Percutaneous biopsies of splenic lesions--a clinical and contrast enhanced ultrasound based algorithm.
OBJECTIVE
Splenic lesions are rare and characterization is difficult. Secondary spread is more frequent than primary malignant lesions. Thus clinical circumstances are important in the general work-up. Contrast enhanced ultrasound (CEUS) had high accuracy in recent studies but the positive predictive value is low. Biopsy is considered dangerous. Recent studies have brought back this method into focus showing an excellent efficacy and safety. The aim of this study was to estimate the rate of relevant biopsy results in patients with splenic lesions concerning the clinical circumstances.


METHODS
Patients with unclear splenic lesions which appeared progressively hypoenhancing in the late phase of CEUS with BR1 were included. Biopsy was performed with ultrasound guidance. Patients were sorted into 5 groups according to their clinical symptoms.


RESULTS
44 patients were enrolled, 59% had benign lesions. 73% were rated relevant. For the subgroups the rate was: patients with hints for hemato-oncological diseases 83%, patients without symptoms 38%, patients with infections of unknown origin 100%, patients with suspicion of metastases 33%, immunocompromised patients 100%. One bleeding could be managed conservatively, another bleeding was detected incidentally 2 weeks later.


CONCLUSIONS
Percutaneous biopsy of unclear splenic lesions which appear hypoenhancing in the late phase of CEUS with BR1 results in a high rate of relevant lesions. The results should be tested in larger numbers of patients.
Caritas Hospital, Bad Mergentheim, Germany.
Andre
A
Ignee
Caritas Hospital, Bad Mergentheim, Germany.
Xinwu
X
Cui
Deutsche Klinik für Diagnostik, Aukammallee, Wiesbaden, Germany.
Tim
T
Hirche
Caritas Hospital, Bad Mergentheim, Germany.
Chiara
C
Demolo
Universitätsklinikum Regensburg, Regensburg, Germany.
Ana P
AP
Barreiros
Caritas Hospital, Bad Mergentheim, Germany.
Gudrun
G
Schuessler
Caritas Hospital, Bad Mergentheim, Germany.
Christoph F
CF
Dietrich
D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001706:Biopsy / Q000379:methods; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013158:Splenic Diseases / Q000000981:diagnostic imaging* / Q000473:pathology*; D014463:Ultrasonography / Q000379:methods; D055815:Young Adult
D003287:Contrast Media
Contrast enhanced ultrasound; contrast agent BR1; signs and symptoms; splenic tumors