesions: different approaches and anatomic considerations. Radiographics. 2005;25(3):763–88.CrossRefPubMed

49.

Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD. American association for the study of liver diseases. Liver Biopsy Hepatol. 2009;49(3):1017–44. doi:10.1002/hep.22742.CrossRef

50.

Kalambokis G, Manousou P, Vibhakorn S, Marelli L, Cholongitas E, Senzolo M, et al. Transjugular liver biopsy–indications, adequacy, quality of specimens, and complications–a systematic review. J Hepatol. 2007;47(2):284–94.CrossRefPubMed

51.

Howlett DC, Drinkwater KJ, Lawrence D, Barter S, Nicholson T. Findings of the UK national audit evaluating image-guided or image-assisted liver biopsy. Part I. Procedural aspects, diagnostic adequacy, and accuracy. Radiology. 2012;265(3):819–31. doi:10.1148/radiol.12111562.CrossRefPubMed

52.

Howlett DC, Drinkwater KJ, Lawrence D, Barter S, Nicholson T. Findings of the UK national audit evaluating image-guided or image-assisted liver biopsy. Part II. Minor and major complications and procedure-related mortality. Radiology. 2013;266(1):226–35. doi:10.1148/radiol.12120224.CrossRefPubMed

53.

Lipnik AJ, Brown DB. Image-guided percutaneous abdominal mass biopsy: technical and clinical considerations. Radiol Clin North Am. 2015;53(5):1049–59. doi:10.1016/j.rcl.2015.05.007.CrossRefPubMed

54.

McInnes MD, Kielar AZ, Macdonald DB. Percutaneous image-guided biopsy of the spleen: systematic review and meta-analysis of the complication rate and diagnostic accuracy. Radiology. 2011;260(3):699–708. doi:10.1148/radiol.11110333.CrossRefPubMed

55.

Rajiah P, Sinha R, Cuevas C, Dubinsky TJ, Bush WH Jr, Kolokythas O. Imaging of uncommon retroperitoneal masses. Radiographics. 2011;31(4):949–76. doi:10.1148/rg.314095132.CrossRefPubMed

56.

Marconi L, Dabestani S, Lam TB, Hofmann F, Stewart F, Norrie J, et al. Systematic review and meta-analysis of diagnostic accuracy of percutaneous renal tumour biopsy. Eur Urol. 2016;69(4):660–73. doi:10.1016/j.eururo.2015.07.072.CrossRefPubMed

57.

Bancos I, Tamhane S, Shah M, Delivanis DA, Alahdab F, Arlt W, et al. DIAGNOSIS OF ENDOCRINE DISEASE: the diagnostic performance of adrenal biopsy: a systematic review and meta-analysis. Eur J Endocrinol. 2016;175(2):R65–80. doi:10.1530/EJE-16-0297.CrossRefPubMed

58.

Vanderveen KA, Thompson SM, Callstrom MR, Young WF Jr, Grant CS, Farley DR, et al. Biopsy of pheochromocytomas and paragangliomas: potential for disaster. Surgery. 2009;146(6):1158–66. doi:10.1016/j.surg.2009.09.013.CrossRefPubMed

59.

Ukimura O, Coleman JA, de la Taille A, Emberton M, Epstein JI, Freedland SJ, et al. Contemporary role of systematic prostate biopsies: indications, techniques, and implications for patient care. Eur Urol. 2013;63(2):214–30. doi:10.1016/j.eururo.2012.09.033.CrossRefPubMed

60.

Jiang X, Zhu S, Feng G, Zhang Z, Li C, Li H, et al. Is an initial saturation prostate biopsy scheme better than an extended scheme for detection of prostate cancer? A systematic review and meta-analysis. Eur Urol. 2013;63(6):1031–9. doi:10.1016/j.eururo.2013.01.035.CrossRefPubMed

61.

Pua BB, Solomon SB. Lymph Node Biopsy. In: Gervais DA, Sabharwal T, editors. Interventional radiology procedures in biopsy and drainage. London: Springer; 2011. p. 73–9.

62.

