Transgastric Feeding Tube Insertion into the Jejunum after Esophagectomy: Direct Puncture of the Gastric Conduit.

PURPOSE: To evaluate the safety and efficacy of percutaneous ultrasound (US)-guided direct puncture of a reconstructed gastric conduit after esophagectomy for performing a percutaneous radiologic gastrojejunostomy. MATERIALS AND METHODS: Between 2014 and 2020, 26 consecutive patients with esophageal cancer (mean age, 70 years ± 8.3) with a total of 27 attempts of percutaneous radiologic gastrojejunostomy for postsurgical enteral feeding at the National Cancer Center Hospital were included in this study. One patient required a repeat procedure because of persistent anorexia after the removal of the first tube. All patients except 1 had a gastric conduit reconstructed via a retrosternal route. All procedures were performed under local anesthesia with moderate sedation and analgesia. A gastric conduit was directly punctured with an 18-gauge needle under ultrasonographic guidance, followed by feeding tube insertion into the proximal jejunum. Technical details of the procedures, technical success (defined as adequate tube placement), procedure-related complications, and clinical outcomes were reviewed. RESULTS: The mean procedure time was 25 minutes ± 15, and technical success was obtained in every attempt. Minor complications included mild local pain (n = 7), unintentional tube removal (n = 2), local abdominal wall hematoma (n = 1), and superficial cellulitis (n = 1); no major complications were observed. During a mean follow-up period of 118.3 days ± 85.8, 13 patients resumed oral intake, and the feeding tube could be removed in 4 patients. No procedure-related deaths occurred. CONCLUSIONS: The US-guided direct puncture technique is feasible for percutaneous gastrojejunal tube insertion in postsurgical patients with esophageal cancer with gastric conduit reconstruction.

Balloon-Occluded Retrograde Transvenous Obliteration for the Treatment of Gastric Varices: Polidocanol Foam Versus Liquid Ethanolamine Oleate.

OBJECTIVE: The purpose of this study was to evaluate the clinical results of the management of gastric varices by balloon-occluded retrograde transvenous obliteration with polidocanol foam versus ethanolamine oleate. MATERIALS AND METHODS: Twenty patients treated with ethanolamine oleate and 21 patients treated with polidocanol foam were enrolled in this study. Early therapeutic effects were assessed mainly by dynamic contrast-enhanced CT. Subjective symptoms, objective findings associated with the procedures, and changes in laboratory data during the obliteration process were evaluated. Rebleeding from gastric varices was assessed after the procedures. RESULTS: Complete obliteration was confirmed in all but one case of early recanalization after treatment with polidocanol foam. One patient died of acute respiratory distress syndrome after treatment with ethanolamine oleate. The total sclerosant volume was significantly lower for 3% polidocanol foam (13.5 ± 6.8 mL) than for 5% ethanolamine oleate (30.6 ± 15.6 mL) (p < 0.01). Polidocanol foam caused fewer severe reactions, including pain, during and after injection. High body temperature, hemoglobinuria, and reactive pleural effusion were not observed with polidocanol foam. The variance in laboratory data values associated with hemolysis was significantly greater with ethanolamine oleate. No postprocedural rebleeding from the gastric varices was observed during a median follow-up time of 39.5 months after procedures with ethanolamine oleate and 34 months after procedures with polidocanol foam. CONCLUSION: Polidocanol foam can achieve obliteration of gastric varices comparable to that of ethanolamine oleate but with a significantly lower sclerosant dose and reduced risk of hemolysis-induced complications and harmful reactions, including pain and fever.

Feasibility and safety of direct percutaneous embolization of lymphopseudoaneurysm for postoperative lymphatic leakage.

