title: Formalin-fixed blood clots--additional histological findings on computed tomography-guided fine-needle aspiration biopsies in comparison with core biopsies.
abstract: OBJECTIVE
  We investigated the diagnostic yield of histological examined formalin-fixed blood clots (FFBCs) in comparison with the established procedures of fine-needle aspiration biopsy (FNAB) and core biopsy (CB) obtained by percutaneous puncture under computed tomography (CT) guidance.
  
  
  METHODS
  A total of 76 CT-guided punctures with removal of tissue by means of all 3 different techniques (FFBC, FNAB, and CB) were performed. Specimens were obtained from the lung (n=18), mediastinum (n=10), upper abdominal organs (n=32), pelvis (n=4), retroperitoneum (n=4), bones (n=7), and neck (n=1). All results were correlated with the clinical course of the patients (minimum, 6 months; mean period, 10 months). The results of each technique were compared. Results of a combined use of FFBC and FNAB were analyzed.
  
  
  RESULTS
  The overall sensitivity (regardless of biopsy site) was 79% for FFBC, 83% for FNAB, and 95% for CB. In chest biopsies, FFBC reached a sensitivity of 92%, FNAB of 86%, and CB of 96%. In liver biopsies, the sensitivities were 47%, 70%, and 88% for FFBC, FNAB, and CB and, for the remaining biopsy sites, 90%, 90%, and 100%, respectively. The combination of FFBC and FNAB showed higher sensitivities than FFBC and FNAB alone. Overall sensitivity for the combination was 88%, with 92%, 72%, and 100% for thorax, liver, and other locations. A definitive diagnosis was made by FFBC in 87% of cases, by FNAB in 74%, and by CB in 88%. The combination of FFBC and FNAB showed a definite diagnosis in 90% of the cases. A tentative diagnosis has been established in 12%, 7%, 5%, and 4%, respectively. In 4 cases (5%), all 3 techniques failed to yield reliable diagnoses.
  
  
  CONCLUSIONS
  The examination of FFBCs is a useful supplement to the established technique of CT biopsy. In combination with FNAB, FFBC has a comparable sensitivity as CB in chest punctures and other extrahepatic lesions.
authors.affiliation: Department of Radiology, Charité, Universitätsmedizin Berlin, and Department of Pathology, Worms Municipal Hospital, Worms, Germany. christian.althoff@charite.de
authors.forename: Christian E
authors.initials: CE
authors.lastname: Althoff
authors.forename: Kay-Geert A
authors.initials: KG
authors.lastname: Hermann
authors.forename: Kai
authors.initials: K
authors.lastname: Wiechen
authors.forename: Alexander
authors.initials: A
authors.lastname: Lembcke
authors.forename: Christian N H
authors.initials: CN
authors.lastname: Enzweiler
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
authors.forename: Patrik
authors.initials: P
authors.lastname: Rogalla
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods; D001707:Biopsy, Needle / Q000379:methods*; D001769:Blood; D005260:Female; D005404:Fixatives; D005557:Formaldehyde; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D005404:Fixatives; D005557:Formaldehyde