Percutaneous fine needle biopsy (P.F.N.B.) of intra-abdominal lesions.

Four hundred and seventeen percutaneous fine needle biopsies (P.F.N.B) have been performed in 405 patients. Two hundred and thirteen had a focal lesion of the liver, 116 a lesion of the pancreas, 74 an abdominal mass and 14 miscellaneous lesions. Real-time ultrasound has been used as a method of guidance in 90% of cases, fluoroscopy in 7% and computed tomography (CT) in 3%. The main indication for P.F.N.B. was detection of malignant lesions which represent 70% of the 338 proven cases. In these 338 cases, P.F.N.B. was successful in 310 (92%) and results were non-conclusive in 28 (8%). Sensitivity of P.F.N.B. in detection of malignancy of the liver, pancreas of abdominal masses was respectively 92%, 77% and 85%. Specificity was respectively 100%, 100% and 94%. Non-malignant lesions included benign solid tumours, cystic lesions or abscesses. Three symptomatic complications occurred in the 405 patients (0.75%). P.F.N.B. complements imaging procedures, especially real-time ultrasound, in obtaining a specific diagnosis of focal lesions within the abdomen.

[Treatment of cholestasis caused by stenosis of the intrahepatic bile ducts in alveolar echinococcosis. Trial of biliary drainage by the percutaneous transhepatic approach]. / Le traitement de la cholestase par sténose des voies biliaires intrahépatiques au cours de l'échinococcose alvéolaire. Essai de drainage biliaire par voie percutanée transhépatique.

Six cases of hepatic alveolar echinococcosis with involvement of the hepatic hilum and cholestasis were treated by percutaneous biliary drainage. Clinical and morphological follow-up ranged from 18 to 34 months. A decrease of jaundice and bilirubinemia and the regression of the intrahepatic bile duct dilatation were observed in all cases. Biliary drainage was associated with percutaneous drainage of an hepatic necrotic cavity in four cases. Left hepatectomy was performed later in three cases. These results are encouraging and suggest that percutaneous biliary drainage is an effective and useful procedure for biliary drainage in hepatic alveolar echinococcosis with cholestasis due to obstruction of the intrahepatic bile ducts.

[Inferior vena cava thrombosis responsible for chronic Budd-Chiari syndrome during hepatic and digestive amyloidosis]. / Thrombose de la veine cave inférieure responsable d'un syndrome de Budd-Chiari chronique au cours d'une amylose hépatique et digestive.

The case of a 39 year old woman with amyloidosis of the liver and the digestive tract presenting with obstruction of the inferior vena cava is reported. Computed tomography after bolus injection of contrast material revealed a typical patchy fan-shaped image, of hepatic vein obstruction. The association of Budd-Chiari's syndrome with amyloidosis may be related to the increased risk of thrombosis observed in the latter disease.

[Diagnostic and therapeutic strategy in carcinoma of the extrahepatic bile ducts]. / Stratégie diagnostique et thérapeutique des carcinomes des voies biliaires extra-hépatiques.

The preoperative diagnostic approach in 25 patients with bile duct carcinoma was studied. Investigation procedures included gray-scale ultrasonography with guided fine needle biopsy of focal lesions, percutaneous transhepatic or retrograde cholangiography, transhepatic biliary drainage with brush and forceps biopsy of biliary stenosis as well as selective angiography for feasibility of surgical resection. Diagnosis was ensured in 23 patients by cytologic or histologic tissue specimens. Twenty-one lesions were judged unresectable on the basis of bile duct or vascular tumor extension and patient status. These patients were treated either by iridium 192 wire radiation therapy (6 cases) or by nonsurgical biliary drainage. Four patients with a potentially resectable tumor underwent surgery. This preoperative diagnostic approach can be recommended for selecting appropriate therapy in patients with bile duct carcinoma.

[Value of intraductal biopsies and intraductal cytology in the etiological diagnosis of biliary stenoses]. / Intérêt des biopsies et de la cytologie endocanalaires pour le diagnostic étiologique des sténoses biliaires.

Endobiliairy tissue specimens were obtained for cytologic and histologic examinations at the site of stenosis after percutaneous biliary drainage or endoscopic retrograde sphincterotomy in 49 patients with benign (10 cases) or malignant (39 cases) biliary stricture. Final etiologic diagnosis was obtained by surgery (18 cases), autopsy (one case), aspiration cytology of metastasis (2 cases), serology (2 cases), and in 26 cases, was determined by the course and outcome of the disease. As the sensitivity of each method, cytology and histology, was weak, it was necessary to associate them to improve results. Accurate etiologic diagnosis was achieved in 77 p. 100 of cases. The specificity of the method was satisfactory and specimen examination allowed to correct and confirm the initial etiologic diagnosis in 12 and 65 p. 100 of cases, respectively. The specificity of the method and its low morbidity prompt us to recommend it during transhepatic or retrograde therapeutic drainage as it can serve as a guide for later treatment. On the other hand, achievement of a transhepatic drainage or an endoscopic sphincterotomy only to obtain endobiliairy tissue specimens means taking into account the poor sensitivity of the method and the complications inherent to transhepatic drainage and endoscopic sphincterotomy. The practice of obtaining specimens by the retrograde technique without sphincterotomy or under cholangioscopy should be developed.

