Biopsy Screen Can Save a Spleen

Image-guided percutaneous biopsy is a viable substitute for splenectomy while causing fewer complications for patients, a new study published in the journal Radiology has found.

The study, led by Matthew D.F. McInnes, MD, of the University of Ottawa,  used study data from MEDLINE and other databases to determine the complication rate and diagnostic accuracy of image-guided percutaneous needle biopsy of the spleen in adult patients suspected of having a spleen disease.

Radiologists have traditionally been wary of the procedures because of concerns regarding accessibility, risk of hemorrhage, and high reported complication rates using 14-gauge needles (13 percent), the authors say. That contrasts with complication rates of about 0.5 percent for percutaneous biopsies of the liver and kidney. Splenectomy is risky, too, though, with morbidity rates of 8.6 percent to 37 percent and mortality rates as high as 2.9 percent, mainly due to infection.

The study looked at 1,573 biopsies on 1,380 patients in two arms: complication rates and diagnostic accuracy.

In the complication rate arm, 714 patients had had 859 biopsies. There were370 core-needle biopsies (CNB) and 489 fine-needle aspiration biopsies (FNAB), using needles ranging from 14 to 25 gauge. Complications were reported in 46 of the biopsies, 10 major and 36 minor; of the major biopsies, nine were related to hemorrhage and one was phneumothorax. Among the minor complications, 29 were related to pain, six to hemorrhage, and one was a vasovagal episode. The major complication rate was 2.2 percent for all biopsies (1.3 percent for FNAB; 3.2 percent for CNB); and the overall complication rate was 4.2 percent.

The bigger the needle, though, the more risky the procedure. The authors found major complication rates of 12.5 percent and total complication rate of 60.6 percent with 14-gauge needles.

In the diagnostic accuracy arm, 639 patients had had 714 biopsies. The researchers found pooled (CNB and FNAB) sensitivity of 87 percent and specificity of 96.4 percent, with CNB having slightly better results on both counts.

“The diagnostic accuracy is likely lower than what could be obtained with splenectomy,” the authors concluded. “However, given the lower complication rate of biopsy, the tradeoff is acceptable.

The study: http://radiology.rsna.org/cgi/content/abstract/radiol.11102136v1