CT Guided Biopsy

Computed tomography (CT) is a radiological test that can obtain excellent images of
most parts of the body. These images are obtained in cross sections and then analyzed by
a computer into 3 dimensional images. The detailed images and improved resolution of
most pathology in the body can be effectively seen with this technique. Many a times, a
mass/fluid is seen in an unusual position. CT scan is increasingly being used to confirm
the identity of these abnormal masses. CT guided needle biopsy is widely used all over
North America and is an excellent tool in preventing unnecessary surgery for many
individuals.

Which part of the body can biopsied?

Ct guided biopsy can done almost anywhere in the body, as long as there is a radiologist
trained in the technique. CT scans of the relevant part of the body are done and a needle
is used to obtain a biopsy. The precise location of the needle is guided by the CT scan.
The organs which are common biopsied using Ct scan are the liver, lungs, kidneys,
pelvis, pancreas, pleura, lymph nodes, bone.

What type of pathology can CT scan needle biopsy be used for?

CT needle guided biopsy can be used to make a diagnosis of:

• lung cancer
• kidney cancers
• liver masses
• pancreatic masses
• retroperitoneal masses
• bone
• aspirate fluid in the lung or abdomen
• remove blood (hematoma) from abdomen
• biopsy pleural
• biopsy lymph nodes in neck or groin
• biopsy collections or masse sin extremities
• aspirate fluid from cysts

What are precautions for CT scan?

The patient that suffers from claustrophobia will want to discuss this with their physician.
This procedure involves the patient being placed into the CT scanner, typically a small,
enclosed area. Depending on the specific type of biopsies being performed, certain
anesthetics will be used, so discuss drug allergies with your physician.
What preparations are required?

Before a CT guided biopsy can be done, the individual must get some blood work to
ensure that the kidney function is okay and the coagulation profile (bleeding parameters)
are okay. One is asked not eat for several hours before the procedure. The individual
should always bring old CT scans or x rays to the radiology suite. These are general
preparations for a CT guided biopsy and more details are always available from the
radiologist prior to the procedure.

How is the procedure done?

Once the individual arrives at the radiology site, he or she is asked to lie down on a flat
table. The appropriate part of the body is exposed and the table is moved into the CT
scanner where images are obtained. Once the location of the mass is identified, the body
site is cleaned with an antibiotic solution and draped in a sterile fashion. A small amount
of local anesthetic is injected into the skin. Using a special needle, under x ray guidance
the biopsy of the pathology is obtained. The tissue samples or fluid are then sent to the
pathology department for histological analysis. Once the needle is removed, a small
sterile dressing is applied and the individual is observed for a few hours. The individual
can go home if there are no complications.

What are risks of CT guided biopsy?

Unlike surgery, the risks of CT guided biopsy are infinitely less. However, certain
complications can and do occur and include the following:

• allergy reaction to dye

• renal failure from the use of the contrast dye
• bleeding at the site
• pain
• other complications are based on what site is being biopsied

What happens after the procedure?

The CT guided biopsy generally takes anywhere from 30-60 minutes. Once the procedure
is done, the individual is always observed for at least 2-4 hours. Only in some minor
cases is the individual admitted if there is suspicion of a possible problem. Most
individuals are asked to rest for the next 24 hrs. Following this, all patients can resume
their normal activities?

What are the advantages vs disadvantages of a needle biopsy?

Advantages
• CT guided biopsy is less invasive then surgery
• It can help prevent unnecessary surgery
• There is only need for local anesthesia
 • Is a useful tool in sick patients who may not be candidates for surgery
• Can access sites which may be difficult with surgery
• Is usually an out patient procedure
• Is much cheaper than surgery

Disadvantages

With any technique where needles are inserted in the body, risks can be expected and
these include:

• Bleeding
• Pain
• Other complications depend on where the biopsy is performed

What are the limitations of CT guided Needle Biopsy?

In some cases where the lesion is very small, the needle may not be able to obtain a
decent sample size. In such cases, either a second attempt may be done or surgery.

Needle biopsy is not cost effective when the lesions are less than 1-2 mm

For those individual who have blood disorders, CT guided biopsy may be very risky.

For those individuals with congestive heart failure, CT needle biopsy is not
recommended.

Alternatives to biopsy may include continued follow-up with imaging and surgical
removal of the abnormality.