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Percutaneous Image-Guided Biopsy
Kamran Ahrar • Sanjay Gupta
Editors
Percutaneous
Image-Guided Biopsy
Editors
Kamran Ahrar, MD, FSIR
Department of Interventional Radiology
Department of Thoracic
and Cardiovascular Surgery
The University of Texas MD Anderson Cancer Center
Houston, TX
USA
Sanjay Gupta, MD, DNB
Department of Interventional Radiology
Department of Diagnostic Radiology
The University of Texas MD Anderson Cancer Center
Houston, TX
USA
Medical Illustrator
David L. Bier
The University of Texas MD Anderson Cancer Center
ISBN 978-1-4614-8216-1
ISBN 978-1-4614-8217-8
DOI 10.1007/978-1-4614-8217-8
Springer New York Heidelberg Dordrecht London
(eBook)
© Springer Science+Business Media New York 2014
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Preface
Percutaneous needle biopsy has largely replaced more invasive surgical methods of tissue
sampling. The first image-guided biopsies were performed with fluoroscopic guidance; however, the true era of percutaneous image-guided biopsy was ushered in with the advancement
of ultrasound, computed tomography, and magnetic resonance imaging technologies. Imaging
guidance allows for precise targeting of lesions, resulting in high accuracy and low complication rates.
Traditionally, biopsies were performed to evaluate newly discovered masses or mass-like
lesions in order to establish an initial diagnosis of cancer or infection. Biopsies today, in addition to performing a diagnostic function, are commonly obtained for detecting recurrence of
metastatic disease and for monitoring response to therapy. Furthermore, in the era of molecular
targeted therapy and personalized cancer medicine, accurate subtyping of tumors has necessitated the procurement of larger and more frequent biopsy samples. In the future, image-guided
biopsy will likely play an even larger role in drug discovery, assessment of biomarker targets,
and evaluation of disease susceptibility. In light of the growing number of indications for targeted tissue acquisition, it will likely become necessary for nearly all practicing radiologists to
take part in this important endeavor at some point in their professional career.
Percutaneous Image-Guided Biopsy is a textbook and atlas that offers valuable information
to every reader. This well-illustrated book was designed to be a practical, easy-to-use learning
and state-of-the-art reference tool. Those in radiology training programs or those with limited
previous experience in performing image-guided biopsies may read the entire book from cover
to cover. Others may read a particular chapter in preparation for a specific upcoming procedure. Even for experienced radiologists, the book can serve as a quick reference to highlight
various approaches to specific anatomic sites, list potential complications, and outline management strategies. Nearly all chapters provide detailed review of relevant anatomy with illustrations and an ample number of clinical cases to demonstrate the salient points of each section.
We hope that the readers will find this book informative and useful. We wish to express our
sincere appreciation to all of the authors for sharing their time, knowledge, and skills in producing this volume, which ultimately attempts to enable every radiologist to perform imageguided biopsies safely and effectively.
Houston, TX, USA
Houston, TX, USA
Kamran Ahrar, MD, FSIR
Sanjay Gupta, MD, DNB
v
Contents
1
Biopsy Devices and Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Kamran Ahrar and Sanaz Javadi
1
2
CT-Guided Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Kamran Ahrar
19
3
Radiation Protection During CT-Guided Interventions . . . . . . . . . . . . . . . . . . . .
A. Kyle Jones
33
4
Ultrasound-Guided Biopsy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Judy U. Ahrar and Kamran Ahrar
39
5
MRI-Guided Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Kamran Ahrar and R. Jason Stafford
49
6
Fluoroscopy-Guided Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Kamran Ahrar
65
7
Advanced Tools and Devices: Navigation Technologies,
Automation, and Robotics in Percutaneous Interventions . . . . . . . . . . . . . . . . . .
