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CT-guided biopsies of unspecified suspect intrahepatic lesions: pre-procedure Lipiodol-marking improves the biopsy success rate

Marcel Christian Langenbach
Marcel Christian Langenbach
, 
Thomas Joseph Vogl
Thomas Joseph Vogl
, 
Amelie Buchinger
Amelie Buchinger
, 
Katrin Eichler
Katrin Eichler
, 
Jan-Erik Scholtz
Jan-Erik Scholtz
, 
Renate Hammerstingl
Renate Hammerstingl
 und 
Tatjana Gruber-Rouh
Tatjana Gruber-Rouh
   | 21. Juni 2023
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Article Category: Research Article
Online veröffentlicht: 21. Juni 2023
Seitenbereich: 158 - 167
Eingereicht: 17. Feb. 2023
Akzeptiert: 20. Apr. 2023
DOI: https://doi.org/10.2478/raon-2023-0024
Schlüsselwörter
© 2023 Marcel Christian Langenbach et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

The Standards for the Reporting of Diagnostic Accuracy studies (STARD) flow diagram for a study of 607 patients undergoing CT-guided liver biopsy.
The Standards for the Reporting of Diagnostic Accuracy studies (STARD) flow diagram for a study of 607 patients undergoing CT-guided liver biopsy.

FIGURE 2.

The decision for a biopsy of the suspicious hepatic lesion was made for the same male patient. Because of the small lesion size and isodensity in the unenhanced CT, a prior intra-arterial Lipiodol-marking (A) was performed. Directly after the intervention (B) and during the CT intervention (C) (white arrow) was well displayable, and the biopsy was successful, revealing a hepatocellular carcinoma.
The decision for a biopsy of the suspicious hepatic lesion was made for the same male patient. Because of the small lesion size and isodensity in the unenhanced CT, a prior intra-arterial Lipiodol-marking (A) was performed. Directly after the intervention (B) and during the CT intervention (C) (white arrow) was well displayable, and the biopsy was successful, revealing a hepatocellular carcinoma.

FIGURE 3.

A male patient with a suspect and unclear hepatic lesion with 6 mm in segment 7. While not visible in the unenhanced CT (A), the lesion impressed arterial hypervascularized after intravenous contrast medium application (B) (white arrow).
A male patient with a suspect and unclear hepatic lesion with 6 mm in segment 7. While not visible in the unenhanced CT (A), the lesion impressed arterial hypervascularized after intravenous contrast medium application (B) (white arrow).

FIGURE 4.

Presentation of histopathologically correlated puncture successes for the overall cohort and individual groups individually.
Presentation of histopathologically correlated puncture successes for the overall cohort and individual groups individually.

Overview of patient characteristics. P-values based on the Chi-square test indicate only a difference in the distribution of liver cirrhosis in comparison of the three enhancement groups

Characteristic Overall Unenhanced biopsy Lipiodol-enhanced i.v. contrast-enhanced p-value
Age, y (SD) 61.0 ± 12.0 61.9 ± 11.95 60.4 ± 11.12 59.6 ± 13.04 0.228
Gender, n (%) 0.134
  Male 358 (59.0) 177 (55.1) 108 (74.5) 73 (51.8)
  Female 249 (41.0) 144 (44.9) 37 (25.5) 68 (48.2)
Hepatic disease, n (%) 0.354
  HCV 101 (16.6) 34 (10.6) 53 (36.6) 14 (9.9)
  HBV 28 (4.6) 6 (1.9) 17 (11.7) 5 (3.5)
  HCV+HBV 8 (1.3) 3 (0.9) 3 (2.1) 2 (1.4)
  NASH 34 (5.6) 12 (3.7) 17 (11.7) 5 (3.5)
  Toxic damage 48 (7.9) 20 (6.2) 16 (11.0) 12 (8.5)
  Others 53 (8.7) 26 (8.1) 19 (13.1) 8 (5.7)
  No disease 335 (55.2) 220 (68.5) 20 (13.8) 95 (67.4)
Cirrhosis 188 (33.0) 59 (19.2) 100 (71.9) 29 (3.6) 0.013
Intrahepatic lesions, n (%) 0.541
  1 lesion 297 (48.9) 164 (51.1) 68 (46.9) 65 (46.1)
  2 lesions 116 (19.1) 45 (14.0) 37 (25.5) 34 (24.1)
  3 or more lesions 194 (32.0) 112 (34.9) 40 (27.6) 42 (29.8)
Lesion size, mm (SD) 29.3 ± 18.0 30.1 ± 18.1 25.9 ± 17.4 29.8 ± 18.7 0.182

Biopsy characteristics overall and for the three enhancement groups. A Chi-square test was performed to test for differences between the groups. Significance is indicated in bold

Characteristic Overall Unenhanced biopsy Lipiodol-enhanced i.v. contrast-enhanced p-value
Biopsy access path 0.718
  Lateral-intercostal 335 (55.2) 162 (50.5) 94 (64.8) 79 (56.0)
  Anterior-subcostal 224 (36.9) 25 (7.8) 9 (6.2) 10 (7.1)
  Anterior-lateral 44 (7.2) 132 (41.1) 42 (29.0) 50 (35.5)
  Dorsal-lateral 4 (0.7) 2 (0.6) 0 2 (1.4)
Segment localization 0.052
  1 6 (1.0) 2 (0.6) 2 (1.4) 2 (1.4)
  2 54 (8.9) 29 (9.0) 14 (9.7) 11 (7.8)
  3 41 (6.8) 23 (7.2) 8 (5.5) 10 (7.1)
  4 112 (18.5) 66 (20.6) 23 (15.9) 23 (16.3)
  5 95 (15.7) 57 (17.8) 21 (14.5) 17 (12.1)
  6 112 (18.5) 69 (21.5) 21 (14.5) 22 (15.6)
  7 82 (13.5) 31 (9.7) 22 (15.2) 29 (20.6)
  8 105 (17.3) 44 (13.7) 34 (23.4) 27 (19.1)
Access path length [mm] (SD)
  Cutis to lesion 83 ±26 82 ±27 85 ±27 83 ±26 0.527
  Liver capsule to lesion 43 ±26 44 ±21 41 ±21 43 ±21 0.473
Obtained probes (SD) 2.6 ±1.3 2.7 ±1.5 2.5 ±0.9 2.4 ±0.9 0.158
Radiation exposure (SD)
  Whole examination [mGycm2] 498.3 ±429.5 361.0 ±166.6 411.3 ±517.9 900.3 ±495.6 0.019
  Biopsy scans [mGycm2] 80.1 ±58.0 79.7 ±60.0 88.2 ±56.3 72.6 ±56.4 0.053
  Intervention (i)-images [n] 34.4 ±24.0 34.6 ±23.8 37.7 ±23.4 30.6 ±24.7 0.182
Complications 0.870
  Sub-capsular liver bleeding 3 (0.5) 1 (0.3) 1 (0.7) 1 (0.7)
  Fluid edge around liver 2 (0.3) 1 (0.3) 0 1 (0.7)
  Bleeding along the access path 1 (0.2) 0 1 (0.7) 0
  Circulatory problems 1 (0.2) 1 (0.3) 0 0
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