Percutaneous endovascular biopsy of intravascular masses: efficacy and safety in establishing pre-therapy diagnosis.

PURPOSE

To evaluate the efficacy and safety of percutaneous endovascular biopsy (PEB) in intravascular filling-defect lesions (IVLs) of the great vessels.

MATERIAL AND METHODS

We retrospectively reviewed 19 patients (age 65 ± 12 years), 11 men and eight women, who underwent PEB for IVLs, between March 2004 and November 2014. All PEBs were performed for early diagnosis and/or characterization of the IVL, or in case of reasonable doubt about the IVL nature. Pre-intervention imaging work-up included CT, MRI and/or PET-CT. PEBs were obtained with a 7F biopsy forceps device. Clinical profile, procedure technical success and safety, and clinical success were evaluated.

RESULTS

PEB was technically successful in all patients (mean of two samples per IVL). No intra- or post-procedural complications were reported. Histopathological analysis provided a diagnosis in all PEBs with a clinical success of 100%. Of the 19 IVLs, 14 were malignant (74%). The most frequent malignant lesion observed was leiomyosarcoma (29%). Benign lesions (26%) included three thrombi (pulmonary artery) and two myxomas.

CONCLUSION

PEB is a safe and efficient procedure providing the most effective technique to obtain a tissue sample of high diagnostic quality, which serves to establish early diagnosis in patients with suspected malignant lesions.

KEY POINTS

• Intravascular filling-defect lesions are related to both benign conditions and malignant tumours. • Endovascular biopsy is indicated in case of doubt about intravascular lesion nature. • Percutaneous endovascular biopsy is a safe technique. • Endovascular biopsy provides tissue samples leading to correct histopathological analysis. • Percutaneous endovascular biopsy provides early diagnosis of malignant intravascular lesions.