Ultrasound-guided Fine-needle Aspirate and Biopsy Technique
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Transcript of Ultrasound-guided Fine-needle Aspirate and Biopsy Technique
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Ultrasound-guidedUltrasound-guided
fine-needle aspirate andfine-needle aspirate andbiopsy techniquebiopsy technique
Copyright © 2010 The Academy of Veterinary maging
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The Academy of Veterinary ImagingThe Academy of Veterinary Imaging2409 Avenue J, Suite C
Arlington, TX !00!"#00$ 2!#%&'&4 o(t 4
)))*+oundelin*com-academy%of%imaging
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ntroductionntroduction
This presentation describes the methods to use as !ell as other
factors to consider !hen performing an ultrasound-guided fine-
needle aspirate "#$A% or core biopsy& The scanning planes used
for #$A and core biopsy are the same& The technique 'aries
some!hat( and the differences are demonstrated& Animation isused to demonstrate the aspirate)biopsy techniques& *lease
note that this animation !ill not run properly !ith older 'ersions
of *o!er*oint or *o!er*oint 'ie!er&
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+irections+irections
n this presentation select the appropriate button on the homepage to see the described information& The for!ard arro! button
!ill ta,e you to the net topic& The bac, arro! !ill ta,e you to
the prior topic& The .home/ button !ill ta,e you to the home
page( and the .i/ button !ill ta,e you to the title page&
ou may 'ie! the animation of each procedure up to three times
before ha'ing to reset "eit% the presentation& elect a button
!ith under the procedure you !ould li,e to 'ie! to run the
animation& f there are no more buttons seen( you !ill need to
reset the presentation to 'ie! that procedure again& To reset the
presentation( either press .scape/ on you computer( or selectthe appropriate button on the home page&
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ndications
Accuracy
3aterials
Animal
preparation
Ultrasound-guided #$A and biopsyUltrasound-guided #$A and biopsy
techniquetechnique
*robe orientation
uperficial lesion
+eep lesion3ethod
creen orientation
4eferences
4oc,)slide the probe
5eep needle in
plane of beam
3ethod details6
4eset "eit% program
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ndicationsndications
There are many indications for ultrasound-guided aspirates and
biopsies as there are essentially no pathognomonic lesions in
ultrasound& 3ost of the time a cytologic or histopathologic
sample is needed to ma,e a definiti'e diagnosis& amples for
cytology and histopathology may obtained !ith ultrasound-
guided( laparoscopic and surgical procedures&
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ndicationsndications
cterus)li'er en7yme ele'ation)ele'ated bile acids
plenomegaly#ocal nodules or masses any!here
4enal disease sometimes "i&e& renal dysplasia( renal masses(
lymphosarcoma suspects%
*rostatomegaly
#ree abdominal fluidCysts
8ymphadenopathy
U) guided #$A)biopsies generally not done on6
Adrenal glandsTransitional cell carcinoma suspect masses
Chronic renal failure( glomerulonephritis
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AccuracyAccuracy
Currently there is a lac, of consensus about the
accuracy of ultrasound-guided fine needle aspirates
and biopsies compared to surgical or post mortem
biopsy sample results& ome studies report high
accuracy( others( lo! accuracy& The differential
diagnosis and case presentation both should be
considered !hen determining the best method of
obtaining a cytology or histopathology sample&
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Animal preparationAnimal preparation
• Coagulation concerns6
• A physical eamination should be done to assess e'idence of acoagulopathy( and if one is suspected( no aspirate or biopsy is
recommended&• The pre-biopsy hematocrit should be ,no!n&• At least a platelet count is recommended before a fine-needle
aspirate is done&• *erform a buccal mucosal bleeding time if i&e& 'on 9illebrand/s
disease( or other disorders of primary coagulation are
suspected&• A platelet count as !ell as coagulation profile
"*T( a*TT and)or *V5A% are recommended before a core biopsy
is done&• edation)brief anesthesia may be indicated&• *repare a sterile field
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Coagulation testsCoagulation tests
• *T : *rothrombin time• *TT : *artial thromboplastin time• *V5A : *roteins induced by 'itamin 5 antagonism
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3aterials3aterials
• ;iopsy guide or not• 22-< 1&= inch >cysto/ needle or 22-< ?&= inch spinal needle is
often used for fine-needle aspirates&•
Attach needle to etension set then syringe for easierhandling
• 1@-< to 1-< core biopsy needles• ;ardB automatic biopsy needles
• ne hand to trigger • #or!ard .thro!D 'aries from 11 to 22 mm• rder from ound Technologies or other distributors
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3ethod3ethod
• ;iopsy guide or freehand• Thic,ness of beam is 1-2 mm• 3ust ,eep needle in plane of beam "biopsy guide !ould do this
for you%• hortest distance)safest path!ay•
>e!ing-machineD motion for fine-needle .aspirates/• tab incision in s,in before doing a core biopsy• ample preparation and e'aluation6• pray aspirates carefully on the slide• mear gently( dry rapidly• Vie! representati'e slide before submitting• *lace core biopsy samples in cassette( pouch or lens paper • *ic, pathologist carefully
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*robe orientation*robe orientation
4eference
mar,er correspondsto left side of screen
"see
creen rientation
slide%
*robe
,in
chematic of the
resulting ultrasound
image
uperficial >lesionD
to biopsy
+eep >lesionD
to biopsy
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4eference
mar,er
$ear field
#ar field
pposite
reference
mar,er
creen orientationcreen orientation
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4oc, and)or slide the probe4oc, and)or slide the probe
to line up the lesionto line up the lesion
to a >reachableD positionto a >reachableD position
+eep lesion needs
to be lined up
to!ard the edge of
the beam
uperficial lesion
can be to!ard the edge
or in the center
of the beam
