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Title: Percutaneous Management of Accidentally Retained Foreign Bodies During Image-Guided Non-vascular Procedures: Novel Technique Using a Large-Bore Biopsy System

Abstract

ObjectiveTo describe a novel percutaneous image-guided technique using a large-bore biopsy system to retrieve foreign bodies (FBs) accidentally retained during non-vascular interventional procedures.Materials and MethodsBetween May 2013 and October 2015, five patients underwent percutaneous retrieval of five iatrogenic FBs, including a biopsy needle tip in the femoral head following osteoblastoma biopsy and radiofrequency ablation (RFA); a co-axial needle shaft within a giant desmoid tumour following cryoablation; and three post-vertebroplasty cement tails within paraspinal muscles. All FBs were retrieved immediately following original procedures under local or general anaesthesia, using combined computed tomography (CT) and fluoroscopic guidance. The basic technique involved positioning a 6G trocar sleeve around the FB long axis and co-axially advancing an 8G biopsy needle to retrieve the FB within the biopsy core. Retrospective chart review facilitated analysis of procedures, FBs, technical success, and complications.ResultsMean FB size was 23 mm (range 8–74 mm). Four FBs were located within 10 mm of non-vascular significant anatomic structures. The basic technique was successful in 3 cases; 2 cases required technical modifications including using a stiff guide-wire to facilitate retrieval in the case of the post-cryoablation FB; and using the central mandrin of the 6G trocar to push a cement tract back into an augmented vertebramore » when initial retrieval failed. Overall technical success (FB retrieval or removal to non-hazardous location) was 100 %, with no complications.ConclusionPercutaneous image-guided retrieval of iatrogenic FBs using a large-bore biopsy system is a feasible, safe, effective, and versatile technique, with potential advantages over existing methods.« less

Authors:
;  [1];  [2]; ; ; ; ; ;  [1]
  1. Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France)
  2. Norfolk and Norwich University Hospital, Department of Radiology (United Kingdom)
Publication Date:
OSTI Identifier:
22642490
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 39; Journal Issue: 7; Other Information: Copyright (c) 2016 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ABLATION; ANESTHESIA; BIOPSY; CEMENTS; COMPUTERIZED TOMOGRAPHY; HEAD; IMAGES; MINE SHAFTS; MODIFICATIONS; MUSCLES; NEOPLASMS; PATIENTS; RADIOWAVE RADIATION; REVIEWS; VERTEBRAE

