Percutaneous ultrasonography-guided core needle biopsy of gastrointestinal lesions: what's its actual role in clinical practice? A retrospective study for safety and effectiveness.
OBJECTIVE
Endoscopic biopsy is commonly performed to obtain a pathological diagnosis of gastrointestinal (GI) lesions. When the lesions are submucosal, subserosal, or exophytic, endoscopic biopsy is often unsuccessful, and endoscopic ultrasound (EUS)-guided biopsy is considered the procedure of choice in these cases. Nevertheless, in some patients both endoscopic and EUS-guided biopsy are not indicated, or yield inconclusive cyto-histological results. The aim of this study was to assess the efficacy and safety of percutaneous ultrasonography (US)-guided biopsy of GI wall lesions, and to define its actual role in clinical practice.


METHODS
A retrospective study was conducted on 45 consecutive US-guided biopsies of GI lesions. All biopsies were performed in patients unsuitable for endoscopic or EUS-guided biopsy, or with lesions inaccessible to endoscopic techniques, or with inconclusive results from endoscopic or EUS-guided biopsy. Biopsies were performed with an 18 or 20-gauge Tru-cut needle under US guidance. Biopsy results were compared with the final diagnosis that was based on surgical pathological findings or clinical instrumental follow-up of at least 20 months. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overall accuracy, and complication rate of the procedure were calculated.


RESULTS
One biopsy specimen (2.2 %) was inadequate for cyto-histologic examination. In the remaining 44 cases, US-guided biopsy correctly identified 39 / 40 (97.5 %) malignant lesions, and 4 / 4 (100 %) benign lesions. One case resulted in a false negative (2.2 %). The sensitivity, specificity, PPV, NPV, and overall diagnostic accuracy were 97.5 %, 100 %, 100 %, 80 % and 97.7 %, respectively. Including also the inadequate specimen into the analysis, they were 95.1 %, 100 %, 100 %, 66.7 % and 95.6 %, respectively. No procedure-related complications were observed. In ten cases (22.2 %), US-guided biopsy results made it possible to avoid unnecessary surgical exploration.


CONCLUSIONS
Percutaneous US-guided core biopsy of GI wall lesions is an accurate and safe technique that makes it possible in select cases to obtain a correct pathological diagnosis and prevent unnecessary surgical exploration. Although it has been replaced by EUS-guided biopsy as the procedure of choice to sample submucosal or subserosal GI lesions, US-guided biopsy can still play a useful role in the diagnostic workup of GI lesions when endoscopy or EUS is unsuccessful for various reasons or yields inconclusive cyto-histological results.
Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara, Italy.
P
P
Tombesi
S
S
Postorivo
M
M
Catellani
D
D
Tassinari
V
V
Abbasciano
S
S
Sartori
D000230:Adenocarcinoma / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D003110:Colonic Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D004379:Duodenal Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging* / Q000473:pathology*; D005770:Gastrointestinal Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology; D046152:Gastrointestinal Stromal Tumors / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008223:Lymphoma / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional