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3D cone-beam CT guidance, a novel technique in renal biopsy--results in 41 patients with suspected renal masses.

Braak SJ, van Melick HH, Onaca MG, van Heesewijk JP, van Strijen MJ - Eur Radiol (2012)

Bottom Line: The two nondiagnostic lesions proved to be renal cell carcinoma.This resulted in a sensitivity, specificity, PPV, NPV, and accuracy of 91.7, 100, 100, 89.5, and 95.1%, respectively.There was one minor bleeding complication.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, St Antonius Hospital, PO Box 2500, 3430 EM, Nieuwegein, The Netherlands. sjbraak@gmail.com

ABSTRACT

Objective: To determine whether 3D cone-beam computed tomography (CBCT) guidance allows safe and accurate biopsy of suspected small renal masses (SRM), especially in hard-to-reach anatomical locations.

Materials and methods: CBCT guidance was used to perform 41 stereotactic biopsy procedures of lesions that were inaccessible for ultrasound guidance or CT guidance. In CBCT guidance, a 3D-volume data set is acquired by rotating a C-arm flat-panel detector angiosystem around the patient. In the data set, a needle trajectory is determined and, after co-registration, a fusion image is created from fluoroscopy and a slice from the data set, enabling the needle to be positioned in real time.

Results: Of the 41 lesions, 22 were malignant, 17 were benign, and 2 were nondiagnostic. The two nondiagnostic lesions proved to be renal cell carcinoma. There was no growth during follow-up imaging of the benign lesions (mean 29 months). This resulted in a sensitivity, specificity, PPV, NPV, and accuracy of 91.7, 100, 100, 89.5, and 95.1%, respectively. Mean dose-area product value was 44.0 Gy·cm(2) (range 16.5-126.5). There was one minor bleeding complication.

Conclusion: With CBCT guidance, safe and accurate biopsy of a suspected SRM is feasible, especially in hard-to-reach locations of the kidney.

Key points: • Cone-beam computed tomography has potential advantages over conventional CT for interventional procedures. • CBCT guidance incorporates 3D CBCT data, fluoroscopy, and guidance software. • In hard-to-reach renal masses, CBCT guidance offers an alternative biopsy method. • CBCT guidance offers good outcome and safety and has potential clinical significance.

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Related in: MedlinePlus

An 81-year-old man with a suspected endophytic kidney mass during abdominal CT imaging. After biopsy, histopathological analysis revealed a clear cell renal cell carcinoma. Difference in cone-beam CT (CBCT) without contrast medium (a) and contrast-enhanced CBCT (b). The endophytic renal mass (white arrows) is only visible on the contrast-enhanced CBCT
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Fig1: An 81-year-old man with a suspected endophytic kidney mass during abdominal CT imaging. After biopsy, histopathological analysis revealed a clear cell renal cell carcinoma. Difference in cone-beam CT (CBCT) without contrast medium (a) and contrast-enhanced CBCT (b). The endophytic renal mass (white arrows) is only visible on the contrast-enhanced CBCT

Mentions: CBCT guidance uses a flat panel detector C-arm system (XperCT® and XperGuide®, Allura FD20, Philips Healthcare, the Netherlands). A 3D volume data set is acquired during a 240° rotation of the C-arm around the upper abdomen of the patient in 4–10 s. In six patients, intravenous contrast (50 mL with 4 mL/s Xenetix® 300 mg/mL, Guerbet, the Netherlands; delay before data acquisition of 40 s) was administered during the examination to discriminate the mass from surrounding structures/parenchyma (Fig. 1). For all other masses, no contrast administration was needed because they were exophytic or had other discriminating factors. The radiologist determines a safe needle trajectory within the reconstructed data set, taking account of critical anatomical structures (Fig. 2a, b). Using the information of the planned needle trajectory, a fusion image of fluoroscopy and the relevant double oblique slice of the cone-beam CT is created in which the needle can be accurately positioned. The patient is asked to breathe in until the diaphragm is in the same position as the double oblique slice of the CBCT. When the diaphragm on the fluoroscopy image matches the CBCT slice during inspiration, the patient was given a breath-hold command, and under real-time fluoroscopy the needle is advanced over the predefined needle path to the right depth (Fig. 2c) [6, 7]. The procedure is performed with local anaesthesia. Sampling was done using a coaxial technique with a guiding cannula [Bard® TruGuide®;17 G; 13 or 17 cm (Bard Biopsy Systems, Tempe, AZ, USA)] positioned just proximal to the renal mass. Three to six 18 G biopsies were then taken through the guiding needle to obtain at least 1 cm of biopsy length. The Tru-Cut needle (Bard® Magnum®;18 G; 16, 20 or 25 cm; side cutting, 15 or 22 mm) is loaded in an automated biopsy gun (Bard®).Fig. 1a, b


3D cone-beam CT guidance, a novel technique in renal biopsy--results in 41 patients with suspected renal masses.

