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Ultrasound-guided biopsy

Dr Bruno Di Muzio ◈ and Dr Ian Bickle ◉ et al.

Ultrasound-guided biopsy is one form of image-guided biopsy, typically performed by a radiologist. It is the most common form of image-guided biopsy, offering convenience and real-time dynamic observation with echogenic markers on cannulae allowing for precise placement.

It can potentially be used to perform a biopsy of any body part, being regularly used to biopsy the kidney, liver, breast and lymph nodes. There can be some minor procedural variation in the type of biopsy performed.

Biopsies may be focal or non-focal in nature. Lesions as small as 5 mm may be biopsied, with a range of biopsy needle gauges and sizes available (from 22G to 14G). Broadly speaking needles may be single or co-axial and have 10 mm or 20 mm cutting lengths.

Most common percutaneous biopsies

Laboratory parameters for a safe procedure

Biopsies in deep structures require special attention to coagulation indices. There are widely divergent opinions about the safe values of these indices for percutaneous biopsies. The values suggested below were considered based on the literature review, whose references are cited below.

Complete blood count: Platelet > 50000/mm³ (some institutions determine other values between 50000-100000/mm³) ^1,3.

Coagulation profile: Some studies showed that having a normal INR or prothrombin time is no reassurance that the patient will not bleed after the procedure².

international normalized ratio (INR) ≤1.5 ³
normal prothrombin time (PT), partial thromboplastin time (PTT)

Contraindications

The contraindications must be considered individually in each case. Overall, the most important contraindications to percutaneous biopsies are:

uncooperative patient
lack of safe access
uncorrectable bleeding diathesis (abnormal coagulation indices)

