Selective transitional zone sampling approach versus random biopsy in cases with malignant liver masses: is there any superiority?

BACKGROUND/AIMS: Currently, the diagnostic sensitivity of malignant liver mass biopsies is an important problem in the definitive diagnosis. In this study, we aimed to investigate the role of selective peripheral approach to lesion biopsies for diagnostic sensitivity of liver masses. MATERIALS AND METHODS: Between June 2007 and March 2011, totally 88 patients (50 male, 38 female), referred to our Interventional Radiology Department for sonographically guided Tru-cut biopsies for liver lesions, were examined.All biopsies were performed by an experienced radiologist with an 18-gauge Tru-cut biopsy needle with a spring-loaded biopsy gun under sonographic guidance. We describe two locations (peripheral and central) for liver lesions, with the inner 2/3 part of the mass as central and the outer 1/3 part as peripheral. We obtained biopsy from both of these locations, and samples were transferred to the Pathology Department separately. RESULTS: According to pathological and immunohistochemistry studies, there were 42 hepatocellular carcinomas and 46 metastases. All of the metastatic tumors were stained by cytokeratin (10 lung adenocarcinoma, 15 breast adenocarcinoma, 16 gastrointestinal tract, 4 prostate, and 1 malignant melanoma of these 46 metastases were reported as primary). According to histopathological results, diagnostic sensitivity was 97.7% in peripherally located biopsies and 86.3% in biopsies taken from the center of the masses (p=0.0063). CONCLUSIONS: Selective peripheral biopsy approach in Tru-cut biopsies of liver lesions has better sensitivity rates for histopathologic diagnosis compared to the centrally located and random biopsies.

Sonographic appearance of the normal appendix in children.

PURPOSE: To determine the visualization rate of the appendix in children without appendicitis and investigate factors affecting it. METHODS: Between January 2010 and April 2010, 205 consecutive children (103 boys and 102 girls; mean age: 9 years) without clinical signs of appendicitis were examined by ultrasound (US). The location of appendix was determined. The outer appendiceal diameter with and without compression was measured and the content of the lumen and mural vascularity on color Doppler was determined. The appendix diameter was correlated with age, weight, and height using Pearson correlation. For age, weight, and height, children with a visualized appendix were compared with those in whom the appendix was not visualized using Student's t test. RESULTS: The appendix was visualized in 142 of 205 (69.3%) children. The mean diameters of the appendices without and with compression were 4.2 ± 0.9 mm and 3.5 ± 0.8 mm, respectively, with 53.5% of the appendices in the mid-pelvic location. Appendiceal lumen was empty in 35.2% of children. Only one appendix showed mural vascularity on color Doppler. There was no correlation between the diameter (compressed or noncompressed) of the appendix and age, weight, or height. Mean ± SD age, weight, and height of the children with a visualized appendix (8.6 ± 0.3 years, 29.9 ± 0.9 kg, 127.7 ± 1.7 cm, respectively) were significantly lower than those in children with a nonvisualized appendix (9.8 ± 0.4 years, 36.0 ± 1.8 kg, 134.7 ± 2.5 cm, respectively) (p < 0.05 for all three parameters). CONCLUSION: In the majority of the children, the appendix can be visualized with US. Age, weight, and height affect the visualization rate of the normal appendix.