Percutaneous Image-guided Splenic Biopsy in the Oncology Patient: An Audit of 156 Consecutive Cases

Purpose: To assess the safety and diagnostic accuracy of percutaneous image-guided splenic biopsy in patients known to have or suspected of having malignancy. Materials and Methods: Data from all image-guided splenic biopsies performed at a single institution from January 1992 to March 2007 were retrospectively reviewed. One hundred fifty-six splenic biopsies were performed in 147 patients (78 male and 69 female patients; mean age, 54.9 years; age range, 13-81 years). The most common indications for biopsy were suspected recurrent lymphoma (n = 101, 64.7%), suspected metastatic disease (n = 39, 25%), and unknown diagnosis (n = 16, 10.3%). All biopsies were performed with computed tomographic (n = 86), ultrasonographic (n = 68), or fluoroscopic (n = 2) guidance. Most biopsies (91%) were performed with 22-gauge needles, with a mean of 2.8 passes. The mean lesion size was 3.2 cm (range, 0.8-13 cm). Final diagnosis was confirmed with splenectomy (n = 39), histopathologic correlation with concurrent biopsy or surgical specimen (n = 52), or clinical or imaging follow-up ranging from 2 weeks to 14 years (n = 44). Complications were recorded. Results: Sufficient tissue for pathologic analysis was obtained in 144 of the 156 biopsies (diagnostic yield, 92.3%). The overall sensitivity, specificity, and diagnostic accuracy were 83.4%, 87.8%, and 84.7%, respectively. Complications occurred in 26 biopsies (16.7%), with a 1.9% (n = 3) major complication rate and a 14.7% (n = 23) minor complication rate. Splenectomy was necessary in two patients. Conclusions: Splenic biopsy in the evaluation of new or recurrent neoplasm is a minimally invasive procedure with low complication rates and a high diagnostic yield.