The treatment strategy for refractory postoperative lymphatic leakage is controversial. While the utility of direct percutaneous embolization of lymphopseudoaneurysm has been investigated, only a few reports on this topic exist. The aim of this study was to evaluate the technical and clinical feasibility and safety of direct percutaneous embolization of lymphopseudoaneurysm for refractory postoperative lymphatic leakage. This case series included six consecutive patients who underwent direct percutaneous embolization of lymphopseudoaneurysm for refractory postoperative lymphatic leakage. Technical success (successful percutaneous approach and injection of NBCA glue to the lymphopseudoaneurysm), clinical success (unnecessity of percutaneous drainage tube of the lymphatic leakage), treatment duration (the duration from the treatment to the achievement of clinical success) and procedure-related complications were mainly evaluated. Direct percutaneous embolization of the lymphopseudoaneurysm using NBCA glue was successfully performed in all cases. Clinical success was achieved in five of the six cases (83%). The mean treatment period was 9 days for the cases with clinical success. No major complications occurred postoperatively. In conclusion, direct percutaneous embolization of lymphopseudoaneurysm may become a feasible and safe treatment option for cases of refractory postoperative lymphatic leakage.

Safety of propofol sedation administered by interventional radiologists for radiofrequency ablation in patients with hepatocellular carcinoma.

PURPOSE: To evaluate the safety of propofol sedation administered by interventional radiologists during radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Propofol sedation was administered by interventional radiologists in 72 patients (85 procedures, 93 tumors) during RFA for HCC between August 2018 and December 2020. Interventional radiologists equipped with adequate knowledge and skills in sedation and respiratory management were responsible for sedation. Sedation was carefully assessed based on vital signs, including end-tidal carbon dioxide, consciousness status, and bispectral index. The primary endpoint was the incidence of sedation-related complications, which were evaluated separately as respiratory and cardiovascular complications. Secondary endpoints were technical success rate, ablation-related complications, and local tumor control rate. Technical success was defined as completion of ablation in the planned area. Complications were evaluated using the Clavien-Dindo classification. Sedation-related complications, technical success rate, and ablation-related complications were evaluated on a procedure basis, and local tumor control was evaluated on a tumor basis. RESULTS: Respiratory and cardiovascular complications were observed in eight (8/85, 9.4%) and two (2/85, 2.4%) patients, respectively. Four patients required the jaw thrust maneuver due to glossoptosis, whereas a decrease in oxygen saturation to < 90% was recorded in the other four patients. However, these were temporary, and none required manual ventilation or endotracheal intubation. Bradycardia (< 50 bpm) was detected in two patients; one recovered immediately without treatment, whereas the other rapidly improved after atropine sulfate administration. No severe hypotension (< 80 mmHg) was observed. The technical success rate was 100% (85/85). Grade 3 ablation-related complications were identified in three patients (3/85, 3.5%). The local tumor control rate was 95.7% (89/93). CONCLUSION: Propofol sedation can be safely administered by interventional radiologists during RFA for HCC. Although it requires special safety considerations, it may be a sedation option during hepatic RFA.

Safety and feasibility of percutaneous abdominal lavage cytology screening (PACS) prior to surgical resection for pancreatic cancer.

PURPOSE: This study aimed to evaluate the feasibility, safety, diagnostic yield, and technical aspects of percutaneous abdominal lavage cytology screening (PACS) in patients with resectable pancreatic cancer. METHODS: This single-center, retrospective study included patients with resectable pancreatic cancer who underwent PACS before pancreatectomy between May 2022 and October 2023. The technical success rate, position of the drainage tube, volume of fluid administered, volume of fluid retrieved, fluid retrieval rate, and adverse events were evaluated. The cytological results of PACS were compared with those of surgical peritoneal lavage performed during pancreatectomy. RESULTS: Forty-four patients were enrolled in this study. The technical success rate for PACS was 100%. Drainage tube placement was outside the pouch of Douglas in all patients in the right-sided abdominal approach group (n = 10), whereas the placement was in the pouch of Douglas in all patients in the suprapubic approach group (n = 34). The mean volume of fluid administered, mean volume of fluid retrieved, and fluid retrieval rate were 185.0 ± 22.9 ml vs. 97.1 ± 32.0 ml (p < 0.001), 36.8 ± 25.6 ml vs. 50.5 ± 21.6 ml (p = 0.059), and 19.0 ± 12.4% vs. 54.9 ± 21.9% (p < 0.001) in the right abdominal approach and suprapubic approach groups, respectively. No adverse events were reported. The cytological results were benign in 42 patients; no discrepancy was observed in the results of surgical peritoneal lavage (n = 36). CONCLUSION: PACS is a feasible and safe procedure that can be performed before pancreatectomy in patients with resectable pancreatic cancer. the suprapubic approach may be ideal and PACS could be a screening method to detect carcinomatous peritonitis.

