Imaging-guided percutaneous biopsy of focal splenic lesions: Update on safety and effectiveness

OBJECTIVE. The purpose of this study is to determine the safety and effecti veness of percutaneous imaging-guided biopsy in the diagnosis of focal sple nic lesions. MATERIALS AND METHODS, From May 1995 to November 1997, 20 imaging-guided bi opsies of focal splenic lesions were performed in 18 patients, including se ven patients with a prior diagnosis of extrasplenic malignancy (breast canc er, n = 3; lymphoma, n = 2; ovarian cancer, n = 1; and osteogenic sarcoma, n = 1), three immunosuppressed patients (cause of immunosuppression: AIDS, n = 1; liver transplantation, n = 1; and bone marrow transplantation, n = 1 ), two patients with anemia, one patient with a recent history of IV drug a buse, and five patients with incidentally discovered splenic lesions. Biops ies were performed with an 18-gauge (n = 1), a 20-gauge (n = 8), or a 22-ga uge (n = 14) self-aspirating needle or an 18-gauge cutting needle (n = 1). Biopsies were considered successful if a specific diagnosis of benign or ma lignant disease was made. RESULTS. A specific diagnosis was made in 16 (88.9%) of 18 patients, and no complications occurred. Malignancy was diagnosed in six patients including three patients with lymphoma. Benign conditions were diagnosed in 10 patie nts: a cyst in two patients, hamartoma in one; lipogranuloma in one; infarc t in one; and infection in four, including one case each of Candida albican s, Pneumocystis carinii, Mycobacterium tuberculosis, and mixed flora. The t enth benign diagnosis was a pseudotumor of the spleen related to a bulbous tail of the pancreas that was inseparable from the splenic hilum. Biopsy di d not establish a diagnosis in one patient with lymphoma and in one patient with presumed splenic candidiasis. A mean of 1.5 needle passes was made pe r biopsy. CONCLUSION. Imaging-guided splenic biopsy is a safe technique that provides a specific diagnosis in most patients with focal splenic lesions.