[Real time ultrasonic guidance of percutaneous fine needle biopsies]. / Une technique simple de guidage des ponctions percutanées par l'échographie en temps réel.

Real time ultrasonic guidance of percutaneous fine needle biopsies with a standard transducer is described. This technique is simple, reliable, and cheap to obtain samples in focal liver and pancreatic lesions or abdominal masses.

[Hydatid cyst of the psoas muscle. Diagnosis using the CT scanner]. / Kyste hydatique du psoas. Diagnostic grâce au CT scanner.

A 30-year-old Maroccan man was admitted with a swelling in the right iliac fossa and right flank. Serology gave negative results but ultrasonography and CT scan images were suggestive of a hydatid cyst of the psoas muscle. A cystectomy was followed by total recovery. Hydatid cysts are rarely detected in France and their clinical and diagnostic characteristics are discussed. Ultrasonography and particularly CT scaner imaging are effective diagnostic procedures, avoiding unnecessary needle punctures and enabling adequate therapeutic measures to be instituted.

Obstructive jaundice by a dissecting aneurysm of celiac axis and hepatic artery.

We report a case of dissecting aneurysm of the celiac axis and hepatic artery resulting in obstructive jaundice. The aneurysm was demonstrated both by ultrasound and by angiography, but the associated aortic dissection was apparent only on CT scan. The patient was treated with percutaneous transhepatic biliary drainage, surgical exclusion of the aneurysm by ligation, and progressive dearterialization of the hepatic artery.

Hepatocellular carcinoma: diagnosis by percutaneous fine needle biopsy.

One hundred fifty-nine cases of hepatocellular carcinomas (HCCs) were reviewed from a series of 1060 cases of percutaneous fine needle biopsies of the liver. The biopsies were performed under ultrasonic guidance using a 22-gauge needle with a beveled tip. Specimens were obtained from the lesion and from areas of normal-appearing liver for comparison. Two sets of slides were prepared for Papanicolaou and Giemsa staining. In 147 cases (92%), the diagnosis of malignancy was established. In 134 cases (84%), the specific diagnosis of HCC was made. Fifty-four percent of the HCCs were well differentiated without cytonuclear abnormalities. In these cases, the diagnosis was made by comparison of specimens from the tumor with those obtained from the normal liver. Thirty-seven percent of the HCC were moderately differentiated with cytonuclear abnormalities. Nine percent of the HCCs were poorly differentiated, and in these cases, identification of glycogen on periodate-Schiff's procedure staining permitted differentiation from a metastatic tumor. In 9 cases, the aspirate was inadequate: there was insufficient tissue in 3 cases and the lesion was missed in the 6 other cases. In 3 cases, a biopsy of normal liver was not obtained and the diagnosis of HCC could only be suspected. Significant bleeding after biopsy occurred in 4 of 1060 cases, all with HCC.

Ultrasonic features of aneurysms of splanchnic arteries.

A review of nine patients with aneurysms of the splanchnic arteries was undertaken. The records and the sonographic findings were analysed. Seven of the nine aneurysms could be diagnosed ultrasonographically. The aneurysm appeared as a round hypoechogenic nodule connected to or in close relation with the feeding artery. In four patients the lesions were incidentally detected and two of them were operated upon because of a risk of spontaneous rupture.

Ultrasonically guided fine-needle biopsy in focal intrahepatic lesions: six years' experience.

We report the results of 322 ultrasonically guided percutaneous fine-needle biopsies of focal intrahepatic lesions. The technique is original in several respects; it is an aspiration of both the lesion and normal-looking liver, and it includes both cytology and histology when the tiny cores are obtained. Cytology included Papanicolaou and Giemsa staining and other special staining when necessary. Sensitivity was 88.6% and specificity was 100% in the diagnosis of malignancy. Out of 141 metastases, 14 false negatives, 5 misclassifications, and 122 correct diagnoses were obtained. Out of 69 hepatomas the correct diagnosis of malignancy was made in 63 patients and of these the correct classification in 49. Complications occurred in six patients and marked hemorrhage in four. This technique is a simple, accurate, safe method for the diagnosis of focal intrahepatic lesions.