Partial splenic embolisation using n-butyl cyanoacrylate: intraprocedural evaluation by magnetic resonance imaging.

OBJECTIVES: To evaluate the use of diffusion-weighted imaging (DWI) for estimating infarcted splenic volume during partial splenic embolisation (PSE) using n-butyl cyanoacrylate (NBCA). METHODS: Twenty consecutive patients (57.2 ± 11.7 years) with hypersplenism underwent PSE. Intrasplenic branches were embolised using NBCA via a 2.1-French microcatheter aiming at infarction of 50 to 80 % of total splenic volume. Immediately after PSE, signal intensities (SI) of embolised and non-embolised splenic parenchyma were measured on DWI. Semi-automated volumetry (SAV) on DWI was compared with conventional manual volumetry (MV) on contrast-enhanced CT 1 week after PSE. Platelet counts were recorded before and after PSE. RESULTS: The SI on DWI in the embolised parenchyma decreased significantly (P < 0.01) to 24.7 ± 8.1 % as compared to non-embolised parenchyma. SAV and MV showed a strong correlation (r = 0.913 before PSE, r = 0.935 after PSE, P < 0.01) and significant (P < 0.01) reduction of normal splenic volume was demonstrated on both SAV (71.9 ± 12.4 %) and MV (73.6 ± 9.3 %) after PSE. Based on the initial SAV, three patients (15 %) underwent additional branch embolisation to reach sufficient infarction volume. Platelet counts elevated significantly (522.8 ± 209.1 %, P < 0.01) by 2 weeks after PSE. No serious complication was observed. CONCLUSION: Immediate SI changes on DWI after PSE allowed semi-automated splenic volumetry on site. KEY POINTS: • Partial splenic embolisation (PSE) is an important interventional technique for hypersplenism • Diffusion-weighted MR reveals an immediate decrease in signal in the embolised parenchyma • Such signal reduction permits semi-automated splenic volumetry on site. • This allows precise quantification of the amount of parenchyma infarcted, avoiding additional PSE.

Percutaneous Image-Guided Transesophageal Long Intestinal Tube Placement for Palliative Decompression in Advanced Cancer Patients with Unresectable Malignant Small Bowel Obstruction.

PURPOSE: To assess the safety and efficacy of long intestinal tube placement following percutaneous image-guided esophagostomy for palliative decompression of incurable malignant small bowel obstruction. MATERIALS AND METHODS: Between January 2013 and June 2022, a single-institution retrospective study was conducted to examine patients undergoing percutaneous transesophageal intestinal intubation for an occluded intestinal segment. Patients' baseline characteristics, procedural details, and clinical courses were reviewed. Severe complications were defined as those with ≥ 4 grade according to the CIRSE classification. RESULTS: This study included 73 patients (mean age, 57.7 years) who underwent 75 procedures. All bowel obstructions were caused by peritoneal carcinomatosis or similar disease, which precluded transgastric access in almost 50% of the patients due to massive cancerous ascites (n = 28), diffuse gastric involvement (n = 5), or omental dissemination in front of the stomach (n = 3). Technical success (appropriate tube positioning) was achieved in 98.7% (74/75) of procedures. The cumulative 1-month overall survival and sustained clinical success (adequate bowel decompression) rates were estimated at 86.8% and 88%, respectively, using Kaplan-Meier analysis. At the median survival of 70 days, the disease progression required other gastrointestinal interventions, including additional tube insertion, repositioning, or venting enterostomy in 16 patients (21.9%). The severe complication rate was 4% (3/75); one patient aspirated to death due to tube clogging and two encountered fatal perforation of isolated intestinal loops developing far beyond the tip of the indwelling tube. CONCLUSION: Percutaneous image-guided transesophageal intestinal intubation achieves feasible bowel decompression as palliative care in advanced cancer patients. LEVEL OF EVIDENCE: Level 4, Case Series.