Citation Formats

Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it, Garnon, Julien, E-mail: juleiengarnon@gmail.com, Ramamurthy, Nitin, E-mail: nitin-ramamurthy@hotmail.com, Tsoumakidou, Georgia, E-mail: georgia.tsoumakidou@chru-strasbourg.fr, Caudrelier, Jean, E-mail: jean.caudrelier@chru-strasbourg.fr, Thénint, Marie-Aude, E-mail: marie-aude.thenint@chru-strasbourg.fr, Rao, Pramod, E-mail: pramodrao@me.com, Koch, Guillaume, E-mail: guillaume.koch@chru-strasbourg.fr, and Gangi, Afshin, E-mail: gangi@unistra.fr. Percutaneous Management of Accidentally Retained Foreign Bodies During Image-Guided Non-vascular Procedures: Novel Technique Using a Large-Bore Biopsy System. United States: N. p., 2016. Web. doi:10.1007/S00270-016-1302-9.
Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it, Garnon, Julien, E-mail: juleiengarnon@gmail.com, Ramamurthy, Nitin, E-mail: nitin-ramamurthy@hotmail.com, Tsoumakidou, Georgia, E-mail: georgia.tsoumakidou@chru-strasbourg.fr, Caudrelier, Jean, E-mail: jean.caudrelier@chru-strasbourg.fr, Thénint, Marie-Aude, E-mail: marie-aude.thenint@chru-strasbourg.fr, Rao, Pramod, E-mail: pramodrao@me.com, Koch, Guillaume, E-mail: guillaume.koch@chru-strasbourg.fr, & Gangi, Afshin, E-mail: gangi@unistra.fr. Percutaneous Management of Accidentally Retained Foreign Bodies During Image-Guided Non-vascular Procedures: Novel Technique Using a Large-Bore Biopsy System. United States. doi:10.1007/S00270-016-1302-9.
Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it, Garnon, Julien, E-mail: juleiengarnon@gmail.com, Ramamurthy, Nitin, E-mail: nitin-ramamurthy@hotmail.com, Tsoumakidou, Georgia, E-mail: georgia.tsoumakidou@chru-strasbourg.fr, Caudrelier, Jean, E-mail: jean.caudrelier@chru-strasbourg.fr, Thénint, Marie-Aude, E-mail: marie-aude.thenint@chru-strasbourg.fr, Rao, Pramod, E-mail: pramodrao@me.com, Koch, Guillaume, E-mail: guillaume.koch@chru-strasbourg.fr, and Gangi, Afshin, E-mail: gangi@unistra.fr. 2016. "Percutaneous Management of Accidentally Retained Foreign Bodies During Image-Guided Non-vascular Procedures: Novel Technique Using a Large-Bore Biopsy System". United States. doi:10.1007/S00270-016-1302-9.
@article{osti_22642490,
title = {Percutaneous Management of Accidentally Retained Foreign Bodies During Image-Guided Non-vascular Procedures: Novel Technique Using a Large-Bore Biopsy System},
author = {Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it and Garnon, Julien, E-mail: juleiengarnon@gmail.com and Ramamurthy, Nitin, E-mail: nitin-ramamurthy@hotmail.com and Tsoumakidou, Georgia, E-mail: georgia.tsoumakidou@chru-strasbourg.fr and Caudrelier, Jean, E-mail: jean.caudrelier@chru-strasbourg.fr and Thénint, Marie-Aude, E-mail: marie-aude.thenint@chru-strasbourg.fr and Rao, Pramod, E-mail: pramodrao@me.com and Koch, Guillaume, E-mail: guillaume.koch@chru-strasbourg.fr and Gangi, Afshin, E-mail: gangi@unistra.fr},
abstractNote = {ObjectiveTo describe a novel percutaneous image-guided technique using a large-bore biopsy system to retrieve foreign bodies (FBs) accidentally retained during non-vascular interventional procedures.Materials and MethodsBetween May 2013 and October 2015, five patients underwent percutaneous retrieval of five iatrogenic FBs, including a biopsy needle tip in the femoral head following osteoblastoma biopsy and radiofrequency ablation (RFA); a co-axial needle shaft within a giant desmoid tumour following cryoablation; and three post-vertebroplasty cement tails within paraspinal muscles. All FBs were retrieved immediately following original procedures under local or general anaesthesia, using combined computed tomography (CT) and fluoroscopic guidance. The basic technique involved positioning a 6G trocar sleeve around the FB long axis and co-axially advancing an 8G biopsy needle to retrieve the FB within the biopsy core. Retrospective chart review facilitated analysis of procedures, FBs, technical success, and complications.ResultsMean FB size was 23 mm (range 8–74 mm). Four FBs were located within 10 mm of non-vascular significant anatomic structures. The basic technique was successful in 3 cases; 2 cases required technical modifications including using a stiff guide-wire to facilitate retrieval in the case of the post-cryoablation FB; and using the central mandrin of the 6G trocar to push a cement tract back into an augmented vertebra when initial retrieval failed. Overall technical success (FB retrieval or removal to non-hazardous location) was 100 %, with no complications.ConclusionPercutaneous image-guided retrieval of iatrogenic FBs using a large-bore biopsy system is a feasible, safe, effective, and versatile technique, with potential advantages over existing methods.},
doi = {10.1007/S00270-016-1302-9},
journal = {Cardiovascular and Interventional Radiology},
number = 7,
volume = 39,
place = {United States},
year = 2016,
month = 7
}
  • ObjectiveTo evaluate the diagnostic accuracy and safety of magnetic resonance imaging (MRI)-guided percutaneous biopsy of mediastinal masses performed using a wide-bore high-field scanner.Materials and MethodsThis is a retrospective study of 16 consecutive patients (8 male, 8 female; mean age 74 years) who underwent MRI-guided core needle biopsy of a mediastinal mass between February 2010 and January 2014. Size and location of lesion, approach taken, time for needle placement, overall duration of procedure, and post-procedural complications were evaluated. Technical success rates and correlation with surgical pathology (where available) were assessed.ResultsTarget lesions were located in the anterior (n = 13), middle (n = 2), and posterior mediastinummore » (n = 1), respectively. Mean size was 7.2 cm (range 3.6–11 cm). Average time for needle placement was 9.4 min (range 3–18 min); average duration of entire procedure was 42 min (range 27–62 min). 2–5 core samples were obtained from each lesion (mean 2.6). Technical success rate was 100 %, with specimens successfully obtained in all 16 patients. There were no immediate complications. Histopathology revealed malignancy in 12 cases (4 of which were surgically confirmed), benign lesions in 3 cases (1 of which was false negative following surgical resection), and one inconclusive specimen (treated as inaccurate since repeat CT-guided biopsy demonstrated thymic hyperplasia). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in our study were 92.3, 100, 100, 66.7, and 87.5 %, respectively.ConclusionMRI-guided mediastinal biopsy is a safe procedure with high diagnostic accuracy, which may offer a non-ionizing alternative to CT guidance.« less
