Keywords:
Cancer, Complications, Biopsy, CT, Liver, Interventional non-vascular, Abdomen
Authors:
D. Stefanou1, A. Hopkins1, C. Cambakis1, E. Lazaridou2, D. Exarhos1; 1ATHENS/GR, 2Holargos-Attiki/GR
DOI:
10.26044/ecr2019/C-1899
Results
Out of 16 patients,
3 patients had sever ascites,
1 had hemorrhagic sever ascites ,4 had moderate and 8 had slight (6 free/ 2 encapsulated).
The patients with severe ascites had evacuation of the ascitic fluid by an interventional radiologist placing an arrow catheter under ultrasound guidance and the patients with moderate ascites had aspiration of the ascitic fluid without placing any catheter by a 4mm needle.
8 patients with slight ascites did not undergo a pre biopsy evacuation.
All our patients tolerated the biopsy well and no major complications were noticed,
despite the presence of ascites.
The presence of ascites,
however is regarded by many as a minor-major contraindication of performing a percutaneous liver biopsy,
while from a practical standpoint it is more difficult and demanding to approach the liver via the standard intercostal approach in patients with moderate or severe ascites,
as well as it is thought to decrease the tamponade effect from the proximal abdominal wall and the coagulation mechanisms making the liver more susceptible to uncontrolled bleeding [2,3,4].
Major complications are considered those that need extensive medical therapy ( blood transfusion) or surgery.
Minor complications include hypotension,
moderate fall in haematocrit ( a decrease of 3-8.5 ml/dl) and prolonged pain (over 6 hours post biopsy uncontrolled by medication).
In our series,
only one patient due to prolonged pain underwent ultrasound scan 8 hours post biopsy,
which did not report any signs of laceration,
sub capsular hematoma,
increase on the amount of the ascitic fluid or alteration of the type (e.g haemorrhagic) .
18/19 patients complained about pain at the area of needle point,
which was controlled by medication the first 4 hours post biopsy.
The histological outcome was conclusive for 16/16 patients,
100% success rate,
( 10/16 HCC,
1/16 sclerosing cholangitis,
1/16 possible hepatic adenoma and 4/16 gastrointestinal metastasis).