Necessity of Prophylactic Anticoagulation Therapy Following Inferior Vena Cava Stent Placement in Patients with Cancer.

Purpose: Although percutaneous stent placement for malignant inferior vena cava syndrome is a highly feasible and effective treatment option, there is no clear evidence for the necessity of prophylactic anticoagulation therapy after inferior vena cava stent placement. This study retrospectively evaluated the necessity of prophylactic anticoagulation following inferior vena cava stent placement in patients with malignant inferior vena cava syndrome. Methods: The data of 54 patients (28 men and 26 women; median age 61.2 years) with malignant inferior vena cava syndrome who received inferior vena cava stent placement between 2011 and 2021 were retrospectively reviewed. Prophylactic anticoagulation was administered to 15 of 54 patients (27.8%) following stent placement. Symptom recurrence rates at 1 and 2 months after stent placement were compared between patients with and without prophylactic anticoagulation using Gray relational analysis. The timeline of symptom recurrence, survival time, and adverse events were also evaluated. Results: At 1 and 2 months, symptom recurrence rates were 48.6% and 71.4%, respectively, in patients with prophylactic anticoagulation and 28.3% and 37.0%, respectively, in patients without prophylactic anticoagulation. The overall median follow-up duration was 27 days and that of the patients with and without prophylactic anticoagulation was 37 and 25 days, respectively. The median survival times of patients with and without anticoagulation therapy were 69 and 30 days, respectively (p = 0.236). No procedure-related complications occurred. Conclusions: There was no significant difference in the symptom recurrence rates after inferior vena cava stent placement with or without prophylactic anticoagulation in this study.

Artificial Pneumothorax Using the Liver-Directed Approach and Seldinger's Technique: Technical Feasibility and Safety.

Purpose This study aimed to evaluate the technical feasibility and safety of artificial pneumothorax induction for percutaneous procedures using the liver-directed approach and Seldinger's technique. Materials and methods The data of 25 consecutive patients who underwent percutaneous procedures after inducing artificial pneumothorax were reviewed retrospectively. The liver surface was punctured with an 18-gauge indwelling needle via the intercostal space in the inferior thoracic cavity under ultrasound guidance, avoiding the lung parenchyma and leaving the catheter in place. After a deep inhalation pulled the catheter tip into the pleural cavity, a hydrophilic guidewire was inserted through the catheter. Finally, a small-diameter catheter was inserted into the pleural cavity over the guidewire to induce artificial pneumothorax. Procedure time (the time from local anesthesia to completion of the procedure), technical success (successful induction of artificial pneumothorax), clinical success (successful completion of the percutaneous procedure), and complications (categorized according to the Clavien-Dindo classification) were evaluated in this study. Results The artificial pneumothorax induction was successful in all cases. Clinical success was achieved in 23 of 25 procedures (92%). No severe complications were observed. Conclusion The liver-directed approach and Seldinger's technique for inducing artificial pneumothorax was safe and feasible for avoiding lung injury.

Clinical outcomes of image-guided percutaneous drainage of pericardial effusion in cancer patients: A single-center retrospective analysis.

