Contrast-Enhanced Ultrasound-Guided Biopsy of Focal Liver Lesions not Visualized Well on Standard B-Mode Ultrasound
22 March 2018 (online)
Purpose To assess the procedural success of contrast-enhanced ultrasound (CEUS)-guided biopsy of focal liver lesions (FLLs) not visualized well on standard B-mode ultrasound.
Materials and Methods Twenty-six patients underwent CEUS-guided biopsy of FLLs in this institutional review board (IRB)-approved, Health Insurance Portability and Accountability Act of 1996 (HIPAA)-compliant retrospective study. Seven (27%) patients had liver cirrhosis. The patients were selected for CEUS-guided biopsy based on prior cross-sectional imaging characterization of FLLs and subsequent sub-optimal B-mode ultrasound visualization. Definity contrast (Lantheus Medical Imaging; dosage 0.8–1.0 mL) was used in 19 patients, and Lumason contrast (Bracco Imaging; dosage 2.4–4.8 mL) was used in 7 patients. FLLs were characterized based on location, largest dimension, and appearances on B-mode and CEUS. Analyzed procedural characteristics included procedural time, number of biopsy passes, histopathology, and follow-up time. Procedural success was defined as concordance between cross-sectional imaging, histopathology, and follow-up—demonstrating no need for re-biopsy; or if follow-up demonstrated need for re-biopsy, the repeat histopathology was concordant with initial histopathology.
Results All patient tolerated contrast administration and biopsy without peri-procedural complications. The mean FLL largest dimension was 2.2 ± 1.7 cm. The mean procedural time was 30.7 ± 12.3 minutes with an average of 3.1 ± 1.7 biopsy passes per patient. Twenty-three (88.5%) of 26 CEUS guided-biopsy cases demonstrated procedural success, with 15 cases demonstrating malignancy. Three cases (11.5%) did not demonstrate procedural success. All patients had at least 2 months of follow-up with a mean follow-up period of 7.1 ± 4.6 months.
Conclusion CEUS-guided biopsy of FLLs not visualized well on standard B-mode ultrasound demonstrated a high procedural success rate of 88.5% and thereby increasing diagnostic yield. This may serve as an alternative to computed tomography (CT)-guided biopsy of FLLs, which are difficult to visualize on standard B-mode ultrasound.