Percutaneous ultrasound-guided plugged liver biopsy - a single-centre experience.

BACKGROUND: Liver biopsy is a widely used, safe diagnostic tool utilised by clinicians for the histopathological assessment of the liver. Our study aims to report our experience in patients who underwent ultrasound-guided plugged percutaneous liver biopsy in a tertiary care hospital in India. MATERIAL AND METHODS: The Institutional Ethical Review Board approved this retrospective study, and informed consent was obtained from all the patients. A total of 830 liver biopsies were performed between January 2014 and December 2018, of which 782 were plugged percutaneous liver biopsies. The tract was plugged using Gelfoam slurry. Various observations related to the procedures were recorded. RESULTS: Seven hundred and eighty-two were plugged percutaneous liver biopsies, which were performed during the study period. Of the 782 patients, 163 were male, and 619 were female (20.8 % and 79.2 %, respectively), with a mean age of 49.6 ± 2 years (1 month to 86 years). A 100% technical success rate was seen. No immediate major complications were documented in any of the patients who underwent plugged biopsies. No significant complications were seen in any patient. CONCLUSIONS: Percutaneous liver biopsy is an extensively performed diagnostic tool. We found that ultrasound-guided percutaneous plugged liver biopsy is an easy to perform procedure, which is associated with a lower risk of a bleeding complications.

The utility of ultrasound guidance in transjugular liver biopsy: our experience.

PURPOSE: To demonstrate the utility of ultrasound (US) guidance in improving the safety and efficacy of transjugular liver biopsy (TJLB) by analyzing all the TJLBs performed by us in the last 4 years. MATERIALS AND METHODS: Forty-seven patients who underwent TJLB in the last 4 years in our two centers were retrospectively analyzed. US guidance was used for all but for one patient during the two crucial steps of the procedure-for internal jugular vein (IJV) access and during the parenchymal biopsy. Biopsies were obtained under real-time sonographic guidance from the right lobe after confirming an adequate room for needle throw without breaching the liver capsule or any major hilar structures. Post-procedure complications, tissue yield, and histopathological adequacy of samples were analyzed. RESULTS: Overall technical success rate was 100%. No major complications were found where ultrasound-assisted TJLB (uTJLB) was performed. One patient who underwent non-US guided TJLB had an event of a capsular breach and intra-peritoneal hemorrhage requiring coil embolization. Samples were of adequate dimension. Histopathological positivity was 100%. The overall complication rate for uTJLB was 4.7% which was due to minor complications in two patients. CONCLUSIONS: Addition of US unit to the angiographic suite is effortless and Interventional Radiologists being already skilled in US can easily implement this simple yet valuable modification to conventional TJLB procedures. Our experience on uTJLB further emphasizes the role of US guidance in improving the procedural success rate, safety profile, and efficacy in the histopathological outcome of TJLB in all patients irrespective of age and disease burden.

Prostate artery embolisation: an initial experience from an Indian perspective.

PURPOSE: The study aims to report our very early experience with prostate artery embolisation in patients with benign prostatic hypertrophy (BPH) in an Indian setting. MATERIAL AND METHODS: This prospective study was approved by the Institutional Ethical Review Board, and informed consent was obtained from all the patients. Four patients with lower urinary tract symptoms due to benign prostatic hyperplasia underwent prostate embolisation. Embolisation was performed using polyvinyl alcohol (PVA) particles. International Prostate Symptom Score (IPSS), quality of life (QOL) score, postvoid residual volume, and prostate volume was recorded in each patient for 12 months. No major complications were seen in any patient. RESULTS: Four patients with a mean age of 74.2 years underwent prostate artery embolisation. It was successful in all the cases. Bilateral embolisation was performed in three patients and unilateral approach in one patient. Clinical improvement was characterised by a mean prostate volume reduction of 22% and mean IPSS reduction of 30% at 12-month follow-up. CONCLUSIONS: The initial experience with prostate embolisation has been very rewarding and is a great alternative treatment for BPH. It is a very safe and effective procedure and can be an ideal procedure from an Indian perspective.

Role of Multi Detector Computed Tomography (MDCT) in Preoperative Staging of Pancreatic Carcinoma.

INTRODUCTION: Pancreatic carcinoma is one of the leading causes of cancer related death in advanced countries and has shown rising trends in developing countries like India. Increase in the incidence has been linked to risk factors like lifestyle modification associated with increased alcohol consumption and rapid urbanization. Most patients at the time of diagnosis present with an advanced condition. Surgical resection offers the only chance for cure in them and imaging plays a crucial role in the early diagnosis of the condition. AIM: To compare the staging of pancreatic carcinoma by MDCT (Multi Detector Computed Tomography) with surgery in a preoperative setting in a tertiary referral centre in Kerala. MATERIALS AND METHODS: A cross-sectional observational study was performed between November 2014 and October 2016, 25 patients (12 men, 13 women), with a mean age of 54.2 years, were evaluated. MDCT was performed using 16 slice, 64 slice and 256 slice multi detector CT machines. The gold standard for diagnosis was histopathology and operative data. All statistical analysis was done using IBM SPSS version 20.0. Validity parameters like sensitivity, specificity, accuracy and Positive Predictive Value (PPV) / Negative Predictive Value (NPV) were computed for MDCT with respect to surgery. RESULTS: Of the 25 patients who were evaluated for surgery, 15 (60%) cases were classified as resectable tumours, 3 (12%) as borderline resectable and 7 (28%) as unresectable tumours. CT showed a sensitivity of 82.3% with a specificity of 87.5%. However, for assessing vascular invasion, CT showed sensitivity and specificity of 100% and 93.3% respectively. Three (12%) patients in the study who were classified as borderline resectable pancreatic tumours underwent surgery. CONCLUSION: Contrast-enhanced multiphase pancreatic imaging using MDCT plays a pivotal role in diagnosing and assessing resectability and vascular invasion of pancreatic tumours. It is very useful for determining borderline resectable tumours pre-operatively, which aids for better treatment planning.