Splenic biopsy

Percutaneous splenic biopsy, utilizing either ultrasound or CT guidance, is an accurate and reliable method of acquiring splenic tissue for histopathological assessment and has been proposed as an alternative for splenectomy in selected patients.

Although the procedure has been historically feared by most radiologists due to a perception of a potentially high risk of hemorrhage, meta-analysis has shown a similar complication rate compared to liver and kidney biopsies when using 18 G or smaller needles .

Indications

• known or suspected Hodgkin and non-Hodgkin lymphoma requiring histopathological assessment of diagnosis or recurrence/transformation
  • no other organ is available for biopsy (i.e. the spleen is the only abnormal or most accessible organ for biopsy)
  • prior investigations have not yielded a diagnosis
• known extrasplenic neoplasm and indeterminate focal splenic lesion for which the diagnosis of metastasis implicates in management decisions
  • prior investigations have not yielded a diagnosis (e.g. review of prior imaging and PET-CT) 

Contraindications

The contraindications must be considered individually in each case. Overall, the most important contraindications are:

• uncooperative patient
• uncorrectable bleeding diathesis (abnormal coagulation indices)

Procedure

Laboratory parameters for a safe procedure

Interventional procedures require special attention to coagulation indices. There are widely divergent opinions about the safe values of these indices for percutaneous biopsies. The suggested values were considered based on the references cited below:

• platelet count
  • platelet >50000/mm (some institutions determine other values between 50000-100000/mm) 
• coagulation profile
  • some studies showed that having a normal INR or prothrombin time is no reassurance that the patient will not bleed after the procedure:
    • international normalized ratio (INR) ≤1.5-1.8 range
    • normal prothrombin time (PT)/partial thromboplastin time (PTT)