AIM: Catheter removal, survival, and recurrence rates after percutaneous pericardial effusion drainage in cancer patients are not fully understood. We evaluated the clinical outcomes of image-guided percutaneous pericardial effusion drainage in cancer patients. METHODS: From January 2014 to September 2017, 113 percutaneous drainages for symptomatic pericardial effusion were performed in 100 cancer patients (median 60 years; range, 7-84 years) using ultrasound or angio-computed tomography. An 8-Fr drainage catheter was placed using the Seldinger technique via the subxiphoid (n = 73), apical (n = 23), or left parasternal (n = 17) routes. Success rates, complications, and postprocedural clinical outcomes of drainages were retrospectively assessed. RESULTS: The technical and clinical success rates were 100% and 99%, respectively, without major complications. The median duration of catheterization and evacuated pericardial effusion volume were 6 days (range, 1-72 days) and 970 ml (range, 140-7635 ml), respectively. Catheters were removed after the first drainage in 86 cases (86%). Symptomatic pericardial effusion recurred in nine patients after catheter removal, in whom redrainages were performed 13 times with a median duration to redrainage time of 48 days (range, 13-529 days). During the follow-up period (median 106 days [range, 1-1396 days]), 61 patients died. The median survival was 140 days (95% confidence interval [CI], 95-276 days), and the median catheter-free survival was 111 days (95% CI, 60-152 days). CONCLUSIONS: Image-guided percutaneous pericardial effusion drainage for cancer patients is safe and helps alleviate symptoms. Additionally, catheter removal is possible in most patients, allowing a catheter-free period for patients.

Carbon dioxide (CO2) vs iodinated contrast digital subtraction angiography during balloon-occluded retrograde transvenous obliteration (BRTO) using foam sclerosant for gastric varices.

PURPOSE: To compare the visualization of the target gastric varices (GV) on balloon-occluded retrograde transvenous venography (BRTV) using iodinated contrast material vs carbon dioxide (CO(2)) in preparation for subsequent balloon-occluded retrograde transvenous obliteration (BRTO) using foam sclerotherapy. MATERIALS AND METHODS: In 16 consecutive patients with nonruptured GV, BRTV was performed first using iodinated contrast material and then with CO(2). BRTV was repeated whenever there were changes in the catheter or patient position or when coil embolization of collaterals was needed. Each visualization grade of GV (grade 1 = GV only; grade 2 = GV > collaterals; 3 = GV < collaterals; grades 4-5 = collaterals only) was determined by two observers in consensus. During foam BRTO, the GV visualization grade was recorded again and confirmed by C-arm computed tomography (CT). RESULTS: In 38 pairs of BRTV, GV grades were significantly (P < .0001) lower (ie, favoring BRTO) on CO(2) BRTV (mean ± standard deviation, 1.8 ± 0.8) than on iodine BRTV (3.4 ± 0.8). GV grades on foam BRTO (1.4 ± 0.7) were similar to the grades obtained on the most recent CO(2) BRTV (1.3 ± 0.5) but were significantly smaller (P < .0001) than on iodinated BRTV (3.1 ± 0.9). GV were opacified by foam on initial C-arm CT in 14 patients (87.5%), and complete thrombosis of GV was obtained without any complication in all 16 patients (100%). CO(2) reached the GV even when iodinated contrast material could not (grade 4) in seven of our 16 patients (43.8%), leading to successful BRTO. CONCLUSIONS: CO(2) BRTV visualized GV better than did iodine BRTV and changed the management of more than 40% of patients by enabling successful foam BRTO in patients in which conventional liquid BRTO could not be performed.

Balloon-occluded retrograde transvenous obliteration of gastric varices: use of CT-guided foam sclerotherapy to optimize technique.

