Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Straße, Gebäude 50.1, 66421, Homburg, Germany.
Eur Radiol. 2019 Sep;29(9):5007-5012. doi: 10.1007/s00330-019-06015-z. Epub 2019 Feb 22.
To evaluate technical feasibility and safety of endovascular tumor specimen sampling using an escalating endovascular biopsy strategy using a directional atherectomy device compared with forceps biopsy and catheter aspiration.
Between 2013 and 2017, a cohort of ten consecutive patients (6 male; median age 56, range 39-73 years) was referred for sampling of endovascular masses. Localizations included the abdominal aorta (n = 4), left brachiocephalic vein (n = 2), inferior vena cava (n = 1), and left pulmonary artery (n = 3). For each individual mass, all three endovascular tissue sampling approaches were applied including catheter-based aspiration, straight two-jaw biopsy forceps, and directional atherectomy during a single session.
Aspiration and forceps biopsy did not provide sufficient material for histological analyses. In contrast, technical success for endovascular tumor sampling using directional atherectomy was 100%. After two atherectomy passages, sufficient material was available for each vessel region allowing histologic diagnosis, which revealed sarcoma and chronic inflammation for masses in the aorta, angiosarcoma for brachiocephalic vein, hepatocellular carcinoma for inferior vena cava, and angiosarcoma for pulmonary artery. In case of a histologically benign diagnosis, no malignant tumor proliferation was obvious on follow-up imaging studies after 3 months and 1 year. Thus, the rate of false-negative results was considered 0%. No procedure-associated complications, e.g., vessel perforation, were recorded.
Preliminary results in a limited number of patients proved directional atherectomy beneficial as a safe and feasible technique for endoluminal tissue sampling of vascular masses. Additional large-scale studies are necessary and worthy for further evaluation in clinical practice.
• Endovascular masses pose a challenge to appropriate clinical management. • Off-label directional atherectomy proved to be a safe and feasible technique for endoluminal tissue sampling of vascular masses. Furthermore, directional atherectomy was superior to aspiration or forceps biopsy in our small study cohort. • Directional atherectomy may represent the last or only option for tissue probing as a prerequisite for further treatment decisions.
评估使用定向旋切装置逐步升级的腔内肿瘤标本取样的技术可行性和安全性，与活检钳活检和导管抽吸相比。
2013 年至 2017 年间，连续 10 例患者（6 例男性；中位年龄 56 岁，范围 39-73 岁）被转诊进行腔内肿块取样。病变部位包括腹主动脉（n=4）、左头臂静脉（n=2）、下腔静脉（n=1）和左肺动脉（n=3）。对于每个单独的肿块，在单个治疗过程中，所有三种腔内组织取样方法均应用于包括基于导管的抽吸、直双爪活检钳和定向旋切。
抽吸和活检钳活检均未提供足够的组织学分析材料。相比之下，使用定向旋切的腔内肿瘤取样技术成功率为 100%。两次旋切后，每个血管区域均获得了足够的组织材料，可进行组织学诊断，结果显示主动脉内肿块为肉瘤和慢性炎症，头臂静脉为血管肉瘤，下腔静脉为肝细胞癌，肺动脉为血管肉瘤。对于组织学良性诊断，如果在 3 个月和 1 年后的随访影像学研究中没有发现恶性肿瘤的明显增殖，则认为假阴性结果的发生率为 0%。没有记录到与程序相关的并发症，例如血管穿孔。
在有限数量的患者中初步结果表明，定向旋切作为一种安全可行的技术，有利于血管肿块的腔内组织取样。需要进一步评估其在临床实践中的安全性和有效性。
腔内肿块对适当的临床管理构成挑战。
定向旋切在我们的小研究队列中被证明是一种安全且可行的血管内组织取样技术，与抽吸或活检钳相比具有优势。
定向旋切可能代表进一步治疗决策的组织探查的最后或唯一选择。
