CT-guided biopsies of unspecified suspect intrahepatic lesions: pre-procedure Lipiodol-marking improves the biopsy success rate

Lipiodol-marking improves biopsy success in CT-guided liver biopsy

Abstract

Background

While CT-guided liver biopsies are commonly performed using unenhanced images, contrast-enhanced images are beneficial for challenging puncture pathways and lesion locations. This study aimed to evaluate the accuracy of CT-guided biopsies for intrahepatic lesions using unenhanced, intravenous-enhanced, or intra-arterial Lipiodol-marked CT for lesion marking.

Patients and methods

607 patients (men: 358 [59.0%], mean age 61 years; SD ±12.04) with suspect hepatic lesions and CT-guided liver biopsies were retrospectively evaluated. Successful biopsies were defined as histopathological findings other than typical liver tissue or non-specific findings. Data was ascertained regarding the use of contrast media for the biopsy-planning CT, unenhanced (group 1) vs. Lipiodol (group 2) vs. intravenous contrast (group 3). Technical success and influencing factors were insulated. Complications were noted. Statistical analysis of the results was performed using the Wilcoxon-Man-Whitney t-test, Chi-square test, and Spearman-Rho.

Results

Overall lesion hitting rate was 72.7% with significantly better rates using Lipiodol-marked lesions (78.6%) compared to group 1 (73.2%) and group 3 (65.2%) (p=0.038). Smaller lesions (<20 mm diameter) benefited significantly from Lipiodol-marking with 71.2% successful biopsy compared to group 1 (47.7%) and group 3 (65.5%) (p=0.021). Liver cirrhosis (p=0.94) and entity of parenchymal lesions (p=0.78) had no impact on the hitting rate between the groups. No major complications occurred during the interventions.

Conclusion

Pre-biopsy Lipiodol marking of suspect hepatic lesions significantly increases the lesion hitting rate and is especially beneficial for biopsy of smaller targets below 20 mm diameter. Target lesion entity has no impact on the hitting rate.