Intravascular Ultrasound-Guided Transvenous Biopsy of Abdominal and Pelvic Targets Difficult to Access by Percutaneous Needle Biopsy: Technique and Initial Clinical Experience.

Autor:	Swenson C; Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, North Carolina., Martin JG; Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, North Carolina., Jaffe T; Division of Abdominal Imaging, Department of Radiology, Duke University Medical Center, Durham, North Carolina., Gupta RT; Division of Abdominal Imaging, Department of Radiology, Duke University Medical Center, Durham, North Carolina., Sag AA; Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, North Carolina., Befera NT; Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, North Carolina., Pabon-Ramos WM; Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, North Carolina., Suhocki PV; Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, North Carolina., Smith TP; Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, North Carolina., Kim CY; Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, North Carolina., Ronald J; Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, North Carolina. Electronic address: james.ronald@duke.edu.
Jazyk:	angličtina
Zdroj:	Journal of vascular and interventional radiology : JVIR [J Vasc Interv Radiol] 2021 Sep; Vol. 32 (9), pp. 1310-1318.e2. Date of Electronic Publication: 2021 May 28.
DOI:	10.1016/j.jvir.2021.04.029
Abstrakt:	Purpose: To report initial clinical experience with intravascular ultrasound (US)-guided transvenous biopsy (TVB) for perivascular target lesions in the abdomen and pelvis using side-viewing phased-array intracardiac echocardiography catheters. Materials and Methods: In this single-institution, retrospective study, 48 patients underwent 50 intravascular US-guided TVB procedures for targets close to the inferior vena cava or iliac veins deemed difficult to access by conventional percutaneous needle biopsy (PNB). In all procedures, side-viewing phased-array intracardiac echocardiography intravascular US catheters and transjugular liver biopsy sets were inserted through separate jugular or femoral vein access sheaths, and 18-gauge core needle biopsy specimens were obtained under real-time intravascular US guidance. Diagnostic yield, diagnostic accuracy, and complications were analyzed. Results: Intravascular US-guided TVB was diagnostic of malignancy in 40 of 50 procedures for a diagnostic yield of 80%. There were 5 procedures in which biopsy was correctly negative for malignancy, with a per-procedure diagnostic accuracy of 90% (45/50). Among the 5 false negatives, 2 patients underwent repeat intravascular US-guided TVB, which was diagnostic of malignancy for a per-patient diagnostic accuracy of 94% (45/48). There were 1 (2%) mild, 2 (4%) moderate, and 1 (2%) severe adverse events, with 1 moderate severity adverse event (venous thrombosis) directly attributable to the intravascular US-guided TVB technique. Conclusions: Intravascular US-guided TVB performed on difficult-to-approach perivascular targets in the abdomen and pelvis resulted in a high diagnostic accuracy, similar to accepted thresholds for PNB. Complication rates may be slightly higher but should be weighed relative to the risks of difficult PNB, surgical biopsy, or clinical management without biopsy. (Copyright © 2021 SIR. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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