OBJECTIVE: Balloon-occluded retrograde transvenous obliteration has been traditionally based on liquid sclerotherapy. However, overdose and systemic spillage of liquid sclerosant can cause severe complications, such as hemolysis, which lead to hemoglobinuria, allergy, acute respiratory distress syndrome, and other disorders. The purpose of this study was to evaluate the performance of foam sclerotherapy with C-arm CT guidance to reduce the amount of sclerosant and to optimize the safety of balloon-occluded retrograde transvenous obliteration while preserving its efficacy. MATERIALS AND METHODS: Twenty consecutively registered patients with gastric varices underwent balloon-occluded retrograde transvenous obliteration with polidocanol foam. C-arm CT guidance was used to confirm gas filling of the target vessels. In this retrospective analysis of a prospectively encoded database, total net doses of polidocanol used for transvenous obliteration and of contrast medium used for venography before transvenous obliteration were compared, and subsequent complications, including hemoglobinuria, were documented. RESULTS: In all patients, foam was observed in the target vessels at C-arm CT. The mean dose of polidocanol used for balloon-occluded retrograde transvenous obliteration (3.9 ± 1.5 mL) was significantly smaller (p < 0.001) than the dose of contrast medium used for venography (16.4 ± 7.9 mL). Hemoglobinuria was found in only one patient. Except in one instance of recanalization, full variceal thrombosis was confirmed at contrast-enhanced CT 1 week after transvenous obliteration (success rate, 95%). In one patient, air migrated into the liver during transvenous obliteration but was spontaneously absorbed. No serious complication occurred. CONCLUSION: Balloon-occluded retrograde transvenous obliteration with polidocanol foam under C-arm CT guidance allowed significant reduction of sclerosant dose and resulted in a low complication rate while a high technical success rate and efficacy were maintained.

Percutaneous Radiologic Gastrostomy in Patients After Partial Gastrectomy: A Retrospective Study to Assess the Technical Feasibility of Postsurgical Remnant Stomach Access.

PURPOSE: To evaluate the technical feasibility of percutaneous radiologic gastrostomy in patients after partial gastrectomy. MATERIALS AND METHODS: This retrospective study included 15 consecutive gastrectomized patients with attempted percutaneous radiologic gastrostomy at our institution between April 2014 and March 2021. When the stomach was sufficiently insufflated to distend below the left anterior subcostal margin, percutaneous radiologic gastrostomy with gastropexy was conventionally performed by the Seldinger technique. When the stomach was still highly positioned and/or overlaid by the other organs, some adjunctive maneuvers, such as hydro-displacement, intragastric balloon support, or cephalad oblique puncture or left intercostal puncture, were employed as modified gastrostomy. Ultrasonography or x-ray or computed tomography fluoroscopy was used for imaging guidance during the gastric puncture. Adequate tube placement was defined as technical success. Technical details, clinical outcomes, and complications were reviewed. RESULTS: One patient underwent percutaneous radiologic jejunostomy instead of gastrostomy because safe gastric access could not be ensured. Seven patients underwent conventional gastrostomy; the other seven underwent modified gastrostomy with no gastropexy. The technical success rate was 100% (7/7) in the conventional group and 85.7% (6/7) in the modified group. The stomach was punctured under x-ray or computed tomography fluoroscopy for conventional gastrostomy. In contrast, the combination of various modalities was used for modified gastrostomy except for one failed case with unintentional transhepatic access. During a median follow-up of 108 days, no major complications occurred. CONCLUSION: The adequate combination of multimodal imaging guidance and technical modifications could secure radiological creation of gastrostomy for the postsurgical stomach. LEVEL OF EVIDENCE: Level 4, Case Series.

The value of angio-CT system on splanchnic nerve neurolysis.

