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Ultrasound-guided fine-needle aspirate and biopsy technique

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Presentation on theme: "Ultrasound-guided fine-needle aspirate and biopsy technique"— Presentation transcript:

1 Ultrasound-guided fine-needle aspirate and biopsy technique
Copyright © 2010 The Academy of Veterinary Imaging

2 The Academy of Veterinary Imaging
2409 Avenue J, Suite C Arlington, TX (800) opt 4

3 Introduction This presentation describes the methods to use as well as other factors to consider when performing an ultrasound-guided fine-needle aspirate (FNA) or core biopsy. The scanning planes used for FNA and core biopsy are the same. The technique varies somewhat, and the differences are demonstrated. Animation is used to demonstrate the aspirate/biopsy techniques. Please note that this animation will not run properly with older versions of PowerPoint or PowerPoint viewer.

4 Directions In this presentation select the appropriate button on the home page to see the described information. The forward arrow button will take you to the next topic. The back arrow will take you to the prior topic. The ‘home’ button will take you to the home page, and the ‘i’ button will take you to the title page. You may view the animation of each procedure up to three times before having to reset (exit) the presentation. Select a button with under the procedure you would like to view to run the animation. If there are no more buttons seen, you will need to reset the presentation to view that procedure again. To reset the presentation, either press ‘Escape’ on you computer, or select the appropriate button on the home page.

5 Ultrasound-guided FNA and biopsy
technique Indications Method details: Rock/slide the probe Accuracy Keep needle in plane of beam Probe orientation Animal preparation Screen orientation Superficial lesion Materials Deep lesion Reset (exit) program Method References

6 Indications There are many indications for ultrasound-guided aspirates and biopsies as there are essentially no pathognomonic lesions in ultrasound. Most of the time a cytologic or histopathologic sample is needed to make a definitive diagnosis. Samples for cytology and histopathology may obtained with ultrasound-guided, laparoscopic and surgical procedures.

7 Indications Icterus/liver enzyme elevation/elevated bile acids
Splenomegaly Focal nodules or masses anywhere Renal disease sometimes (i.e. renal dysplasia, renal masses, lymphosarcoma suspects) Prostatomegaly Free abdominal fluid Cysts Lymphadenopathy U/S guided FNA/biopsies generally not done on: Adrenal glands Transitional cell carcinoma suspect masses Chronic renal failure, glomerulonephritis

8 Accuracy Currently there is a lack of consensus about the accuracy of ultrasound-guided fine needle aspirates and biopsies compared to surgical or post mortem biopsy sample results. Some studies report high accuracy, others, low accuracy. The differential diagnosis and case presentation both should be considered when determining the best method of obtaining a cytology or histopathology sample.

9 Animal preparation Coagulation concerns:
A physical examination should be done to assess evidence of a coagulopathy, and if one is suspected, no aspirate or biopsy is recommended. The pre-biopsy hematocrit should be known. At least a platelet count is recommended before a fine-needle aspirate is done. Perform a buccal mucosal bleeding time if i.e. von Willebrand’s disease, or other disorders of primary coagulation are suspected. A platelet count as well as coagulation profile (PT, aPTT and/or PIVKA) are recommended before a core biopsy is done. Sedation/brief anesthesia may be indicated. Prepare a sterile field

10 Coagulation tests PT = Prothrombin time
PTT = Partial thromboplastin time PIVKA = Proteins induced by vitamin K antagonism

11 Materials Biopsy guide or not
22-G 1.5 inch “cysto’ needle or 22-G 3.5 inch spinal needle is often used for fine-needle aspirates. Attach needle to extension set then syringe for easier handling 14-G to 18-G core biopsy needles Bard® automatic biopsy needles One hand to trigger Forward ‘throw” varies from 11 to 22 mm Order from Sound Technologies or other distributors

12 Method Biopsy guide or freehand Thickness of beam is 1-2 mm
Must keep needle in plane of beam (biopsy guide would do this for you) Shortest distance/safest pathway “Sewing-machine” motion for fine-needle ‘aspirates’ Stab incision in skin before doing a core biopsy Sample preparation and evaluation: Spray aspirates carefully on the slide Smear gently, dry rapidly View representative slide before submitting Place core biopsy samples in cassette, pouch or lens paper Pick pathologist carefully

13 Probe orientation Reference marker corresponds to left side of screen
(see Screen Orientation slide) Probe Skin Schematic of the resulting ultrasound image Superficial “lesion” to biopsy Deep “lesion” to biopsy

14 Screen orientation Near field Opposite reference marker
Far field

15 Rock and/or slide the probe to a “reachable” position
to line up the lesion to a “reachable” position Superficial lesion can be toward the edge or in the center of the beam Deep lesion needs to be lined up toward the edge of the beam

16 Keep needle in the same plane
as the beam See rotated views

17 Keep needle in the same plane as the beam: Rotated views of the
probe/beam/biopsy plane Needle is placed in the plane of the beam

18 Angle to use for a superficial lesion:
Aim needle more perpendicular to beam FNA: Core biopsy:

19 Superficial lesion FNA

20 Superficial lesion FNA

21 Superficial lesion FNA

22 Superficial lesion FNA

23 Superficial lesion FNA

24 Superficial lesion FNA

25 Superficial lesion FNA

26 Superficial lesion FNA

27 Superficial lesion FNA

28 Superficial lesion core biopsy

29 Superficial lesion core biopsy
Take biopsy

30 Superficial lesion core biopsy

31 Superficial lesion core biopsy

32 Superficial lesion core biopsy

33 Superficial lesion core biopsy
Take biopsy

34 Superficial lesion core biopsy

35 Superficial lesion core biopsy

36 Superficial lesion core biopsy

37 Superficial lesion core biopsy
Take biopsy

38 Superficial lesion core biopsy

39 Superficial lesion core biopsy

40 Angle to use for a deep lesion: Aim needle more parallel to beam
FNA: Core biopsy:

41 Deep lesion FNA

42 Deep lesion FNA

43 Deep lesion FNA

44 Deep lesion FNA

45 Deep lesion FNA

46 Deep lesion FNA

47 Deep lesion FNA

48 Deep lesion FNA

49 Deep lesion FNA

50 Deep lesion core biopsy

51 Deep lesion core biopsy
Take biopsy

52 Deep lesion core biopsy

53 Deep lesion core biopsy

54 Deep lesion core biopsy

55 Deep lesion core biopsy

56 Deep lesion core biopsy
Take biopsy

57 Deep lesion core biopsy

58 Deep lesion core biopsy

59 Deep lesion core biopsy

60 Deep lesion core biopsy

61 Deep lesion core biopsy
Take biopsy

62 Deep lesion core biopsy

63 Deep lesion core biopsy

64 Deep lesion core biopsy

65 References Fife WD (2005) Abdominal ultrasound: Aspirations and biopsies, In Ettinger SJ, Feldman EC (eds), Textbook of Veterinary Internal Medicine, 6th edition, St. Louis, Elsevier Saunders, pp Nyland TG, Mattoon JS, Herrgesell EJ, Wisner ER (2002) Ultrasound-guided biopsy, In Nyland TG, Mattoon JS (eds), Small Animal Diagnostic Ultrasound, Philadelphia, WB Saunders, Co., pp

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