Aradhana M. Venkatesan and Bradford J. Wood
73
Pathologic Evaluation of Tissues Obtained by Interventional
Radiology Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Savitri Krishnamurthy
85
8
9
Biopsy of Head and Neck Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sanjay Gupta
97
10
Biopsy of Mediastinal Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Sanjay Gupta
11
Percutaneous Transthoracic Lung Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Antonio Gutierrez, Fereidoun Abtin, and Robert D. Suh
12
Pleural Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Kamran Ahrar and Sanaz Javadi
13
Liver Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Ashraf Thabet and Debra A. Gervais
14
Percutaneous Biopsy of the Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Sanjay Gupta
15
Spleen Biopsy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Alda Lui Tam
16
Adrenal Gland Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Alda Lui Tam
vii
viii
Contents
17
Renal Mass Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Kamran Ahrar, Sanaz Javadi, and Judy U. Ahrar
18
Percutaneous and Transjugular Kidney Biopsy. . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Judy U. Ahrar, Sanaz Javadi, and Kamran Ahrar
19
Nodes and Soft Tissue Masses Involving the Retroperitoneum,
Mesentery, Omentum, and Peritoneal Ligaments . . . . . . . . . . . . . . . . . . . . . . . . . 267
Colette M. Shaw, Bruno C. Odisio, Rony Avritscher,
and David C. Madoff
20
Biopsy of Pelvic Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Efe Ozkan and Sanjay Gupta
21
MRI-Guided Prostate Biopsy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
R. Jason Stafford, Stephen E. McRae, and Kamran Ahrar
22
Biopsy of the Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Sanjay Gupta
23
Anatomic Guidelines and Approaches for Biopsy of the Long Bones . . . . . . . . . 335
Sendasaperumal Navakoti Sendos and Sanjay Gupta
24
Musculoskeletal Biopsies: Extremities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
David R. Marker and John A. Carrino
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
Contributors
Fereidoun Abtin, MD Department of Radiological Sciences, Ronald Reagan UCLA
Medical Center, Los Angeles, CA, USA
Judy U. Ahrar, MD Department of Interventional Radiology, The University of Texas
MD Anderson Cancer Center, Houston, TX, USA
Kamran Ahrar, MD, FSIR Department of Interventional Radiology, Department of Thoracic
and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center,
Houston, TX, USA
Rony Avritscher, MD Department of Interventional Radiology, Division of Diagnostic Imaging,
The University of Texas MD Anderson Cancer Center, Houston, TX, USA
John A. Carrino, MD, MPH Radiology and Orthopaedic Surgery, Musculoskeletal
Radiology, The Russell H. Morgan Department of Radiology and Radiological Science,
The Johns Hopkins University, Baltimore, MD, USA
Debra A. Gervais, MD Division of Abdominal Imaging and Intervention,
Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
Sanjay Gupta, MD, DNB Department of Interventional Radiology, Department of Diagnostic
Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Antonio Gutierrez, MD Department of Radiological Sciences, David Geffen School of
Medicine at UCLA Medical Center, Ronald Reagan UCLA Medical Center, Los Angeles,
CA, USA
Sanaz Javadi, MD Department of Radiology, Baylor College of Medicine,
Houston, TX, USA
A. Kyle Jones, PhD Department of Imaging Physics, The University of Texas MD
Anderson Cancer Center, Houston, TX, USA
Savitri Krishnamurthy, MD Department of Pathology, The University of Texas MD
Anderson Cancer Center, Houston, TX, USA
David C. Madoff, MD Division of Interventional Radiology, Department of Radiology,
New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
David R. Marker, MD The Russell H. Morgan Department of Radiology
and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD, USA
Stephen E. McRae, MD Department of Interventional Radiology, The University of Texas
MD Anderson Cancer Center, Houston, TX, USA
Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University
of Texas MD Anderson Cancer Center, Houston, TX, USA
ix
x
Bruno C. Odisio, MD Department of Interventional Radiology, Division of Diagnostic Imaging,
The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Efe Ozkan, MD Department of Radiology, The Ohio State University, Columbus, OH, USA
Sendasaperumal Navakoti Sendos, MD Department of Radiology,
Memorial Hermann Hospital, Houston, TX, USA
Colette M. Shaw, MD Division of Interventional Radiology, Thomas Jefferson University
Hospital, Philadelphia, PA, USA
R. Jason Stafford, PhD Department of Imaging Physics, The University of Texas
MD Anderson Cancer Center, Houston, TX, USA
Robert D. Suh, MD Department of Radiological Sciences, David Geffen School of
Medicine at UCLA Medical Center, Los Angeles, CA, USA
Thoracic Imaging and Intervention, Department of Radiology, Ronald Reagan UCLA Medical
Center, Los Angeles, CA, USA
Alda Lui Tam, MD, MBA, FRCPC Department of Interventional Radiology,
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center,
Houston, TX, USA
Ashraf Thabet, MD Division of Abdominal Imaging and Intervention,
Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
Aradhana M. Venkatesan, MD Department of Radiology and Imaging Sciences
and Center for Interventional Oncology, NIH Clinical Center, Bethesda, MD, USA
Bradford J. Wood, MD Department of Radiology and Imaging Sciences,
Center for Interventional Oncology, Interventional Radiology, NIH Clinical Center,
Bethesda, MD, USA
Contributors