  • BackgroundA novel coaxial biopsy system powered by a handheld drill has recently been introduced for percutaneous bone biopsy. This technical note describes our initial experience performing fluoroscopy-guided vertebral body biopsies with this system, compares the yield of drill-assisted biopsy specimens with those obtained using a manual technique, and assesses the histologic adequacy of specimens obtained with drill assistance.MethodsMedical records of all single-level, fluoroscopy-guided vertebral body biopsies were reviewed. Procedural complications were documented according to the Society of Interventional Radiology classification. The total length of bone core obtained from drill-assisted biopsies was compared with that of matched manual biopsies. Pathology reportsmore » were reviewed to determine the histologic adequacy of specimens obtained with drill assistance.ResultsTwenty eight drill-assisted percutaneous vertebral body biopsies met study inclusion criteria. No acute complications were reported. Of the 86 % (24/28) of patients with clinical follow-up, no delayed complications were reported (median follow-up, 28 weeks; range 5–115 weeks). The median total length of bone core obtained from drill-assisted biopsies was 28 mm (range 8–120 mm). This was longer than that obtained from manual biopsies (median, 20 mm; range 5–45 mm; P = 0.03). Crush artifact was present in 11 % (3/28) of drill-assisted biopsy specimens, which in one case (3.6 %; 1/28) precluded definitive diagnosis.ConclusionsA drill-assisted, coaxial biopsy system can be used to safely obtain vertebral body core specimens under fluoroscopic guidance. The higher bone core yield obtained with drill assistance may be offset by the presence of crush artifact.« less
  • Purpose: To compare the accuracy and complication rate of two different CT-guided transthoracic needle biopsy techniques: fine needle aspiration and an automated biopsy device.Methods: Two consecutive series of respectively 125 (group A) and 98 (group B) biopsies performed using 20-22 gauge coaxial fine needle aspiration (group A) and an automated 19.5 gauge coaxial biopsy device (group B) were compared in terms of their accuracy and complication rate.Results: Groups A and B included respectively 100 (80%) and 77 (79%) malignant lesions and 25 (20%) and 18 (21%) benign lesions. No significant difference was found between the two series concerning patients, lesions,more » and procedural variables. For a diagnosis of malignancy, a statistically significant difference in sensitivity was found (82.7% vs 97.4%) between results obtained with the automated biopsy device and fine needle aspiration respectively. For a diagnosis of malignancy, the false negative rate of the biopsy result was significantly higher (p <0.005) in group A (17%) than in group B (2.6%). For a specific diagnosis of benignity, no statistically significant difference was found between the two groups (44% vs 26%) but the automated biopsy device provided fewer indeterminate cases. There was no difference between the two groups concerning the pneumothorax rate, which was 20% in group A and 15% in group B, or the hemoptysis rate, which was 2.4% in group A and 4% in group B.Conclusion: For a diagnosis of malignancy when a cytopathologist is not available on-site, automated biopsy devices provide a lower rate of false negative results and a similar complication rate to fine needle aspiration.« less
  • ObjectiveTo describe a new interventional technique to remove foreign bodies (FBs) embedded in soft tissues around vital vessels.MethodsUnder fluoroscopic guidance and using local anesthesia, percutaneous removal of FBs was performed using forceps in nine patients. All patients suffered from a metallic soft tissue FB located in close proximity to important vessels and one also had a small traumatic pseudoaneurysm adjacent to the FB. Prior to removal of the FB, the position of the nearest vessel was identified using a guide wire or catheter placed into the vessel. Balloon catheter was also simultaneously used to temporarily stop the blood flow ofmore » the nearest artery during the FB removal in three of the nine patients.ResultsAll of the nine FBs with 0–2 mm interval to the nearest vessel were successfully removed in the nine patients without any serious complications. The removed FBs measured 3–12 mm in length and 1–3 mm in width. The total fluoroscopic time of retrieval of each FB was 5–9 min (mean, 6.4 min). The volume of intraoperative bleeding ranged from 5 to 12 ml (mean, 7.5 ml). The length of hospital stay for each patient ranged from 4 to 8 days (mean, 5.5 days).ConclusionVascular intervention-aided percutaneous FB removal is minimally invasive and an effective method for removal of FBs around vital vessels.« less
  • Image-guided percutaneous biopsy is a well-established and safe technique for obtaining tissue specimens from various regions of the body and plays a crucial role in patient management. Improvements in needle designs, development of new biopsy techniques, and continual advances in image-guidance technology have improved the safety and efficacy of the procedure. Lesions previously considered relatively inaccessible can now be safely biopsied. This review looks at the recent technologic developments in image guidance for percutaneous biopsy procedures. Improvements in needle design and other innovations intended to enhance the diagnostic yield of biopsy specimens are briefly discussed. Also described are some newmore » techniques and unconventional approaches that help provide safe access to difficult-to-reach lesions.« less