References

Ultrasound - general index

ultrasound (introduction)
ultrasound physics
- basic physics
  - absorption
  - acoustic impedance
  - attenuation
  - decibel
  - propagation speed
  - reflection
  - refraction
  - scattering
- transducers
  - ultrasound frequencies
  - piezoelectric effect
  - linear array
  - convex array
  - phased array
  - beam focusing
  - beam steering
  - gain
  - time gain compensation
  - power output
  - focal zone
  - dynamic range
  - frame rate
  - line density
  - frame averaging (frame persistence)
  - ultrasound image resolution
    - axial resolution
    - lateral resolution
    - elevational (azimuthal) resolution
    - temporal resolution
- imaging modes and display
  - pulse-echo imaging
  - real-time imaging
  - Doppler imaging
    - Doppler effect
    - color Doppler
    - power Doppler
    - B flow
    - color box
    - Doppler angle
    - pulse repetition frequency and scale
    - wall filter
    - color write priority
    - packet size (dwell time)
    - resistive index
    - pulsatility index
  - panoramic imaging
  - compound imaging
  - harmonic imaging
  - elastography
  - scanning modes
    - 2D ultrasound
    - 3D ultrasound
    - 4D ultrasound
    - M-mode
- ultrasound artifacts
  - acoustic shadowing
  - acoustic enhancement
  - beam width artifact
  - reverberation artifact
    - comet tail artifact
      - color comet tail artifact
    - ring down artifact
  - mirror image artifact
  - side lobe artifact
  - speed displacement artifact
  - refraction artifact
  - multipath artifact
  - anisotropy
  - electrical interference artifact
  - Doppler artifacts
    - aliasing
    - tissue vibration
    - spectral broadening
    - blooming
    - motion (flash) artifact
    - twinkle artifact
    - acoustic streaming
- biological effects of ultrasound
  - mechanical index
  - thermal index
- history of ultrasound
obstetric ultrasound
- other
- placenta
- second trimester
  - fetal biometry
    - basic biometry
  - fetal morphology assessment
    - fetal echocardiography views
  - soft markers
    - nuchal fold thickness
    - ventriculomegaly
    - absent nasal bone
      - hypoplastic nasal bone
    - echogenic intracardiac focus
    - choroid plexus cysts
    - echogenic bowel
    - aberrant right subclavian artery
  - amnioreduction
  - echogenic fetal bowel
  - umbilical artery Doppler assessment
    - absent umbilical arterial end diastolic flow
    - reversal of umbilical arterial end diastolic flow
- chorionic villus sampling (CVS) and amniocentesis
- nuchal translucency
- failed early pregnancy
- subchorionic hematoma
- multiple gestations
- ectopic pregnancy
- first trimester and early pregnancy
gynecologic ultrasound
- acute pelvic pain
- chronic pelvic pain
- uterus
- ovaries
  - ovarian torsion
  - pelvic inflammatory disease
    - tubo-ovarian abscess complex
  - ovarian cysts and masses
  - paraovarian cyst
  - polycystic ovaries
  - ovarian hyperstimulation syndrome
  - post-hysterectomy ovary
- cervix
- fallopian tube
- other
  - pelvic congestion syndrome
  - peritoneal inclusion cyst
vascular ultrasound
- carotids
  - internal carotid artery
  - cartoid stenosis
- extremities
  - ankle brachial index
- mesenteric vessels
  - chronic mesenteric ischemia
- other
  - fibrin sheath
  - tardus parvus
breast ultrasound
- benign and malignant characteristics of breast lesions at ultrasound
- hyperechoic breast lesions on ultrasound
- differential diagnosis of dilated ducts on breast imaging
musculoskeletal ultrasound
- technique/artifacts
  - anisotropy
- ultrasound of arthropathies
  - musculoskeletal manifestations of rheumatoid arthritis
- skin/soft tissue ultrasound
  - lipoma
  - parasitic infection
    - scrotal filariasis
    - filarial dance sign
- other
  - sonographic features of malignant lymph nodes
  - sonography of peripheral nerves
- pediatric musculoskeletal ultrasound
  - ultrasound classification of developmental dysplasia of the hip
    - alpha angle
    - beta angle
- ankle/foot ultrasound
  - Morton neuroma
- knee ultrasound
  - Baker cyst (popliteal cyst)
  - infrapatellar bursitis
- hip ultrasound
  - Morel-Lavallee lesion
- hand ultrasound
  - gamekeeper thumb
  - glomus tumor
- wrist ultrasound
- elbow ultrasound
- shoulder ultrasound
  - sonographic evaluation of rotator cuff tears
liver ultrasound
- liver
  - focal
  - diffuse
  - hepatic vasculature
  - other
    - hepatic trauma on ultrasound
- liver transplant
  - hepatic arterial resistive index
- biliary
gallbladder ultrasound
- diffuse gallbladder wall thickening (differential)
- focal gallbladder wall thickening (differential)
- gallstones
  - twinkling artifact
  - wall-echo-shadow sign
- gallbladder sludge
  - hepatisation of the gallbladder
- acute cholecystitis
- chronic cholecystitis
- gallbladder polyp
- gallbladder cholecystoses
  - adenomyomatosis
  - gallbladder wall cholesterolosis
    - strawberry gallbladder
- porcelain gallbladder
- gallbladder carcinoma
- gallbladder metastases
- gallbladder lymphoma
- gallbladder volvulus / torsion
- variants
- variants and anomalies
pancreatic ultrasound
- pancreatitis
  - acute
  - chronic
  - pseudocyst
- pancreatic necrosis
- pancreatic abscess
- pancreatic carcinoma
- pancreatic endocrine tumors / islet cell tumors
- cystic pancreatic neoplasms
- intraductal papillary mucinous neoplasm (IPMN)
- pancreatic metastases
- pancreatic lymphoma
- pancreatic trauma
- pancreas transplant
gastrointestinal ultrasound
- appendicitis
- hyperechoic bowel
- inguinal hernia
renal ultrasound
- hydronephrosis
- renal stone
- focal lesion
- diffuse
  - pyelonephritis
  - renal abscess
- renal vascular
  - renal artery stenosis
- renal transplant ultrasound
- other
  - renal trauma
bladder ultrasound
- bladder wall thickening
- bladder diverticulum
- bladder calculi
- ureterocele
- pseudoureterocele
- schistosomiasis
testicular and scrotal ultrasound
- other
- epididymis
- paratesticular lesions
- bilateral testicular lesion
- unilateral testicular lesion
  - testicular torsion
  - orchitis
  - testicular rupture
  - germ cell tumor of the testis
    - testicular seminoma
    - non seminomatous germ cell tumors
      - mixed germ cell tumor
      - yolk sac tumor (endodermal sinus tumor)
      - embryonal cell carcinoma
      - choriocarcinoma
      - testicular teratoma
      - testicular epidermoid (teratoma with ectodermal elements only)
    - burned out testis tumor
  - sex cord / stromal tumors of the testis
    - Leydig cell tumor
prostate ultrasound
- transrectal ultrasound (TRUS)
- prostate carcinoma
- prostatitis
other lower genitourinary ultrasound
- urachal cyst
- urethra
- penis
  - Peyronie's disease
  - priapism
neck and thyroid ultrasound
- thyroid
- parathyroid
echocardiography
- echocardiographic modalities
  - transthoracic echocardiography (TTE)
  - transesophageal echocardiography (TEE)
  - three dimensional (3D) echocardiography
  - epicardial echocardiography
  - contrast enhanced echocardiography
  - fetal echocardiography
  - speckle tracking echocardiography
- physics and imaging modes
  - grey-scale (B-mode)
  - motion mode (M-mode)
  - color flow Doppler (CFD)
  - spectral Doppler
    - pulsed wave Doppler (PWD)
    - continuous wave Doppler (CWD)
  - tissue Doppler imaging (TDI)
- left ventricular systolic and diastolic function
  - structure and morphology
  - systolic function
  - diastolic function
- right ventricular assessment
  - structure and morphology
  - right ventricular (RV) dysfunction
- right and left atria
  - right atrial enlargement
  - left atrial enlargement
- valvular structure and function
  - mitral valve
    - mitral regurgitation
    - mitral stenosis
  - aortic valve
    - aortic stenosis
    - aortic regurgitation
  - pulmonic valve
    - pulmonic regurgitation
    - pulmonic stenosis
  - tricuspid valve
    - tricuspid regurgitation
    - tricuspid stenosis
- hemodynamics
- pericardium
  - pericardial effusion
  - constrictive pericarditis
- cardiomyopathies
- congenital heart disease
  - echocardiographic approach
  - deductive echocardiography
- great vessels
  - thoracic aorta
    - thoracic aortic aneurysm
    - thoracic aortic dissection
  - main pulmonary artery
    - pulmonary embolism
  - inferior vena cava
    - collapsability index
    - distensibility index
  - superior vena cava
pediatric ultrasound
- intussusception
- appendicitis
- vesicoureteric reflux grading
- transcranial ultrasound
ultrasound interventions
- ultrasound-guided biopsy
- ultrasound-guided percutaneous drainage
  - thoracentesis
- ultrasound-guided musculoskeletal interventions
  - joint injection
  - nerve blocks
    - interscalene brachial plexus block
- ultrasound-guided intravenous cannulation
contrast-enhanced ultrasound
- liver
- kidney

