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Ultrasound-guided fine-needle aspirate and biopsy technique Copyright © 2006 Sound Technologies, Inc. Sound Technologies, Inc. 5817 Dryden Place Carlsbad, CA 92008 1-760-918-9626 www.soundvet.com www.soundveteducation.com Introduction

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ultrasound guided fine needle aspirate and biopsy technique

Ultrasound-guidedfine-needle aspirate and biopsy technique

Copyright © 2006 Sound Technologies, Inc.

slide2

Sound Technologies, Inc.

5817 Dryden Place

Carlsbad, CA 92008

1-760-918-9626

www.soundvet.com

www.soundveteducation.com

slide3

Introduction

This presentation describes the methods to use as well as other factors to consider when performing an ultrasound-guided fine-needle aspirate (FNA) or core biopsy. The scanning planes used for FNA and core biopsy are the same. The technique varies somewhat, and the differences are demonstrated. Animation is used to demonstrate the aspirate/biopsy techniques. Please note that this animation will not run properly with older versions of PowerPoint or PowerPoint viewer.

slide4

Directions

In this presentation select the appropriate button on the home page to see the described information. The forward arrow button will take you to the next topic. The back arrow will take you to the prior topic. The ‘home’ button will take you to the home page, and the ‘i’ button will take you to the title page.

You may view the animation of each procedure up to three times before having to reset (exit) the presentation. Select a button with under the procedure you would like to view to run the animation. If there are no more buttons seen, you will need to reset the presentation to view that procedure again. To reset the presentation, either press ‘Escape’ on you computer, or select the appropriate button on the home page.

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Ultrasound-guided FNA and biopsy

technique

Method details:

Indications

Rock/slide the probe

Accuracy

Keep needle in

plane of beam

Probe orientation

Animal

preparation

Superficial lesion

Screen orientation

Materials

Deep lesion

Reset (exit) program

Method

References

slide6

Indications

There are many indications for ultrasound-guided aspirates and biopsies as there are essentially no pathognomonic lesions in ultrasound. Most of the time a cytologic or histopathologic sample is needed to make a definitive diagnosis. Samples for cytology and histopathology may obtained with ultrasound-guided, laparoscopic and surgical procedures.

slide7

Indications

Icterus/liver enzyme elevation/elevated bile acids

Splenomegaly

Focal nodules or masses anywhere

Renal disease sometimes (i.e. renal dysplasia, renal masses, lymphosarcoma suspects)

Prostatomegaly

Free abdominal fluid

Cysts

Lymphadenopathy

U/S guided FNA/biopsies generally not done on:

Adrenal glands

Transitional cell carcinoma suspect masses

Chronic renal failure, glomerulonephritis

slide8

Accuracy

Currently there is a lack of consensus about the accuracy of ultrasound-guided fine needle aspirates and biopsies compared to surgical or post mortem biopsy sample results. Some studies report high accuracy, others, low accuracy. The differential diagnosis and case presentation both should be considered when determining the best method of obtaining a cytology or histopathology sample.

slide9

Animal preparation

  • Coagulation concerns:
    • A physical examination should be done to assess evidence of a coagulopathy, and if one is suspected, no aspirate or biopsy is recommended.
    • The pre-biopsy hematocrit should be known.
    • At least a platelet count is recommended before a fine-needle aspirate is done.
    • Perform a buccal mucosal bleeding time if i.e. von Willebrand’s disease, or other disorders of primary coagulation are suspected.
    • A platelet count as well as coagulation profile (PT, aPTT and/or PIVKA) are recommended before a core biopsy is done.
  • Sedation/brief anesthesia may be indicated.
  • Prepare a sterile field
slide10

Coagulation tests

  • PT = Prothrombin time
  • PTT = Partial thromboplastin time
  • PIVKA = Proteins induced by vitamin K antagonism
slide11

Materials

  • Biopsy guide or not
  • 22-G 1.5 inch “cysto’ needle or 22-G 3.5 inch spinal needle is often used for fine-needle aspirates.
    • Attach needle to extension set then syringe for easier handling
  • 14-G to 18-G core biopsy needles
    • Bard® automatic biopsy needles
      • One hand to trigger
      • Forward ‘throw” varies from 11 to 22 mm
      • Order from Sound Technologies or other distributors
slide12

Method

  • Biopsy guide or freehand
  • Thickness of beam is 1-2 mm
  • Must keep needle in plane of beam (biopsy guide would do this for you)
  • Shortest distance/safest pathway
  • “Sewing-machine” motion for fine-needle ‘aspirates’
  • Stab incision in skin before doing a core biopsy
  • Sample preparation and evaluation:
  • Spray aspirates carefully on the slide
  • Smear gently, dry rapidly
  • View representative slide before submitting
  • Place core biopsy samples in cassette, pouch or lens paper
  • Pick pathologist carefully
slide13

Probe orientation

Reference

marker corresponds

to left side of screen

(see

Screen Orientation

slide)

Probe

Skin

Schematic of the

resulting ultrasound

image

Superficial “lesion”

to biopsy

Deep “lesion”

to biopsy

slide14

Screen orientation

Near field

Opposite reference marker

Reference marker

Far field

slide15

Rock and/or slide the probe

to line up the lesion

to a “reachable” position

Superficial lesion

can be toward the edge

or in the center

of the beam

Deep lesion needs

to be lined up

toward the edge of

the beam

slide16

Keep needle in the same plane

as the beam

See rotated views

slide17

Keep needle in the same plane as the beam:

Rotated views of the

probe/beam/biopsy plane

Needle is placed in the plane of the beam

slide18

Angle to use for a superficial lesion:

Aim needle more perpendicular to beam

FNA:

Core biopsy:

slide40

Angle to use for a deep lesion:

Aim needle more parallel to beam

FNA:

Core biopsy:

slide50

Deep lesion

core biopsy

slide51

Deep lesion

core biopsy

Take biopsy

slide52

Deep lesion

core biopsy

slide53

Deep lesion

core biopsy

slide54

Deep lesion

core biopsy

slide55

Deep lesion

core biopsy

slide56

Deep lesion

core biopsy

Take biopsy

slide57

Deep lesion

core biopsy

slide58

Deep lesion

core biopsy

slide59

Deep lesion

core biopsy

slide60

Deep lesion

core biopsy

slide61

Deep lesion

core biopsy

Take biopsy

slide62

Deep lesion

core biopsy

slide63

Deep lesion

core biopsy

slide64

Deep lesion

core biopsy

slide65

References

  • Fife WD (2005) Abdominal ultrasound: Aspirations and biopsies, InEttinger SJ, Feldman EC (eds), Textbook of Veterinary Internal Medicine, 6th edition, St. Louis, Elsevier Saunders, pp. 271-275.
  • Nyland TG, Mattoon JS, Herrgesell EJ, Wisner ER (2002) Ultrasound-guided biopsy, In Nyland TG, Mattoon JS (eds), Small Animal Diagnostic Ultrasound, Philadelphia, WB Saunders, Co., pp. 30-48.