Traina F, Errani C, Toscano A, Pungetti C, Fabbri D, Mazzotti A, Donati D, Faldini C. Current concepts in the biopsy of musculoskeletal tumors. J Bone Joint Surg Am. 2015;97(1):e7.CrossRef

63.

Huang AJ, Kattapuram SV. Musculoskeletal neoplasms: biopsy and intervention. Radiol Clin North Am. 2011;49(6):1287–305. doi:10.1016/j.rcl.2011.07.010.CrossRefPubMed

64.

Atwell TD, Smith RL, Hesley GK, Callstrom MR, Schleck CD, Harmsen WS, et al. Incidence of bleeding after 15,181 percutaneous biopsies and the role of aspirin. Am J Roentgenol. 2010;194(3):784–9. doi:10.2214/AJR.08.2122.CrossRef

65.

Heerink WJ, de Bock GH, de Jonge GJ, Groen HJ, Vliegenthart R, Oudkerk M. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. Eur Radiol. 2017;27(1):138–48.CrossRefPubMed

66.

Moreland A, Novogrodsky E, Brody L, Durack J, Erinjeri J, Getrajdman G, et al. Pneumothorax with prolonged chest tube requirement after CT-guided percutaneous lung biopsy: incidence and risk factors. Eur Radiol. 2016;26(10):3483–91. doi:10.1007/s00330-015-4200-7.CrossRefPubMed

67.

Wu CC, Maher MM, Shepard JA. Complications of CT-guided percutaneous needle biopsy of the chest: prevention and management. Am J Roentgenol. 2011;196(6):W678–82. doi:10.2214/AJR.10.4659.CrossRef

68.

Tomiyama N, Yoshifumi Y, Yasuo N, et al. CT-guided needle biopsy of lung lesions: a survey of severe complications based on 9783 biopsies in Japan. Eur J Radiol. 2006;59:60–4.CrossRefPubMed

69.

Herts B, Baker M. The current role of percutaneous biopsy in the evaluation of renal masses. Curr Opin Urol. 2000;10:105–9.CrossRefPubMed

70.

Silva MA, Hegab B, Hyde C, Guo B, Buckels JA, Mirza DF. Needle track seeding following biopsy of liver lesions in the diagnosis of hepatocellular cancer: a systematic review and meta-analysis. Gut. 2008;57:1592–6.CrossRefPubMed

71.

Stigliano R, Marelli L, Yu D, Davies N, Patch D, Burroughs AK. Seeding following percutaneous diagnostic and therapeutic approaches for hepatocellular carcinoma: what is the risk and the outcome? Seeding risk for percutaneous approach of HCC. Cancer Treat Rev. 2007;33:437–47.CrossRefPubMed

72.

Rodgers M, Collinson R, Desai S, et al. Risk of dissemination with biopsy of colorectal liver metastases. Dis Colon Rectum. 2003;46:454–9.CrossRefPubMed

73.

Jones O, Rees M, John T, et al. Biopsy of resectable colorectal liver metastases causes tumour dissemination and adversely affects survival after liver resection. Br J Surg. 2005;92:1165–8.CrossRefPubMed

74.

Agarwal P, Seely J, Matzinger F, et al. Pleural mesothelioma: sensitivity and incidence of needle tract seeding after image-guided biopsy versus surgical biopsy. Radiology. 2006;241:589–94.CrossRefPubMed

Titel: CIRSE Guidelines on Percutaneous Needle Biopsy (PNB)
verfasst von: Andrea Veltri
Irene Bargellini
Luigi Giorgi
Paulo Alexandre Matos Silva Almeida
Okan Akhan
Publikationsdatum: 18.05.2017
Verlag: Springer US
Erschienen in: CardioVascular and Interventional Radiology / Ausgabe 10/2017
Print ISSN: 0174-1551
Elektronische ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-017-1658-5

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CIRSE Guidelines on Percutaneous Needle Biopsy (PNB)

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Neu im Fachgebiet Radiologie

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Wie toxische Männlichkeit der Gesundheit von Männern schadet

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