Interventional procedures

introduction
- procedure overview
breast
chest
- thoracic biopsy (CT-guided)
- thoracentesis (pleural tap)
gastrointestinal
- stomach
  - percutaneous endoscopic gastrostomy (PEG)
hepatobiliary
- liver
- biliary system
neck
- thyroid gland
  - thyroid gland FNA
musculoskeletal
- bone biopsy (CT-guided)
- shoulder (disambiguation)
  - acromioclavicular joint injection
  - glenohumeral joint injection
    - glenohumeral (shoulder) arthrography
    - glenohumeral (shoulder) hydrodilatation
  - long head of biceps tendon sheath injection
  - subacromial bursal injection
spine
- spinal interventional procedures (general)
urogenital
- bladder
  - cystolithotomy
- kidney
- prostate
  - prostate biopsy
  - transurethral resection of the prostate (TURP)
vascular
- venous
  - intravenous cannulation (ultrasound-guided)
  - inferior vena cava filter

Article information

rID: 21143

System: Gastrointestinal, Hepatobiliary, Musculoskeletal, Interventional

Section: Interventional Radiology

Tag: refs

Synonyms or Alternate Spellings:

Ultrasound guided biopsies

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Cases and figures

Figure 1: photograph - typical co-axial needleFigure 1: photograph - typical co-axial needle

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Images obtained d...

Case 1: breast massCase 1: breast mass

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Figure 2: photograph - renal biopsy gunFigure 2: photograph - renal biopsy gun

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Case 2: needle position beautifully illustratedCase 2: needle position beautifully illustrated

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Case 3: liver biopsyCase 3: liver biopsy

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Case 4: hemorrhage post liver biopsyCase 4: hemorrhage post liver biopsy

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Case 5Case 5

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Case 6: head and neck biopsyCase 6: head and neck biopsy

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Case 7: neck nodeCase 7: neck node

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Case 8: lungCase 8: lung

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