Ultrason Kılavuzluğunda Omental Biyopsinin Diagnstik Doğruluğu ve Güvenliği : Tek Merkez Sonuçları

Öz

Amaç: Omental biyopsi geleneksel olarak cerrahi bir yaklaşım kullanılarak yapılmaktadır. Kalınlaşmış omentum, klinik pratikte tanı koyulabilmesi için ultrasonografi eşliğinde perkütan biyopsi yapılabilir bir hedeftir. Çalışmamızın amacı, omental kalınlaşmanın ultrason eşliğinde perkütan biyopsisinin tanısal doğruluğunu ve güvenliğini incelemektir. Ek olarak, biyopsi sonuçlarının parasentez sıvısı sitolojisi ile ilişkisini araştırmayı amaçlıyoruz. Gereç ve Yöntemler: Bu retrospektif çalışma, 2014-2022 yılları arasında ultrasonun kılavuz olarak kullanıldığı omental biyopsi yapılan 49 hastayı (33 kadın ve 16 erkek; ortalama yaş, 64 ± 13.9 [SD] yıl) içermektedir. Hastaların biyopsi sonrası klinik takip ve patoloji sonuçları değerlendirilmiştir. Ayrıca kor biyopsi ve parasentez sıvı sitolojisi sonuçlarını karşılaştırılmıştır. Bulgular: Çalışmamıza toplam 49 hasta dahil edildi. Ultrason kılavuzluğunda biyopsi hastaların 49 hastanın 46’sında (%93,8) tanı koydurucuydu. Toplam 36 (%73,4) malign olgu v, 5 (%10,2) tüberkülozu düşündüren kronik inflamasyon, 2 (%4,1) kronik periton enfeksiyonu vardı. 3 hastada kor biyopsi sonucu benign idi ve bunlar; Ig4 ilişkili inflamatuar psödotümör, desmoid fibromatoz ve yağ nekrozu-yabancı cisim reaksiyonu olarak rapor edildi. 36 malign vakanın 17'sinde (%47,2) ovaryen kanser olarak raporlandı. İşlemlerin hiçbirinde yakın dönem majör komplikasyon görülmedi. Parasentez sıvı örneklemesi yapılan 25 hastanın 21'inde (%84) sitoloji sonuçları (malign veya benign sitoloji) omental biyopsi sonuçları ile uyumlu bulundu. Sitolojik değerlendirmede 25 hastanın 16’sı (%64) malign sitoloji olarak raporlandı. Sonuç: Ultrason eşliğinde perkütan omentum biyopsisi daha ucuz, güvenli ve etkili, tanısal doğruluğu yüksek bir yöntemdir. Omentum kalınlaşması olan hastalarda parasentez sıvısı sitolojisi sonuçları oldukça duyarlıdır.

Anahtar Kelimeler

• Biyopsi
• Ultrasonografi
• Omental kalınlaşma

Diagnostic Accuracy and Safety of Ultrasound Guided Omental Biopsy: Single Center Experience

Öz

Aim: Omental biopsy has conventionally been performed using a surgical approach. The thickened omentum can serve as a useful target for ultrasonography guided percutaneous biopsy, in clinical practice. The objective of our study was to determine the diagnostic value and safety of ultrasound guided percutaneous biopsy of omental thickening. Additionally, we aim to investigate the correlation of biopsy results with the paracentesis fluid cytology. Methods: This retrospective study included 49 patients (33 women and 16 men; mean age, 64 ± 13.9 [SD] years) who underwent ultrasound guided omental biopsy between 2014 and 2022 at a single institution at which US served as the first-line modality for omental biopsy guidance. Post-biopsy clinical follow-up were reviewed for each patient. We compare the outcomes of biopsy and paracentesis fluid cytology results. Results: Total 49 patients were included in our study. US-guided biopsy was diagnostic in 46/49 (93.8%) of patients. There were total 36 (73.4%) malignant cases, 5 (10.2%) chronic inflammation suggestive of tuberculosis, while 2 (4.1%) were chronic peritoneal infection. In 3 patients, the result of core biopsy was benign and reported as Ig4-related inflammatory pseudotumor, desmoid fibromatosis and fat necrosis-foreign body reaction. Out of 36 malignant cases, majority 17 (47.2%) had ovarian cancer. There were no major complications. In 21 of 25 patients (%84) who underwent paracentesis fluid sampling, cytology results (malign or bening cytology) were found to be consistent with omental biopsy results. The ascitic cytological evaluation was favourable for malignancy in 16/25 (64%) patients. Conclusions: Ultrasound-guided percutaneous biopsy of omentum is less expensive, safe and effective method with a high diagnostic accuracy. Paracentesis fluid cytology results are highly sensitive in patients with omental thickening.

