Trephine biopsy of solid tumours under the CT and MRI control

M.A. Cherkashin, , D.D. Puchkov, E.A. Reut, A.V. Fedorov, N.V. Nikitina, D.I. Kuplevatskaya, V.I. Kuplevatsky, N.A. Berezina

Diagnostic and Treatment Center of the Medical Institute named after Berezin Sergey, Saint Petersburg

Histological diagnosis verification allows solving many problems that arise in the daily clinical work of an oncologist. The choice of special treatment regimes, the possibility of using targeted and immunotherapy, the need to change the chemotherapy line — these are just some of the questions that cannot be answered without histological material sufficient for immunohistochemical and molecular genetic studies. The gentlest method for the patient to collect tumor tissue is percutaneous trephine biopsy.

Aim: to develop and implement standard approaches to performing percutaneous biopsies of solid tumours.

Patients and Methods: in 2016–2018, at the Oncology Clinic of the Medical Institute named after Berezin Sergey, 280 percutaneous trephine biopsies (TB) of tumours were performed in different localizations: mediastinum, lung, pancreas, kidney, liver,  prostate, mamma, bone metastases and extraorgan tumours. TB was performed under the multispiral computed tomography (MSCT), ultrasound, and magnetic resonance imaging (MRI) control. In 11 cases, cognitive fusions of CT + PET-CT and CT + MRI were used. The intervention involved a number of stages: 1) native scanning and marking of needle input coordinates; 2) setting the needle mark and rescanning; 3) injection of the coaxial needle and control scanning; 4) injection of the biopsy needle with the coaxial unit and sampling the required number of tissue columns; 5) removal of the coaxial needle and scanning to assess possible complications.

Results: the success rate of primary pathomorphological verification was 92%. Complications developed in 7 cases (2.5%): intraperitoneal haemorrhage developed in 1 patient that required laparotomy; 2 patients had haemorrhages that did not require any surgical intervention; pneumothorax developed in 4 patients as a result of transthoracic biopsies, however, thoracostomy and oxygen therapy during the day were required only in one case.

Conclusion: 1. Percutaneous trephine biopsy of the mass lesions is a technically simple and relatively safe method to obtain sufficient material for pathomorphological examination. 2. The technology of combining images (CT + PET-CT, CT + MRI) allows accurately planning the intervention. 3. Freehand technique and step-by-step manipulation execution with constant CT-control allow safe biopsy even in cases of small size and complex tumor localization.

Ke ywords: solid tumors, percutaneous trephine biopsy, CT-navigation, MR-navigation.

For citation: Cherkashin M.A., Puchkov D.D., Reut E.A. et al. Trephine biopsy of solid tumours under the CT and MRI control. RMJ. 2019;6:3–9.