Safety and Accuracy of Percutaneous Image-Guided Core Biopsy of the Spleen.

OBJECTIVE: The purpose of this study is to assess the complication rate and diagnostic accuracy of percutaneous image-guided core needle biopsy (CNB) of the spleen at a single center over the course of 12 years. MATERIALS AND METHODS: A retrospective review of an institutionally maintained biopsy database was used to identify CNBs of the spleen performed between October 2002 and January 2015. Clinical notes were reviewed from the date of biopsy to 3 months after biopsy to ascertain whether any immediate or delayed complications had occurred. Minor complications included pain requiring analgesia and incidental asymptomatic bleeding. Major complications were those scored at or above grade 3 according to the National Institutes of Health's Common Terminology Criteria for Adverse Events, version 4.0. The pathology reports issued for each specimen were evaluated and compared with results obtained from splenectomy, biopsy performed at another anatomic site, or longitudinal clinical or imaging follow-up. Sensitivity, specificity, and accuracy were calculated. RESULTS: A total of 97 CNBs of the spleen were performed, 23 of which were CT guided and 74 of which were ultrasound guided. There were seven (7.2%) minor complications and a single (1.0%) major complication; the overall complication rate was 8.2% (n = 8). The diagnostic yield-defined as adequate tissue to establish a diagnosis-of CNB was 93.8%, the sensitivity was 90.7%, the specificity was 100%, and the accuracy was 94.5%. CONCLUSION: Percutaneous image-guided CNB of the spleen is safe and effective in achieving a tissue diagnosis.

CT Urography for Diagnosis of Upper Urinary Tract Urothelial Carcinoma: Are Both Nephrographic and Excretory Phases Necessary?

OBJECTIVE: The objective of our study was to compare the diagnostic performance of nephrographic phase only, excretory phase only, and both nephrographic and excretory phases of CT urography (CTU) for the detection of upper tract urothelial carcinoma. MATERIALS AND METHODS: Forty-nine consecutive patients with pathologically proven upper tract urothelial carcinoma who underwent a single-bolus CTU examination were evaluated. Forty-nine control patients with normal findings on two CTU examinations performed at a 1-year interval were included. Two radiologists independently reviewed the 98 CTU examinations at three different sessions (nephrographic phase only, excretory phase only, and both nephrographic and excretory phases simultaneously) and rated the likelihood of the presence of a urothelial carcinoma in each segment of the renal collecting system and ureter using a 5-point scale. Sensitivity, specificity, and AUC of ROC curve were calculated per segment and per patient. RESULTS: A total of 314 segments, 56 of which contained tumors, were evaluated. In the per-segment analysis for reviewers 1 and 2, the sensitivity, specificity, and AUC, respectively, were as follows: 88%, 98%, and 0.95 and 84%, 97%, and 0.94 for the nephrographic phase; 79%, 98%, and 0.91 and 89%, 98%, and 0.95 for the excretory phase; and 88%, 99%, and 0.95 and 89%, 99%, and 0.96 for the combined nephrographic and excretory phases. The AUC of the combined nephrographic and excretory phases was significantly higher than that of the nephrographic phase (per-patient analysis, reviewer 2) and that of excretory phase (per-segment analysis, reviewer 1) but was not significantly different in any other comparisons. CONCLUSION: The nephrographic and excretory phases are complementary for the detection of upper tract urothelial carcinoma.