ERS3018. Image-Guided Percutaneous Mesenteric and Bowel Biopsy: Diagnostic Yield and Safety Profile
Authors* Denotes Presenting Author
Sarah Daggett *;
University of Wisconsin School of Medicine & Public Health
Perry Pickhardt;
University of Wisconsin School of Medicine & Public Health
Matthew Elissa;
University of Wisconsin School of Medicine & Public Health
Elizabeth Richards;
University of Wisconsin School of Medicine & Public Health
Ryan Zea;
University of Wisconsin School of Medicine & Public Health; University of Wisconsin School of Medicine & Public Health
Meghan Lubner;
University of Wisconsin School of Medicine & Public Health
Objective:
To evaluate the diagnostic yield and safety profile of percutaneous image-guided biopsy of mesenteric and bowel lesions.
Materials and Methods:
Image-guided percutaneous biopsies of the mesentery and bowel at a single institution from 2000-2022 were identified and reviewed. Relevant demographic and procedural data were abstracted from the medical record. Surgical pathology was reviewed to evaluate if the biopsy was diagnostic and concordant with the patient’s final diagnosis.
Results:
A total of 213 mesenteric (n=195) and bowel (n=18) biopsies were assessed. Of the mesenteric biopsies (mean patient age, 62.6±14.; M/F, 113/82; mean BMI, 30.4), 173 were performed using ultrasound (US) and 22 were performed using CT or a hybrid/combined approach. Core needle biopsy was used in 164 patients, fine-needle aspiration (FNA) was used in 21, and both were used in 10. Mean number of biopsy passes was 2.8±1.3 and 3, respectively (core mean 2.7±1.2; FNA mean 3.4±1.5). Average lesion size was 5.3±4.4cm in the long axis and 2.9±2.0cm in the target plane. Diagnostic yield of core biopsies was 97.7% (n=170/174) and FNA was 80.6% (n=25/31) for an overall combined yield of 96.4% (n=188/195). Of diagnostic biopsies, 95.7% (n=180/188) were concordant with the final diagnosis, 70.8% (n=138) of which were considered malignant. Overall diagnostic rate was 180/195 (92.3%). Neuroendocrine tumor pathology was the only factor associated with lower diagnostic yield (13/15, 87%, p=0.03). Biopsy type (FNA vs core) was near significant (p=0.09) as was in-plane target size (p=0.08).
Of 18 bowel biopsies (mean age, 58.3±16.2; M/F 8/10; mean BMI, 28.0), 14 were performed under ultrasound guidance and 4 used CT or hybrid approach. Core biopsies were performed in 14 patients and FNA in 4 patients. Mean lesion size was 5.4±3.0cm in the long axis and 3.1±1.4cm in the target plane. Diagnostic yield of core biopsies was 100% (n=14/14) and FNA was 50% (n=2/4) with an overall diagnostic yield of 88.9% (n=16/18). 100% of diagnostic biopsies were concordant with the final diagnosis, 88.9% (n=16) of which were malignant.
For all biopsies, average shortest skin-to-target-distance on CT was 6.3±2.8cm, decreased to 4.1±1.3cm with US compression (20% reduction, p<0.001). Additionally, ultrasound created a safe path not available on CT in 30 (15%) biopsies. Conscious sedation was used in 91.3% (n=178) of mesenteric procedures and 88.9% (n=16) of bowel procedures. Complications occurred in 11 mesenteric (5.6%) and 1 bowel (5.6%) biopsies (11/12 were minor or small hematoma).
Conclusion:
This is the largest cohort of image-guided percutaneous biopsies of the mesentery and bowel to date with the majority performed under US guidance, and this technique offers high diagnostic yield and a favorable safety profile for tissue diagnosis. Furthermore, compression with ultrasound reduced skin-to-target distance and created a biopsy path that would not be possible on CT in 15% of US cases.
