Percutaneous Biopsy for Small Lymphadenopathy Around the Abdominal Aorta and Inferior Vena Cava Using the Modified Coaxial Technique Under CT Guidance

ABSTRACT

PURPOSE: The author wanted to report the accuracy and safety of performing percutaneous biopsy of a small lymphadenopathy around the abdominal aorta and inferior vena cava (IVC) with using the modified coaxial technique (MCT) under CT guidance. MATERIALS AND METHODS: Thirty-six cases of CT-guided biopsy using MCT were performed in 35 patients (15 men and 20 women, aged 21-80 years, mean age 56.5 years), who had small lymphadenopathy around the abdominal aorta and IVC. The maximum diameters of the target nodes were 11-20 mm in 21 cases, 21-30 mm in 14 cases and 31-40 mm in 1 case (mean diameter 19.8 mm). The locations of the target lesions were the left or posterior side of the aorta (n=22), between the aorta and IVC (n=7), and the right or posterior side of the IVC (n=7). Using the modified coaxial technique, a guiding cannula was introduced precisely to the border of the target lesion. Fine needle aspiration biopsy was performed through the cannula and this was followed by multiple core biopsies (6-8 cores) using an automated biopsy gun. The pathologic results and complications were reviewed. The clinical course after biopsy and the histopathologic diagnosis were reviewed by following up the medical records. RESULTS: From examining the 36 biopsies, a definitive pathologic diagnosis was made in 33 cases (92%). The etiologies were as follows; 16 (44%) metastatic tumors, 11 (31%) lymphomas and 6 cases (17%) of tuberculosis with positive acid-fast bacilli (AFB). Two cases were reported as chronic granulomatous inflammation due to suspected tuberculosis, and they were treated with tuberculosis medication. One case was reported as chronic inflammation and so re-biopsy was performed; this resulted in the diagnosis of tuberculosis with positive AFB. Serious complications such as rupture of major vessels or bowel perforation did not occur. CONCLUSION: It is considered that performing percutaneous biopsy for small lymphadenopathy around the abdominal aorta and IVC with using the modified coaxial technique under CT guidance is an accurate and safe procedure.