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Park, Shin, Won, Kim, and Lee: Ultrasound-Guided Percutaneous Core Needle Biopsy of Splenic Lesions
Abdominal Radiology
Original Article

Journal of the Korean Society of Radiology 2017; 76(5): 303-309.

Published online: 24 April 2017

DOI: https://doi.org/10.3348/jksr.2017.76.5.303

Ultrasound-Guided Percutaneous Core Needle Biopsy of Splenic Lesions

Sangik Park, MD, Yong Moon Shin, MD, Hyung Jin Won, MD, Pyo Nyun Kim, MD, Moon-Gyu Lee, MD

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Corresponding author: Yong Moon Shin, MD. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel. 82-2-3010-4352, Fax. 82-2-476-0090, cjimage@amc.seoul.kr

Received 2 September 2016       Revised 18 October 2016       Accepted 27 October 2016

Copyrights © 2017 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the safety and efficacy of ultrasound-guided percutaneous core needle biopsy of splenic lesions.

Materials and Methods

This retrospective study included 30 patients who underwent percutaneous core needle biopsy of their splenic lesions using 18- or 20-gauge needles between January 2001 and July 2016 in a single tertiary care center. The characteristics of the splenic lesions were determined by reviewing the ultrasound and computed tomography examinations. Acquisition rate and diagnostic accuracy were calculated, using pathologic results of the splenectomy specimen, clinical course and/or imaging follow-up as a reference standard. Post-procedure complications were identified from electronic medical records, laboratory findings and computed tomography images. Seventy-three specimens were obtained from the 30 patients and splenectomy was performed in 2 patients.

Results

Twenty-nine of the 30 patients had focal splenic lesions, while the remaining patient had homogeneous splenomegaly. Acquisition rate and diagnostic accuracy were 80.0% (24/30) and 76.7% (23/30), respectively. Perisplenic hemorrhage without hemodynamic instability developed in one patient.

Conclusion

Ultrasound-guided percutaneous core needle biopsy of splenic lesions is a safe method for achieving a histopathologic diagnosis and can be considered as an alternative to splenectomy in patients with a high risk of splenectomy-related complications.

Keywords: Core Needle Biopsy, Spleen, Lymphoma, Tuberculosis, Hemangioma

Figures and Tables

Fig. 1

A 66-year-old male with perisplenic hemorrhage after core needle biopsy.

A. Axial computed tomography (CT) obtained for evaluation of fever shows mild splenomegaly (maximal diameter, 13 cm).
B. Axial fused positron emission tomography-CT image shows mildly increased 18F-fluorodeoxyglucose uptake in the spleen (maximum standardized uptake value, 3.0). The differential diagnoses included infection and hematologic malignancy.
C. Percutaneous ultrasound-guided core needle biopsy of the spleen was performed using an 18-G needle. The arrowheads indicate the tip of the biopsy needle. Histopathologic examination showed inflammatory infiltrates without evidence of malignancy.
D. Follow-up CT scan obtained 1 day after the procedure to evaluate a decrease in blood hemoglobin levels (8.0 g/dL to 6.3 g/dL) shows perisplenic hemorrhage (arrowheads) and probable active extravasation of contrast media (arrow). The patient showed no hemodynamic instability and improved with supportive management.
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Fig. 2

A 66-year-old female patient with known lung cancer: case with a nondiagnostic histopathologic result.

A. Axial CT shows multiple low density lesions in the spleen, which were considered as possible splenic metastases.
B. US examination shows a 1.4-cm hypoechoic lesion in the spleen. The index mass and other lesions were poorly visualized owing to poor sonic window. Needle approach was hindered by narrow intercostal space of the patient. The histopathologic result was nondiagnostic, and splenectomy revealed sclerosing angiomatoid nodular transformation.
CT = computed tomography, US = ultrasound
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Fig. 3

A 43-year-old male patient with splenic hemangiomas: case with a favorable result.

A. Axial CT shows numerous hypointense lesions in the spleen.
B. US examination shows multiple hyperechoic lesions in the spleen, one of which was biopsied using an 18-G core needle. The histopathologic diagnosis was hemangioma.
CT = computed tomography, US = ultrasound
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Table 1

Clinical and Radiological Characteristics of 30 Patients and Their Splenic Lesions

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Number of Patients
Symptoms at presentation
 Fever 7
 Left flank pain 5
 Generalized weakness 3
 Hematemesis 1
 Asymptomatic 14
Clinical impression
 Lymphoma 11
 Primary benign mass 8
 Infection 5
 Metastasis 4
 Sarcoidosis 1
 Sarcoma 1
Characteristics of splenic lesions
 Number of splenic lesions Number of patients*
  Solitary 10
  2–5 6
  6 or more 13
 Margin Number of patients*
  Ill-defined 9
  Well-defined 20
 Internal attenuation (homogeneity) Number of patients*
  Homogeneous 22
  Heterogeneous 7
Internal attenuation (CT number) 81.4 ± 23.5 HU*
Maximal diameter of largest splenic lesions 3.6 ± 2.2 cm*
Maximal diameter of spleen 11.6 ± 2.4 cm

*n = 29 (excluding one patient with splenomegaly without focal lesions).

CT = computed tomography, HU = Hounsfield unit

Table 2

Histopathologic Results of Ultrasound-Guided Core Needle Biopsy of Splenic Lesions in 30 Patients

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Result Number of Patients
Malignant
 Non-Hodgkin’s lymphoma (B cell) 8
 Non-Hodgkin’s lymphoma (T cell) 2
 Angiosarcoma 1
 Pleomorphic rhabdomyosarcoma 1
Benign
 Hemangioma 3
 Lymphangioma 2
 Tuberculosis 2
 Sclerosing angiomatoid nodular transformation 2
 Total necrosis and fibrosis 1
 Sarcoidosis 1
 Inflammatory infiltration 1
Nondiagnostic* 6
Total 30

*Nondiagnostic results include normal splenic parenchyma (n = 2), splenic congestion (n = 2), reactive mesothelial cells (n = 1) and normal renal parenchyma (n = 1).

Table 3

Radiologic Impression, Histopathologic Results, Modalities of Further Evaluation and Final Diagnosis in 6 Patients with Nondiagnostic Results on Ultrasound-Guided Percutaneous Core Needle Biopsy

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Patient Number Impression Histopathology Further Evaluation Final Diagnosis
1 Lymphoma Splenic congestion Bone marrow biopsy Tuberculosis
2 Metastasis Reactive mesothelial cells None (follow-up) NA
3 Pancreatic tail cancer with splenic invasion Normal splenic parenchyma EUS-guided FNA Poorly differentiated carcinoma
4 Metastasis Normal renal parenchyma Splenectomy SANT
5 Hamartoma Splenic congestion None (follow-up) NA
6 Tuberculosis Normal splenic parenchyma None (follow-up) NA

EUS = endoscopic ultrasound, FNA = fine needle aspiration, NA = not available, SANT = sclerosing angiomatoid nodular transformation

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