The Role of Imaging-Guided Pelvic or Retroperitoneal Biopsies in Patients with Suspected Gyencological Neoplasms
A Malpica, ED Euscher. The University of Texas M.D. Anderson Cancer Center, Houston, TX
Background: Imaging-guided pelvic or retroperitoneal biopsies (bxs) have become a tool in the work-up of patients with a suspected gynecological neoplasm. We present our experience with 37 cases of suspected gynecological tumors that underwent an imaging-guided pelvic or retroperitoneal bx as part of their work-up.
Design: In a period of 36 mos 65 women underwent a pelvic or retroperitoneal mass CT-, MRI- or ultrasound-guided bx as part of their work-up. 37 of them were suspected to have a gynecological neoplasm. The pathology reports and medical charts of all these cases were reviewed. The following information was recorded: indication for the procedure, bx diagnosis (dx), cytology material dx, dx on subsquent bx/surgical procedure if performed.
Results: Indications for the procedure included: initial dx of a neoplasm (8 cases), dx of recurrent neoplasm (21 cases), distinction between a non-gynecological primary versus a gynecological primary (5 cases), assessment of extension of disease (2 cases) and verification of tumor type (1 case). In 31 the imaging-guided bx provided tissue for histologic and cytologic evaluation. In 6 cases only tissue for histologic examination was obtained. The initial dx was provided in 6 cases while the dx of recurrent tumor was provided in 16 cases. In 2 cases, the dxs of non-neoplastic conditions were rendered: 1 abscess and 1 fibrosis post-radiotherapy. In 4 cases, non-gynecological primaries were diagnosed: 2 metastatic breast carcinomas, 1 metastatic gastric carcinoma and 1 metastatic lung carcinoma. In 19% (7/37) of the cases the results of the histology and cytology evaluations were discrepant as follows: bx with tumor and cytology material non-diagnostic, 3 cases; bx with no tumor and cytology material with tumor, 2 cases; bx with fibrous tissue consistent with radiotherapy-induced changes and cytology material non-diagnostic , 1 cas; discrepant tumor dx between histology and cytology material, 1 case (mesothelioma dx on the biopsy and adenocarcinoma on cytology material). In 22% (8/37) of the cases the material obtained by the image-guided bx was considered insufficient for dx.
Conclusions: Image-guided pelvic or retroperitoneal bxs represent a useful tool in the work-up of patients with suspected gynecological neoplasms.The procurement of both histology and cytology material increases the chances of rendering an accurate dxs. Attending physicians need to be aware that dx discrepancies can exist and these can be related to sampling artifact or error in interpretation.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 217, Wednesday Afternoon