Ultrasound-guided Fine-needle Aspirate and Biopsy Technique

7/26/2019 Ultrasound-guided Fine-needle Aspirate and Biopsy Technique

http://slidepdf.com/reader/full/ultrasound-guided-fine-needle-aspirate-and-biopsy-technique 1/65

Ultrasound-guidedUltrasound-guided

fine-needle aspirate andfine-needle aspirate andbiopsy techniquebiopsy technique

Copyright © 2010 The Academy of Veterinary maging



The Academy of Veterinary ImagingThe Academy of Veterinary Imaging2409 Avenue J, Suite C

Arlington, TX !00!"#00$ 2!#%&'&4 o(t 4

)))*+oundelin*com-academy%of%imaging

http://www.soundeklin.com/academy-of-imaging





ntroductionntroduction

This presentation describes the methods to use as !ell as other

factors to consider !hen performing an ultrasound-guided fine-

needle aspirate "#$A% or core biopsy& The scanning planes used

for #$A and core biopsy are the same& The technique 'aries

some!hat( and the differences are demonstrated& Animation isused to demonstrate the aspirate)biopsy techniques& *lease

note that this animation !ill not run properly !ith older 'ersions

of *o!er*oint or *o!er*oint 'ie!er&



+irections+irections

n this presentation select the appropriate button on the homepage to see the described information& The for!ard arro! button

!ill ta,e you to the net topic& The bac, arro! !ill ta,e you to

the prior topic& The .home/ button !ill ta,e you to the home

page( and the .i/ button !ill ta,e you to the title page&

ou may 'ie! the animation of each procedure up to three times

before ha'ing to reset "eit% the presentation& elect a button

!ith under the procedure you !ould li,e to 'ie! to run the

animation& f there are no more buttons seen( you !ill need to

reset the presentation to 'ie! that procedure again& To reset the

presentation( either press .scape/ on you computer( or selectthe appropriate button on the home page&



ndications

Accuracy

3aterials

Animal

preparation

Ultrasound-guided #$A and biopsyUltrasound-guided #$A and biopsy

techniquetechnique

*robe orientation

uperficial lesion

+eep lesion3ethod

creen orientation

4eferences

4oc,)slide the probe

5eep needle in

plane of beam

3ethod details6

4eset "eit% program



ndicationsndications

There are many indications for ultrasound-guided aspirates and

biopsies as there are essentially no pathognomonic lesions in

ultrasound& 3ost of the time a cytologic or histopathologic

sample is needed to ma,e a definiti'e diagnosis& amples for

cytology and histopathology may obtained !ith ultrasound-

guided( laparoscopic and surgical procedures&



ndicationsndications

cterus)li'er en7yme ele'ation)ele'ated bile acids

plenomegaly#ocal nodules or masses any!here

4enal disease sometimes "i&e& renal dysplasia( renal masses(

lymphosarcoma suspects%

*rostatomegaly

#ree abdominal fluidCysts

8ymphadenopathy

U) guided #$A)biopsies generally not done on6

Adrenal glandsTransitional cell carcinoma suspect masses

Chronic renal failure( glomerulonephritis



AccuracyAccuracy

Currently there is a lac, of consensus about the

accuracy of ultrasound-guided fine needle aspirates

and biopsies compared to surgical or post mortem

biopsy sample results& ome studies report high

accuracy( others( lo! accuracy& The differential

diagnosis and case presentation both should be

considered !hen determining the best method of

obtaining a cytology or histopathology sample&



Animal preparationAnimal preparation

• Coagulation concerns6

• A physical eamination should be done to assess e'idence of acoagulopathy( and if one is suspected( no aspirate or biopsy is

recommended&• The pre-biopsy hematocrit should be ,no!n&• At least a platelet count is recommended before a fine-needle

aspirate is done&• *erform a buccal mucosal bleeding time if i&e& 'on 9illebrand/s

disease( or other disorders of primary coagulation are

suspected&• A platelet count as !ell as coagulation profile

"*T( a*TT and)or *V5A% are recommended before a core biopsy

is done&• edation)brief anesthesia may be indicated&• *repare a sterile field



Coagulation testsCoagulation tests

• *T : *rothrombin time• *TT : *artial thromboplastin time• *V5A : *roteins induced by 'itamin 5 antagonism