PURPOSE: We aimed to evaluate the effectiveness and safety of splanchnic nerve neurolysis (SNN) with angio-CT, a hybrid system combining computed tomography (CT) with X-ray fluoroscopy. METHODS: Thirty-three SNN procedures with angio-CT performed in 30 patients with severe epigastric cancer pain (11 males and 19 females; median age, 57 years; age range, 19-79 years) between January 2010 and July 2017 were retrospectively evaluated. The primary endpoints were the technical success and adverse event rates. The secondary endpoints included the clinical success rate, defined as a reduction in the numerical rating scale for pain score or a decrease in the consumption of analgesics on day 1 and at 1-2 weeks after the procedure; procedure time; the number of needle punctures; amount of ethanol required; and the distribution of contrast medium in the retrocrural space. These endpoints were compared with previous studies that did not employ the angio-CT system. RESULTS: The technical success rate was 96.97%. There were two procedure-related adverse events (one retroperitoneal hemorrhage, one pneumothorax). The clinical success rates on day 1 and at 1-2 weeks after the procedure were 84.38% and 87.5%, respectively. The median procedure time was 60 minutes. The median number of needles used was 2. The median amount of ethanol used was 20 mL. CONCLUSION: SNN under angio-CT is safe and effective, with excellent technical and clinical success rates and acceptable adverse event rates. These results are comparable with previous studies that did not involve angio-CT. However, the use of angio-CT allows for easier needle positioning and an earlier response to complications compared with conventional methods.

Feasibility and Safety of the Craniocaudal Approach for Superior Sulcus Lesions of the Thorax.

PURPOSE: To evaluate the feasibility and safety of the craniocaudal approach for superior sulcus lesions of the thorax. MATERIAL AND METHODS: Between October 2010 and December 2020, the data from 22 consecutive patients who underwent drainage or biopsy using a craniocaudal trajectory were retrospectively reviewed. The craniocaudal approach was applied for patients in which the fluid collection or tumor was limited to the superior thoracic sulcus lesion or otherwise inaccessible owing to intervening structures such as pleural dissemination. The indications for this procedure were drainage in 20 patients and biopsy in 2 patients. Technical success, procedure time, complications, and clinical success were evaluated. RESULTS: Technical and clinical success were achieved in all patients, and no major complications were found. The median procedure time was 25 min (range 15-40 min). This procedure was performed with fluoroscopic guidance in 11 patients and ultrasound guidance in 11 patients. The routes of needle passage were the first intercostal space (n = 16), the second intercostal space (n = 5), and between the clavicle and the first rib (n = 1). CONCLUSION: The craniocaudal approach for superior sulcus lesions might be a safe and feasible option for patients in which the conventional intercostal approach is difficult. LEVEL OF EVIDENCE: Retrospective cohort study. Level 4.

Natural History of Epithelioid Hemangioendothelioma of the Liver: CT Findings of 15 Cases.

RATIONALE AND OBJECTIVES: Little is known about the natural history of epithelioid hemangioendothelioma (EHE) of the liver. This study aimed to assess the natural history of hepatic EHE by evaluating CT findings of patients with pathologically proven hepatic EHE during follow-up without treatment. MATERIALS AND METHODS: CT findings of 15 patients (seven men and eight women; median age, 56 years) with pathologically proven hepatic EHE were retrospectively evaluated. The median interval between the baseline and final CT was 36 months (range, 6-144 months). The maximal diameter of the largest hepatic lesion on the baseline CT and the diameter of the same lesion on the final CT were recorded. Change in size of the largest lesion between the two studies was classified as enlargement, no change, and reduction. When a patient with the largest lesion showing reduction developed a new hepatic lesion on the final CT, it was referred to as "unpredictable growth". RESULTS: CT revealed multiple hepatic lesions in all patients. Enlargement, no change, and reduction of the largest lesion were observed in four, five, and six patients, respectively. Unpredictable growth was observed in five patients. CONCLUSION: During the follow-up of untreated patients with hepatic EHE, spontaneous regression and appearance of a new hepatic lesion were occasionally observed in the same patient.

Analysis of factors affecting the diagnostic yield of image-guided percutaneous core needle biopsy for peritoneal/omental lesions.

