Citation, DOI, disclosures and article data
At the time the article was created Ian Bickle had no recorded disclosures.View Ian Bickle's current disclosures
At the time the article was last revised Andrew Murphy had no recorded disclosures.View Andrew Murphy's current disclosures
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
- ultrasound-guided renal biopsy
- ultrasound-guided breast biopsy
- ultrasound-guided liver biopsy
- ultrasound-guided biopsy of a peripheral soft tissue mass
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: platelets >50,000/mm3 (some institutions determine other values between 50,000-100,000/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 procedure 2.
- international normalized ratio (INR) ≤1.5 3
- normal prothrombin time (PT), partial thromboplastin time (PTT)
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)
- 1. Sue M, Caldwell S, Dickson R et-al. Variation between centers in technique and guidelines for liver biopsy. Liver. 1996;16 (4): 267-270. Liver (abstract) - doi:10.1111/j.1600-0676.1996.tb00741.x
- 2. Gilmore IT, Burroughs A, Murray-Lyon IM et-al. Indications, methods, and outcomes of percutaneous liver biopsy in England and Wales: an audit by the British Society of Gastroenterology and the Royal College of Physicians of London. Gut. 1995;36 (3): 437-41. Free text at pubmed - Pubmed citation
- 3. Walker TG. Interventional Procedures. Lippincott Williams & Wilkins. (2012) ISBN:1931884862. Read it at Google Books - Find it at Amazon
- 4. Zurcher K, Sugi MD, Naidu SG, Oklu R, Knuttinen G, Alzubaidi S, Eversman W, Dahiya N, Young SW, Kriegshauser JS. Multimodality Imaging Techniques for Performing Challenging Core Biopsies. (2020) Radiographics : a review publication of the Radiological Society of North America, Inc. 40 (3): 910-911. doi:10.1148/rg.2020190104 - Pubmed