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Ultrasound-guided needle biopsy in children


Medical editor Heidi Glosli MD
Oncologist
Oslo University Hospital

General

Ultrasound-guided biopsy is sometimes used to diagnose possible pathology in suspect lesions/changes. Fine-needle biopsy is always used initially. The cell smear is immediately stained and assessed by a cytologist. In most cases, a histological pistol biopsy is also performed (Tru-Cut®). It is often necessary to wait 2-6 days for the result before starting treatment. 

Indication

  • Ambiguous lesions detected with radiological testing.

Goal

  • Confirm or rule out malignant histology of suspect lesions.

Equipment

  • Biopsy equipment    

     


  • Preparation

    • For ultrasound-guided puncture under general anesthesia, the child must fast for the last 4-6 hours before the test.
    • Depending on the localization and accessibility of the lesion, precautions should be taken regarding bleeding parameters (hemoglobin, thrombocytes, INR, and Cephotest).
    • The child and parents are informed about the procedure.
    • The biopsy is performed under general anesthesia.

    Implementation

    Ultrasound-guided biopsy is performed under general and local anesthesia depending on the depth and localization.

    • Localize the lesion with the ultrasound probe.
    • Determine the best point and direction for puncture.
    • Mark the puncture point so the canal is easy to remove later.
    • Wash the puncture point with colored chlorhexidine 1 mg/ml.
    • Allow the skin to dry.
    • Inject local anesthesia if necessary.
    • Puncture the spinal needle quickly through the skin.
    • Guide the needle through the peritoneum using ultrasound and further into the lesion.
    • Remove the stylet.
    • Aspirate. 
    • When the material is visible at the top, the needle is retracted.
    • Deposit the material on a slide.
    Smear for cytology
    • Smear the material on to the slide.
    • Allow the material to air dry.
    • Staining: fixing fluid with methanol + Hemacolor + rinsing in water
      • 5 dips in fixing fluid. Allow the solution to drop onto paper. 
      • 3 dips in staining solution 1.
      • 6 dips in staining solution 2. Allow the solution to drop onto paper.
      • Rinse in 2 baths of clean water.
    • Examine the specimen under the microscope with 10x or 20x objective.

    The microscopic assessment of the cell material should be performed by a cytologist to determine if there is adequate tissue or if there should be supplementary testing.

    Histological biopsy (pistol biopsy)
    • Inject the local anesthesia in the skin.
    • Make a small incision in the skin.
    • Insert the biopsy needle on to the lesion and gently into it, depending on the size of the lesion and the type of tissue in front and behind the lesion.
    • Trigger the pistol to retrieve the material.
    • Retract the needle and open it. 
    • Place the piece of tissue onto a slide with medium, for example formalin or 0.9% NaCl.

    Follow-up

    • The child will often remain in the hospital until the following day.
    • Depending on the location of the biopsy, bleeding can sometimes occur after taking the specimen.
    • For pain or bleeding, the patient must be observed at the ward or intensive unit depending on the severity. Necessary measures must be initiated.
    • After a biopsy of parenchymatous organs, an ultrasound examination is made, and hemoglobin is checked possibly the following day.  

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