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U/S biopsies

Hello and Happy New Year to all of you !

In regards to sampling liver was wondering what is the trend inbetween sonographers . Is majority of you still do tru-cut biopsies ( when indicated) or moving more towards surgical biospies ? I ve spoke with few pathologist in my areea and they do prefer surgical obtained samples (larger liver samples with more triads, etc) . From my understanding is that good sample biospies obtained with tru-cut devices are also operator dependent. Another issue in our areea is that there were few cases of bleeding that needed to be transfered for blood transfusion/ monitoring in a 24 h facility, which ussualy doesn’t happen with/after laparatomy/sx liver biopsy procedure 

Just currious what other people are doing

 

Thank you

CMSvishal

6 responses to “U/S biopsies”

  1. FNA for cells and core bx for structure… many complicating scenarios/bleeds non monioted patients that have post sampling death done by others has clouded perceptions in certain regions. Since having implemented telecytology and having found a solid cytologist that puts meat on the diagnistic bone then the need for Bx diminishes with the quality of cyto sample and quality of read.

    2-3 core liver biopsies in a fibrosing liver case is usually more than adequate to get the dx and do quanitative copper if its a young dog as old dogs dont get primary copper storage as they fail earlier.

    I do a lot less core bx than I used to but this isn’t from lack if quality but because our cyto has gotten so much better and sometimes its ecoomical restraint for bx costs vs fna.

    Core bx bleeds happen if technioque is poor (hit a vessel i.e), the pathology is mushy like a lipidotic or necrosing lesion and the sample is not targeting a bridge between normal and abnormal which is where the dx is, and if coags are off and vonwillebrands is in play.

    The USG bx vs sx or laparospcopy controversy has been in play swaying back and forth since i picked up a probe. Remember surgeons will not see lesions that are not on the serosal surface of the organ and same for laparascopes. So if a liver nodule is deep or the intestinal lesion is muscularis, submucosal or mucosal based they won’t see it. I never hear the sx bx people address this but they tend to look perplexed when posed this question. However, Intraoperative ultrasound with surgical bx solves this which is where working together with dual modalities is always the best option.

    Side note we are working on a study with a bx device that is showing great promise that is a half way between cyto and core bx. Stay tuned… but in the meantime shop for your solid cytologist or two that want to give the dx and don’t just default to bx as an indivudal rule or a hidden unwritten corporate rule. Have a ouple that you can go to and send to dircetly. It will take the politics out of the scenario.

  2. That is great advice. Thank you for explaining . Looking forward for the new device. But just wondering, if the main isue with core biopsies is sample size, liver tissue/ nr of triads would a smaller core biopsy device be even more challanging in terms of sample size/ dg quality? Or bigger needle more cells, even tissue. I was wondering how much better a 20 gauge sanple would be and if it s worth the risk? 

  4. I have a downloadable lecture on sampling will add the link here in a bit that will help as the conversaition is long and layered on accurate sampling.

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