Sonographic Guidance in Biopsies and Drainages: Techniques and Applications

Abstract

Imaging guidance for performing nonvascular interventional procedures such as biopsy, aspiration, and drainage has been used with increasing frequency and sophistication for nearly two decades. Percutaneous needle biopsy is used to diagnose primary or metastatic malignancy, diffuse parenchymal disease, and infection. Abscesses, even those in difficult anatomical locations, can be effectively drained using percutaneous, transrectal, and transvaginal approaches. Most imaging-guided nonvascular interventional procedures in this country are performed with the use of computed tomography (CT) and fluoroscopy, while sonography has been reserved for only superficial or very large lesions. However, in recent years sonography has gained increasing recognition and acceptance as a highly useful, cost-effective, and versatile guidance technique. In some institutions, sonography has replaced CT and fluoroscopy as the primary guidance technique for the performance of nearly all nonvascular interventional procedures. This article will discuss the pros and cons of sonographic guidance compared to CT and fluoroscopy, outline the instruments used and the basic steps of the procedures, and describe specific techniques that can increase success when using sonography as a guidance modality. Examples of the broad range of interventional procedures that can be performed using sonographic guidance, from basic to advanced, will be shown. The focus of the chapter will be the use of sonographic guidance in abdominal biopsies, aspirations, drainages, and the newer application of tumor ablation.

Keywords:

Ultrasound guidance - biopsies - abscess - percutaneous drainage