Interventional Radiology (IR), Frankford Hospitals
On many imaging studies, areas of very different types of tissue or disease may look the same. For example, an infection may look like cancer or visa versa, or a benign tumor may look malignant or vice versa. This brings the need often for another kind of diagnostic step to differentiate conditions. Interventional radiologists can place hollow needles, or sometimes catheters or other probes, through the skin to biopsy (take
small samples of tissue from) areas that need to be examined for diagnostic purposes. Microscopically in the lab and with
the use of various lab tests, specialists called pathologists can examine the cells and fluids removed in this way – taken
from
organs or other areas of the body – to help ascertain the condition of the tissue from
which they have been removed.
Most such procedures performed are image-guided biopsy, an approach that has been used successfully for decades now. The radiologists can use various imaging modalities, including CT, ultrasound, and the various forms of angiography, to see the position of fine needles used to take a puncture sample, or to draw up (or aspirate, especially in cases of needing
a sample of a fluid collection), small amounts of tissue. For some biopsies, they will use more than one imaging modality or they may use a special technique of intersecting coordinates
from the imaging (called stereotactic biopsy) to pinpoint an area of tissue. The type of imaging used will depend on the type of abnormality that has been identified or suspected and which type of imaging
reveals the mass most clearly.
Interventional radiologists can biopsy most areas of the body. Most commonly, though, they perform these biopsies on the:
• breast (or under the arm or near the chest wall);
• liver;
• lung;
• or thyroid.
Often patients undergo such biopsies to determine the cause of a lump or mass.
For example, most abnormalities seen on mammograms are not cancer. But to determine whether a patient’s lesion is benign or malignant, specialists often must take a small sample of cells from
the abnormal location and examine them under the microscope. Needle biopsy, often guided by ultrasound, makes this step much less invasive and much easier to undergo than in past eras
when a biopsy required an incision and removal of significantly more tissue. And with image guidance, interventionalists can avoid other tissues or vital structures surrounding the targeted areas. The radiologist will sometimes use a vacuum-assisted needle to remove the entire lesion in question, if the lesion is small.
In addition, specialists have also begun using MR imaging to guide biopsies, especially for breast biopsy. Some lesions are only, or best, visible with MR imaging and, thus, their biopsy is best guided by this modality. The radiologist may also use MR imaging to place a marker clip or guide wire at the site of a small breast lump, to help surgeons
locate and remove the lump.
Nodules or lesions in the lungs are also a common target of needle-guided biopsy. This procedure involves introducing a fine needle through the chest to the location of the abnormality.
Interventionalists may also take other types of needle samples, including (for example from the renal vein, to diagnose endocrine
function) or fluid from the spine (with a lumbar puncture or “spinal tap,” which can also measure or release pressure in the
cerebrospinal fluid).
Biopsy (by needle) leaves no permanent mark. Patients normally need only a local anesthetic or sedation, or both, prior to these studies.
These procedures are almost always performed on an outpatient basis. Most patients can go home shortly after these procedures, although in some cases a brief recovery period at the hospital is
needed.
Liver Biopsy through the Jugular Vein
Liver biopsy can be a critical diagnostic step in evaluating patients for liver abnormalities, including chronic liver disease.
Frankford interventional radiologists offer an alternative in biopsying the liver, with a technique that uses a transjugular
approach. Patients with liver disease often have bleeding problems, and so the conventional needle-biopsy technique of placing
a needle through the skin at the rib cage can present problems for these individuals, especially at the sight from which the
liver tissue is removed. Patients who have a blood-clotting condition or a large amount of fluid in the abdomen may need
another approach.
In transvenous liver biopsy, the interventionalist inserts a small tube into the jugular vein in the neck and uses imaging
to guide it into the primary vein in the liver (right or middle hepatic vein). The radiologist then advances a small needle
through the tube and into the liver to retrieve a sample of core liver tissue. The technique produces very little bleeding
where the sample is removed, and the bleeding that does occur goes back into the vein.
Transjuglar liver biopsy is best for random samples of liver tissue, aimed at identifying liver disease (such as graft rejection
disease in transplant patients). To target specific locations for biopsy, such as discrete masses, specialists are more likely
to rely on percutaneous imaging-guided (needle) biopsy. |