Anahtar Kelimeler

• Biopsy
• Ultrasonography
• Omental thickening

Kaynakça

1. 1. Pickhardt PJ, Bhalla S. Primary neoplasms of peritoneal and subperitoneal origin: CT findings. Radiographics 2005;25. https://doi.org/10.1148/rg.254045140.
2. 2. Perez AA, Lubner MG, Pickhardt PJ. Original Research. Ultrasound-Guided Omental Biopsy: Diagnostic Yield and Association with CT Features Based on a Single-Institution 18- Year Series. American Journal of Roentgenology 2021;217. https://doi.org/10.2214/AJR.21.25545.
3. 3. Kim JW, Shin SS. Ultrasound-guided percutaneous core needle biopsy of abdominal viscera: Tips to ensure safe and effective biopsy. Korean J Radiol 2017;18. https://doi.org/10.3348/ kjr.2017.18.2.309.
4. 4. Sheafor DH, Paulson EK, Simmons CM, DeLong DM, Nelson RC. Abdominal percutaneous interventional procedures: Comparison of CT and US guidance. Radiology 1998;207. https:// doi.org/10.1148/radiology.207.3.9609893.
5. 5. Keogan MT, Freed KS, Paulson EK, Nelson RC, Dodd LG. Imaging- guided percutaneous biopsy of focal splenic lesions: Update on safety and effectiveness. American Journal of Roentgenology, vol. 172, 1999. https://doi.org/10.2214/ajr.172.4.10587123.
6. 6. Sutherland EL, Choromanska A, Al-Katib S, Coffey M. Outcomes of ultrasound guided renal mass biopsies. J Ultrasound 2018;21. https://doi.org/10.1007/s40477-018-0299-0.
7. 7. Lee MH, Lubner MG, Hinshaw JL, Pickhardt PJ. Ultrasound guidance versus CT guidance for peripheral lung biopsy: Performance according to lesion size and pleural contact. American Journal of Roentgenology, vol. 210, 2018. https://doi. org/10.2214/AJR.17.18014.
8. 8. Atwell TD, Smith RL, Hesley GK, Callstrom MR, Schleck CD, Harmsen WS, et al. Incidence of bleeding after 15,181 percutaneous biopsies and the role of aspirin. American Journal of Roentgenology 2010;194. https://doi.org/10.2214/AJR.08.2122.

9. 9. Khalilzadeh O, Baerlocher MO, Shyn PB, Connolly BL, Devane AM, Morris CS, et al. Proposal of a New Adverse Event Classification by the Society of Interventional Radiology Standards of Practice Committee. Journal of Vascular and Interventional Radiology 2017;28. https://doi.org/10.1016/j.jvir.2017.06.019.
10. 10. Ho LM, Thomas J, Fine SA, Paulson EK. Usefulness of sonographic guidance during percutaneous biopsy of mesenteric masses. American Journal of Roentgenology 2003;180. https://doi. org/10.2214/ajr.180.6.1801563.
11. 11. Govindarajan P, Keshava S. Ultrasound-guided omental biopsy: Review of 173 patients. Indian Journal of Radiology and Imaging 2010;20. https://doi.org/10.4103/0971-3026.73533.
12. 12. Spencer JA, Swift SE, Wilkinson N, Boon AP, Lane G, Perren TJ. Peritoneal carcinomatosis: Image-guided peritoneal core biopsy for tumor type and patient care. Radiology 2001;221. https://doi. org/10.1148/radiol.2203010070. 369
13. 13. Souza FF, Mortelé KJ, Cibas ES, Erturk SM, Silverman SG. Predictive value of percutaneous imaging-guided biopsy of peritoneal and omental masses: Results in 111 patients. American Journal of Roentgenology 2009;192. https://doi.org/10.2214/AJR.08.1283.
14. 14. Hill DK, Schmit GD, Moynagh MR, Nicholas Kurup A, Schmitz JJ, Atwell TD. Percutaneous omental biopsy: efficacy and complications. Abdom Radiol (NY) 2017;42:1566–70. https://doi. org/10.1007/s00261-017-1043-5.
15. 15. Vadvala H V., Furtado VF, Kambadakone A, Frenk NE, Mueller PR, Arellano RS. Image-Guided Percutaneous Omental and Mesenteric Biopsy: Assessment of Technical Success Rate and Diagnostic Yield. Journal of Vascular and Interventional Radiology 2017;28. https://doi.org/10.1016/j.jvir.2017.07.001.
16. 16. Elissa M, Lubner MG, Pickhardt PJ. Biopsy of deep pelvic and abdominal targets with ultrasound guidance: Efficacy of compression. American Journal of Roentgenology 2020;214. https://doi.org/10.2214/AJR.19.21104.
17. 17. Yang K, Ganguli S, De Lorenzo MC, Zheng H, Li X, Liu B. Procedure-specific CT dose and utilization factors for CT-guided interventional procedures. Radiology 2018;289. https://doi. org/10.1148/radiol.2018172945.
18. 18. Leng S, Christner JA, Carlson SK, Jacobsen M, Vrieze TJ, Atwell TD, et al. Radiation dose levels for interventional CT procedures. American Journal of Roentgenology 2011;197. https://doi. org/10.2214/AJR.10.5057.
19. 19. Karoo ROS, Lloyd TDR, Garcea G, Redway HD, Robertson GSR. How valuable is ascitic cytology in the detection and management of malignancy? Postgrad Med J 2003;79. https:// doi.org/10.1136/pmj.79.931.292.
20. 20. Salman MA, Salman AA, Hamdy A, Abdel Samie RM, Ewid M, Abouregal TE, et al. Predictive value of omental thickness on ultrasonography for diagnosis of unexplained ascites, an Egyptian centre study. Asian J Surg 2020;43. https://doi. org/10.1016/j.asjsur.2019.03.004.
21. 21. Runyon BA, Hoefs JC, Morgan TR. Ascitic fluid analysis in malignancy‐related ascites. Hepatology 1988;8. https://doi. org/10.1002/hep.1840080521.
22. 22. Parsons SL, Lang MW, Steele RJC. Malignant ascites: A 2-year review from a teaching hospital. European Journal of Surgical Oncology 1996;22. https://doi.org/10.1016/S0748- 7983(96)80009-6.
23. 23. Garrison RN, Kaelin LD, Galloway RH, Heuser LS. Malignant ascites. Clinical and experimental observations. Ann Surg 1986;203. https://doi.org/10.1097/00000658-198606000-00009.
24. 24. Ringenberg QS, Doll DC, Loy TS, Yarbro JW. Malignant ascites of unknown origin. Cancer 1989;64. https://doi.org/10.1002/1097- 0142(19890801)64:3<753::AID-CNCR2820640330>3.0.CO;2-Y.