Image-guided biopsies

A biopsy is the removal of tissue to allow the sample to be examined for the presence of disease. The tissue samples can be obtained from any part of the body. Image-guided biopsies are performed by a pediatric interventional radiologist using a needle placed through the skin (percutaneously) to permit the removal of the tissue. The use of imaging such as ultrasound, CT or x-rays allows the interventional radiologist to specifically place the needle in the area of abnormality through a skin puncture without the need to make a surgical incision.

Tests

Biopsies are common diagnosis tests for cancer or infections. They can also help identify other conditions such as autoimmune disorders or the underlying condition of an organ before, during or after the initiation of medical therapy. Percutaneous (through the skin) biopsies are performed on many parts of the body and organs, including:

Bone biopsy - diagnoses cancer or infection in the bones.

Bone marrow biopsy - diagnoses cancer in the blood, such as leukemia. A small sample of the bone and bone marrow are removed using a needle.

Breast biopsy - determines if a tissue in the breast is cancerous or benign (non-cancer).

Kidney (renal) biopsy - examines the condition of a kidney or a suspected tumor (such as cancer). It also is frequently used to examine a transplanted kidney for signs of transplant rejection.

Liver biopsy - diagnoses diseases of the liver such as hepatitis C, cirrhosis, infections and cancer. It is also frequently performed in children to examine the condition of a transplanted liver for potential signs of transplant rejection. Liver biopsies are typically performed through the skin (percutaneously). However, if there is an increased bleeding risk the liver can also be biopsied by inserting a catheter through the jugular vein (a large neck vein) into the veins inside the liver to obrain, a tissue sample (transjugular liver biopsy)

Lung or chest biopsy - diagnoses an abnormality of the lung found on an x-ray or CT scan. Typically this is performed to help clarify the presence of a cancer or infection.

Lymph node biopsy - diagnoses enlarged or abnormal lymph nodes.

Thyroid biopsy - determines the cause of a nodule in the thyroid gland.

Procedure performance and recovery

The procedure typically requires 30- 90 minutes depending on the location of the tissue that needs to be biopsied.

Frequently, sedation or anesthesia will be used to help facilitate the successful completion of the procedure. This helps to minimize anxiety for the child and decrease risk of complications as a result of movement during the procedure.

The procedure includes positioning the child on the imaging table and placing the a local anesthetic at the expected skin puncture site for the child's comfort. A small skin nick is made to permit insertion of the biopsy needle. The biopsy needle is inserted into the appropriate location or tissue and confirmed with the imaging method. A sample is then obtained. This sample will then be placed into a container and transported to the pathology lab.

The puncture site is then covered with a bandage. No sutures are required. Your child will be monitored for a short period to allow for recovery from the anesthesia or sedation.

Your child may feel sore at the area of the biopsy for a few days. Typically ibuprofen or acetaminophen will be sufficient for pain control. However if there is significant pain from the biopsy a prescription for pain relief may be used.

Image-guided biopsy benefits

No surgical incision is required—only a small skin nick is made at the site for needle puncture. There is no need to have a stitch to close the skin puncture. The recovery period is usually faster than after open surgical biopsy.

A needle biopsy is less invasive than open and closed surgical biopsies, both of which involve a larger incision in the skin. Generally, the procedure is not painful and the results are as accurate as when a tissue sample is removed surgically.

Aftercare instructions vary, but generally the bandage may be removed the day following the procedure, and your child may bath or shower as normal. Recovery time is brief and your child can soon resume their usual activities.

Image-guided biopsy risks

Any procedure where the skin is penetrated carries a potential risk of infection. The chance of developing an infection that requires added antibiotic treatment appears to be less than one in 1,000. Very rarely, an adjacent organ may be injured by percutaneous biopsy. Rarely significant bleeding may occur.

Limitations of image-guided biopsy and recovery

In some cases, the amount of tissue obtained from an image-guided biopsy may not be enough and the biopsy may have to be repeated or performed by surgical methods. Rarely, if the diagnosis remains uncertain after a technically successful procedure, surgical biopsy may be necessary.

Imaging-guided procedures require the area of abnormality to be seen. If the area of interest cannot be seen, a surgical alternative may be required.

Additional Resources

• RadiologyInfo.org
• Society of Interventional Radiology