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5eep needle in the same plane5eep needle in the same plane
as the beamas the beam
ee rotated 'ie!s
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5eep needle in the same plane as the beam65eep needle in the same plane as the beam6
4otated 'ie!s of the4otated 'ie!s of the
probe)beam)biopsy planeprobe)beam)biopsy plane
$eedle is placed in the plane of the beam
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Angle to use for a superficial lesion6Angle to use for a superficial lesion6
Aim needle more perpendicular to beamAim needle more perpendicular to beam
#$A6
Core biopsy6
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uperficial lesion #$Auperficial lesion #$A
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uperficial lesion #$Auperficial lesion #$A
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uperficial lesion #$Auperficial lesion #$A
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uperficial lesion #$Auperficial lesion #$A
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uperficial lesion #$Auperficial lesion #$A
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uperficial lesion #$Auperficial lesion #$A
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uperficial lesion #$Auperficial lesion #$A
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uperficial lesion #$Auperficial lesion #$A
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uperficial lesion #$Auperficial lesion #$A
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uperficial lesion core biopsyuperficial lesion core biopsy
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uperficial lesion core biopsyuperficial lesion core biopsy
Ta,e biopsy
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uperficial lesion core biopsyuperficial lesion core biopsy
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uperficial lesion core biopsyuperficial lesion core biopsy
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uperficial lesion core biopsyuperficial lesion core biopsy
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uperficial lesion core biopsyuperficial lesion core biopsy
Ta,e biopsy
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uperficial lesion core biopsyuperficial lesion core biopsy
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uperficial lesion core biopsyuperficial lesion core biopsy
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uperficial lesion core biopsyuperficial lesion core biopsy
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uperficial lesion core biopsyuperficial lesion core biopsy
Ta,e biopsy
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uperficial lesion core biopsyuperficial lesion core biopsy
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uperficial lesion core biopsyuperficial lesion core biopsy
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Angle to use for a deep lesion6Angle to use for a deep lesion6
Aim needle more parallel to beamAim needle more parallel to beam
#$A6
Core biopsy6
+ l i #$A
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+eep lesion #$A+eep lesion #$A
+ l i #$A
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+eep lesion #$A+eep lesion #$A
+ l i #$A+ l i #$A
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+eep lesion #$A+eep lesion #$A
+ l i #$A+ l i #$A
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+eep lesion #$A+eep lesion #$A
+ l i #$A+ l i #$A
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+eep lesion #$A+eep lesion #$A
+ l i #$A+ l i #$A
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+eep lesion #$A+eep lesion #$A
+ l i #$A+ l i #$A
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+eep lesion #$A+eep lesion #$A
+ l i #$A+ l i #$A
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+eep lesion #$A+eep lesion #$A
+ l i #$A+ l i #$A
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+eep lesion #$A+eep lesion #$A
+ l i+eep lesion
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+eep lesion+eep lesion
core biopsycore biopsy
+ l i+eep lesion
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+eep lesion+eep lesion
core biopsycore biopsy
Ta,e biopsy
+eep lesion+eep lesion
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+eep lesion+eep lesion
core biopsycore biopsy
+eep lesion+eep lesion
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+eep lesion+eep lesion
core biopsycore biopsy
+eep lesion+eep lesion
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+eep lesion+eep lesion
core biopsycore biopsy
+eep lesion+eep lesion
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+eep lesion+eep lesion
core biopsycore biopsy
+eep lesion+eep lesion
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+eep lesion+eep lesion
core biopsycore biopsy
Ta,e biopsy
+eep lesion+eep lesion
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+eep lesion+eep lesion
core biopsycore biopsy
+eep lesion+eep lesion
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+eep lesion+eep lesion
core biopsycore biopsy
+eep lesion+eep lesion
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+eep lesion+eep lesion
core biopsycore biopsy
+eep lesion+eep lesion
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+eep lesion+eep lesion
core biopsycore biopsy
+eep lesion+eep lesion
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+eep lesion+eep lesion
core biopsycore biopsy
Ta,e biopsy
+eep lesion+eep lesion
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+eep lesion+eep lesion
core biopsycore biopsy
+eep lesion+eep lesion
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+eep lesion+eep lesion
core biopsycore biopsy
+eep lesion+eep lesion
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+eep lesion+eep lesion
core biopsycore biopsy
4eferences4eferences
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4eferences4eferences
•
#ife 9+ "200=% Abdominal ultrasound6 Aspirations andbiopsies( In ttinger E( #eldman C "eds%( Tetboo, of
Veterinary nternal 3edicine( Fth edition( t& 8ouis( lse'ier
aunders( pp& 2G1-2G=&
• $yland T<( 3attoon E( Herrgesell E( 9isner 4 "2002%
Ultrasound-guided biopsy( In $yland T<( 3attoon E "eds%( mall
Animal +iagnostic Ultrasound( *hiladelphia( 9; aunders( Co&(
pp& ?0-@&