PURPOSE: To evaluate the diagnostic yield, safety, and factors associated with the diagnostic yield of percutaneous core needle biopsy (PNB) for peritoneal/omental lesions. METHODS: Consecutive 297 patients (67 men, 230 women; median age, 64 years [range 15-87]) who underwent a PNB for 311 peritoneal/omental lesions at a single center from April 2010 to March 2020 were evaluated retrospectively. The preprocedural CT findings, diagnostic yield, sensitivity, specificity, PPV, NPV, technical success rate, and adverse events were analyzed. Surgical or clinical diagnosis with follow-up was the diagnostic reference standard. Adverse events were evaluated using the Society of Interventional Radiology guidelines. RESULTS: The median anteroposterior (AP) diameter and CT value of the target lesion were 24 mm (range 5-78) and 46 HU (range - 75 to 140), respectively. Ascites was interposed on the puncture route in 106 patients (34.1%). The technical success rate was 100%. The diagnostic yield, sensitivity, specificity, PPV, and NPV were 93.9%, 93.8%, 100%, 100%, and 20.8%, respectively. Minor complications were observed following five procedures (1.6%). The diagnostic yield was lower for fat-dominant lesions than for other lesions (82.6% vs. 95.8%, p = 0.002). The diagnostic PNB group had a greater AP diameter than did the non-diagnostic PNB group (27.3 ± 13.0 vs. 20.7 ± 8.4 mm, p = 0.037). CONCLUSION: PNB for peritoneal/omental lesions provided a sufficiently high diagnostic yield and minimal adverse events. Lesions with a greater AP diameter and a higher density on CT would provide more diagnostic specimens from this technique.

Endovascular Catheter Biopsy for the Diagnosis of Pulmonary Artery Sarcoma.

The diagnosis of pulmonary artery sarcoma (PAS) is challenging, and its definitive diagnosis is mainly confirmed using specimens obtained during surgery or autopsy. Endovascular catheter biopsy was performed in five patients with suspected PAS to establish a definitive diagnosis. Aspiration biopsy was performed in all patients, and forceps biopsy was performed in one patient. Three patients were diagnosed with PAS, and no definitive diagnosis was obtained in two patients with squamous cell lung carcinoma with pulmonary artery infiltration. Endovascular catheter biopsy is helpful in the diagnosis of PAS and should be performed when a tumor is suspected.

Feasibility of genomic profiling with next-generation sequencing using specimens obtained by image-guided percutaneous needle biopsy.

Aims: The demand for specimen collection for genomic profiling is rapidly increasing in the era of personalized medicine. Percutaneous needle biopsy is recognized as minimally invasive, but the feasibility of comprehensive genomic analysis using next-generation sequencing (NGS) is not yet clear. The purpose of this study was to evaluate the feasibility of genomic analysis using NGS with specimens obtained by image-guided percutaneous needle biopsy with 18-G needles. Patients and methods: Forty-eight patients who participated in a clinical study of genomic profiling with NGS with the specimen obtained by image-guided needle biopsy were included. All biopsies were performed under local anesthesia, with imaging guidance, using an 18-G cutting needle. A retrospective chart review was performed to determine the rate of successful genomic analysis, technical success rate of biopsy procedure, adverse events, rate of success in pathological diagnosis, and cause of failed genomic analysis. Results: The success rate of genomic analysis was 79.2% (38/48). The causes of failure were unprocessed for DNA extraction due to insufficient specimen volume (6/10), insufficient DNA volume (2/10), and deteriorated DNA quality (2/10). The rate of successful genomic analysis excluding NGS analysis that failed for reasons unrelated to the biopsy procedures was 95.2% (40/42). Technical success of biopsy was achieved in all patients without severe adverse events. The rate of success in the pathological diagnosis was 97.9% (47/48). Conclusions: Image-guided needle biopsy specimens using an 18-G cutting needle yielded a successful NGS genomic analysis rate with no severe adverse events and could be an adoptable method for tissue sampling for NGS.