3aterials3aterials

• ;iopsy guide or not• 22-< 1&= inch >cysto/ needle or 22-< ?&= inch spinal needle is

often used for fine-needle aspirates&•

Attach needle to etension set then syringe for easierhandling

• 1@-< to 1-< core biopsy needles• ;ardB automatic biopsy needles

• ne hand to trigger • #or!ard .thro!D 'aries from 11 to 22 mm• rder from ound Technologies or other distributors



3ethod3ethod

• ;iopsy guide or freehand• Thic,ness of beam is 1-2 mm• 3ust ,eep needle in plane of beam "biopsy guide !ould do this

for you%• hortest distance)safest path!ay•

>e!ing-machineD motion for fine-needle .aspirates/• tab incision in s,in before doing a core biopsy• ample preparation and e'aluation6• pray aspirates carefully on the slide• mear gently( dry rapidly• Vie! representati'e slide before submitting• *lace core biopsy samples in cassette( pouch or lens paper • *ic, pathologist carefully



*robe orientation*robe orientation

4eference

mar,er correspondsto left side of screen

"see

creen rientation

slide%

*robe

,in

chematic of the

resulting ultrasound

image

uperficial >lesionD

to biopsy

+eep >lesionD

to biopsy



4eference

mar,er

$ear field

#ar field

pposite

reference

mar,er

creen orientationcreen orientation



4oc, and)or slide the probe4oc, and)or slide the probe

to line up the lesionto line up the lesion

to a >reachableD positionto a >reachableD position

+eep lesion needs

to be lined up

to!ard the edge of

the beam

uperficial lesion

can be to!ard the edge

or in the center

of the beam



5eep needle in the same plane5eep needle in the same plane

as the beamas the beam

ee rotated 'ie!s



5eep needle in the same plane as the beam65eep needle in the same plane as the beam6

4otated 'ie!s of the4otated 'ie!s of the

probe)beam)biopsy planeprobe)beam)biopsy plane

$eedle is placed in the plane of the beam



Angle to use for a superficial lesion6Angle to use for a superficial lesion6

Aim needle more perpendicular to beamAim needle more perpendicular to beam

#$A6

Core biopsy6



uperficial lesion #$Auperficial lesion #$A



























uperficial lesion core biopsyuperficial lesion core biopsy




Ta,e biopsy













Ta,e biopsy













Ta,e biopsy









Angle to use for a deep lesion6Angle to use for a deep lesion6

Aim needle more parallel to beamAim needle more parallel to beam

#$A6

Core biopsy6

+ l i #$A



+eep lesion #$A+eep lesion #$A

+ l i #$A




+ l i #$A+ l i #$A




+ l i #$A+ l i #$A




+ l i #$A+ l i #$A




+ l i #$A+ l i #$A




+ l i #$A+ l i #$A




+ l i #$A+ l i #$A




+ l i #$A+ l i #$A




+ l i+eep lesion



+eep lesion+eep lesion

core biopsycore biopsy

+ l i+eep lesion





Ta,e biopsy


























Ta,e biopsy


























Ta,e biopsy
















4eferences4eferences



4eferences4eferences

•

#ife 9+ "200=% Abdominal ultrasound6 Aspirations andbiopsies( In ttinger E( #eldman C "eds%( Tetboo, of

Veterinary nternal 3edicine( Fth edition( t& 8ouis( lse'ier

aunders( pp& 2G1-2G=&

• $yland T<( 3attoon E( Herrgesell E( 9isner 4 "2002%

Ultrasound-guided biopsy( In $yland T<( 3attoon E "eds%( mall

Animal +iagnostic Ultrasound( *hiladelphia( 9; aunders( Co&(

pp& ?0-@&

Documents

Ultrasound-guided Fine-needle Aspirate and Biopsy Technique