Percutaneous core needle biopsy for para-aortic retroperitoneal lesions: impact of size and location on diagnostic accuracy of computed tomography-guided biopsy and feasibility of ultrasound guidance

C Itou; M Sone; Y Arai; S Sugawara; S Kimura; Y Onishi; J Omori; Y Koretsune

doi:10.1016/j.crad.2024.10.005

Percutaneous core needle biopsy for para-aortic retroperitoneal lesions: impact of size and location on diagnostic accuracy of computed tomography-guided biopsy and feasibility of ultrasound guidance

Clin Radiol. 2024 Oct 16:80:106723. doi: 10.1016/j.crad.2024.10.005. Online ahead of print.

Authors

C Itou¹, M Sone², Y Arai³, S Sugawara⁴, S Kimura⁵, Y Onishi⁶, J Omori⁷, Y Koretsune⁸

Affiliations

¹ Department of Diagnostic and Interventional Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. Electronic address: [email protected].
² Department of Diagnostic and Interventional Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. Electronic address: [email protected].
³ Department of Diagnostic and Interventional Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; Department of Internal Medicine, Uonuma City Koide Hospital, 34 Hiwatashishinden, Shibata-shi, Niigata 946-0001, Japan. Electronic address: [email protected].
⁴ Department of Diagnostic and Interventional Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. Electronic address: [email protected].
⁵ Department of Diagnostic and Interventional Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. Electronic address: [email protected].
⁶ Department of Diagnostic and Interventional Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan. Electronic address: [email protected].
⁷ Department of Diagnostic and Interventional Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; Department of Diagnostic Radiology, Yokohama Seibu Hospital, Saint Marianna University School of Medicine, Yasashi-cho, Asahi-ku, Yokohama-shi, Kanagawa 241-0811 Japan. Electronic address: [email protected].
⁸ Department of Diagnostic and Interventional Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; Department of Diagnostic and Interventional Radiology, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address: [email protected].

PMID: 39532056
DOI: 10.1016/j.crad.2024.10.005

Abstract

Aim: To evaluate the safety and efficacy of computed tomography (CT)-guided core needle biopsy (CNB) for para-aortic retroperitoneal lesions, identify factors affecting false-negative results, and explore the feasibility of alternative CT-guided and ultrasound-guided approaches for challenging anatomical regions.

Materials and methods: This single-institution retrospective study included 317 consecutive patients who underwent CNB for para-aortic retroperitoneal lesions. A total of 345 biopsies were performed using 18-gauge cutting needles under CT or ultrasound guidance. Diagnostic accuracy was calculated based on biopsy and follow-up results, and univariate analysis was performed to identify predictors of false-negative CT-guided biopsies.

Results: Of the 332 CT-guided biopsies, 203 targeted lateral aortic lesions. The standard posterior paravertebral approach was commonly used; complex cases requiring alternative CT- or ultrasound-guided approaches involved pre-aortocaval or inter-aortocaval lesions. In CT-guided biopsies, 5 of the 30 lesions in these regions were accessed via trans-caval, trans-pedicle, or trans-disc approaches. All 13 ultrasound-guided biopsies were performed with anterior access except for 2 cases. Malignant lymphoma and nodal metastasis were the most common pathologic findings. Overall sensitivity, specificity, and accuracy were 96.7%, 100%, and 97%, respectively. Neither lesion size nor location predicted false-negative CT-guided biopsies with similar accuracy for lesions ≤15 mm (98.4%) and >15 mm (96.9%). Major bleeding occurred in two CT-guided biopsies (0.6%).

Conclusion: CT-guided CNB demonstrated high diagnostic accuracy across all lesion locations, particularly with the standard posterior paravertebral approach. For more challenging pre-aortocaval or inter-aortocaval lesions, alternative CT-guided posterior or ultrasound-guided anterior approaches may help overcome anatomical constrains and expand percutaneous options.