Braak SJ, van Melick HH, Onaca MG, van Heesewijk JP, van Strijen MJ - Eur Radiol (2012)

An 81-year-old man with a suspected endophytic kidney mass during abdominal CT imaging. After biopsy, histopathological analysis revealed a clear cell renal cell carcinoma. Difference in cone-beam CT (CBCT) without contrast medium (a) and contrast-enhanced CBCT (b). The endophytic renal mass (white arrows) is only visible on the contrast-enhanced CBCT
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3472072&req=5

Fig1: An 81-year-old man with a suspected endophytic kidney mass during abdominal CT imaging. After biopsy, histopathological analysis revealed a clear cell renal cell carcinoma. Difference in cone-beam CT (CBCT) without contrast medium (a) and contrast-enhanced CBCT (b). The endophytic renal mass (white arrows) is only visible on the contrast-enhanced CBCT
Mentions: CBCT guidance uses a flat panel detector C-arm system (XperCT® and XperGuide®, Allura FD20, Philips Healthcare, the Netherlands). A 3D volume data set is acquired during a 240° rotation of the C-arm around the upper abdomen of the patient in 4–10 s. In six patients, intravenous contrast (50 mL with 4 mL/s Xenetix® 300 mg/mL, Guerbet, the Netherlands; delay before data acquisition of 40 s) was administered during the examination to discriminate the mass from surrounding structures/parenchyma (Fig. 1). For all other masses, no contrast administration was needed because they were exophytic or had other discriminating factors. The radiologist determines a safe needle trajectory within the reconstructed data set, taking account of critical anatomical structures (Fig. 2a, b). Using the information of the planned needle trajectory, a fusion image of fluoroscopy and the relevant double oblique slice of the cone-beam CT is created in which the needle can be accurately positioned. The patient is asked to breathe in until the diaphragm is in the same position as the double oblique slice of the CBCT. When the diaphragm on the fluoroscopy image matches the CBCT slice during inspiration, the patient was given a breath-hold command, and under real-time fluoroscopy the needle is advanced over the predefined needle path to the right depth (Fig. 2c) [6, 7]. The procedure is performed with local anaesthesia. Sampling was done using a coaxial technique with a guiding cannula [Bard® TruGuide®;17 G; 13 or 17 cm (Bard Biopsy Systems, Tempe, AZ, USA)] positioned just proximal to the renal mass. Three to six 18 G biopsies were then taken through the guiding needle to obtain at least 1 cm of biopsy length. The Tru-Cut needle (Bard® Magnum®;18 G; 16, 20 or 25 cm; side cutting, 15 or 22 mm) is loaded in an automated biopsy gun (Bard®).Fig. 1a, b

Bottom Line: The two nondiagnostic lesions proved to be renal cell carcinoma.This resulted in a sensitivity, specificity, PPV, NPV, and accuracy of 91.7, 100, 100, 89.5, and 95.1%, respectively.There was one minor bleeding complication.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, St Antonius Hospital, PO Box 2500, 3430 EM, Nieuwegein, The Netherlands. sjbraak@gmail.com

ABSTRACT

Objective: To determine whether 3D cone-beam computed tomography (CBCT) guidance allows safe and accurate biopsy of suspected small renal masses (SRM), especially in hard-to-reach anatomical locations.

Materials and methods: CBCT guidance was used to perform 41 stereotactic biopsy procedures of lesions that were inaccessible for ultrasound guidance or CT guidance. In CBCT guidance, a 3D-volume data set is acquired by rotating a C-arm flat-panel detector angiosystem around the patient. In the data set, a needle trajectory is determined and, after co-registration, a fusion image is created from fluoroscopy and a slice from the data set, enabling the needle to be positioned in real time.

Results: Of the 41 lesions, 22 were malignant, 17 were benign, and 2 were nondiagnostic. The two nondiagnostic lesions proved to be renal cell carcinoma. There was no growth during follow-up imaging of the benign lesions (mean 29 months). This resulted in a sensitivity, specificity, PPV, NPV, and accuracy of 91.7, 100, 100, 89.5, and 95.1%, respectively. Mean dose-area product value was 44.0 Gy·cm(2) (range 16.5-126.5). There was one minor bleeding complication.

Conclusion: With CBCT guidance, safe and accurate biopsy of a suspected SRM is feasible, especially in hard-to-reach locations of the kidney.

Key points: • Cone-beam computed tomography has potential advantages over conventional CT for interventional procedures. • CBCT guidance incorporates 3D CBCT data, fluoroscopy, and guidance software. • In hard-to-reach renal masses, CBCT guidance offers an alternative biopsy method. • CBCT guidance offers good outcome and safety and has potential clinical significance.

Show MeSH
Related in: MedlinePlus