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Seeding after US-guided biopsy
S56
Ultrasound in Medicine & Biology
chemotherapy or image-guided ablation with RF, MW, cryo or similar techniques. Use of CEUS and fusion may enable biopsy of otherwise ultrasound invisible lesions. Use of CEUS and fusion may change the classic indications for biopsies and reduce the number of diagnostic biopsies. US-guided biopsies, however, will still be required in case of equivocal findings and likely will continue to serve as Gold-Standard. In addition, CEUS may visualize bleeding related to interventional US thus reducing the risk of severe complication. Interventional US has countless applications and recent technological achievements described herein have provided new valuable elements to its use.
Palliative ultrasonography Dieter Nuernberg Professor for Gastroenterology, Medical School Brandenburg Theodor Fontane, Neuruppin, Germany The lecture summarizes ultrasound applications in palliative care medicine. Which is the part of Sonography in Palliative Medicine? 1. Sonography is an important diagnostic instrument in the detection of palliative situations (in oncological staging). 2. Sonography allows with limited technical effort the monitoring of palliative patients, esp. in detection in situations what need an intervention. 3. A lot of palliative Intervention are possible and useful under sonographically guidance. 4. Palliative Interventions for control of symptoms are not only useful in symptoms control in the hospital but also for outpatients with mobile technique. 5. Last not least ultrasonography is a clinical and low wearing diagnostic method for the patients. Its a dialogic method with high personal care and personal nearness. Its a real point of care method with support for the patient to the end of live.
Seeding after US-guided biopsy Torben Lorentzen Dept of Gastric Surgery, Herlev Hospital, University of Copenhagen, Denmark Percutaneous needle biopsy is almost exclusively performed under imaging guidance, using either ultrasound or computed tomography. Although accepted as a relatively safe procedure, percutaneous needle biopsy is certainly not risk-free. One of the potential serious complications after a percutaneous biopsy is tumor seeding which is relatively poorly understood and documented. Neoplasm seeding is defined as a local implantation of tumor cells by contamination of instruments and surgical equipment resulting in local growth of the cells and tumor formation (according to the National Library of Medicine of the National Institutes of Health, USA). Frequency and mechanisms behind tumor seeding after biopsy are poorly elucidated. In the four largest surveys the range of the needle tract seeding after biopsy of abdominal lesions was miniscule (0 0.009%). Common to these relatively old studies was that they were based on patient and doctor reporting, without performing an active cross-sectional imaging verified tracing of seeding; and therefore the true seeding rate was probably greatly underestimated. Sparsely documented incidences in the more recent studies of the colorectal neoplasm seeding following liver biopsy vary between 10% and 19%. These data consist primarily of relative small case series and
Volume 45, Number S1, 2019 reports limited by small sample size. The reported high seeding rates are therefore probably greatly overestimated in these studies. Some authors suggest that invasive diagnostic procedures should be carefully considered due to risk of seeding which can change a potentially respectable localized cancer to an unrespectable one. Neoplasm seeding has been a subject of particular concern for liver surgeons. Tumor seeding is a well-known phenomenon after traditional open surgical procedures as well as after laparoscopic procedures. Tumor seeding has also been reported after ultrasound guided radiofrequency ablative procedures. Experimental studies have shown cancer cell leakage in the needle tract in the majority of biopsy cases. How do we reduce tumor seeding? The co-axial biopsy technique, whereby the biopsy needle is inserted through an introducing needle, is popular with many practitioners who cite improved needle stability and the ability to obtain multiple cores using only one initial puncture as strong advantages of this system. It has been suggested that the co-axial technique reduces the risk of needle tract seeding by isolating the biopsy specimen from the needle tract when the sample is withdrawn. Unfortunately no randomized studies have proved this yet. Furthermore, seeding after using the co-axial biopsy technique has been described. The use of contrast enhanced ultrasound can reduce the need for ultrasound guided liver biopsy in many cases, and this procedure should be reserved to unclear cases approved by the local multidisciplinary team and to cases where oncologic treatment is planned.
SESSION 11I: PAEDIATRICS Meningitis and complications Lino Piotto Tutor Sonographer, Women’s and Children’s Hospital, Adelaide, SA, Australia Meningitis is inflammation of the pia mater, arachnoid and subarachnoid space. Meningitis is caused by infection, by bacteria or viruses. The most common cause of meningitis is viral infection that usually resolves without treatment. Bacterial meningitis is an extremely serious illness which may affect children of any age, but the most susceptible are infants under one month of age and immunosuppressed children. Children who have had bacterial meningitis have a one in four chance of being left with a permanent disability such as deafness, blindness, cerebral palsy, seizures, hydrocephalus or cognitive impairment. The signs and symptoms of meningitis in babies and young children include fever, vomiting, irritability, drowsiness, skin rash and headache. Meningitis is sometimes difficult to diagnose and requires laboratory analysis of cerebrospinal fluid. The role of ultrasound in infants with meningitis is to evaluate for complications. In the early stages of bacterial meningitis the ultrasound findings are usually normal. However as the disease progresses there may be sonographic findings such as echogenic sulci or parenchyma, ventriculitis, ventriculomegaly, venous thrombosis, infarction and abscess formation. Subdural effusions may also be present over the frontal and parietal convexities. Late sequelae include hydrocephalus, brain atrophy and cystic encephalomalacia.
Paediatric hydrocephalus - size does matter! San Tran Sonographer, Royal Children’s Hospital, Melbourne, VIC, Australia Hydrocephalus refers to a pathological condition that occurs when there is an excessive accumulation of cerebrospinal fluid (CSF) in the head. Hydrocephalus can either be congenital, resulting from disturbance in the development of the CSF pathways or alternatively, it is acquired due to secondary events resulting in blockage to circulation
Ultrasound in Medicine & Biology
chemotherapy or image-guided ablation with RF, MW, cryo or similar techniques. Use of CEUS and fusion may enable biopsy of otherwise ultrasound invisible lesions. Use of CEUS and fusion may change the classic indications for biopsies and reduce the number of diagnostic biopsies. US-guided biopsies, however, will still be required in case of equivocal findings and likely will continue to serve as Gold-Standard. In addition, CEUS may visualize bleeding related to interventional US thus reducing the risk of severe complication. Interventional US has countless applications and recent technological achievements described herein have provided new valuable elements to its use.
Palliative ultrasonography Dieter Nuernberg Professor for Gastroenterology, Medical School Brandenburg Theodor Fontane, Neuruppin, Germany The lecture summarizes ultrasound applications in palliative care medicine. Which is the part of Sonography in Palliative Medicine? 1. Sonography is an important diagnostic instrument in the detection of palliative situations (in oncological staging). 2. Sonography allows with limited technical effort the monitoring of palliative patients, esp. in detection in situations what need an intervention. 3. A lot of palliative Intervention are possible and useful under sonographically guidance. 4. Palliative Interventions for control of symptoms are not only useful in symptoms control in the hospital but also for outpatients with mobile technique. 5. Last not least ultrasonography is a clinical and low wearing diagnostic method for the patients. Its a dialogic method with high personal care and personal nearness. Its a real point of care method with support for the patient to the end of live.
Seeding after US-guided biopsy Torben Lorentzen Dept of Gastric Surgery, Herlev Hospital, University of Copenhagen, Denmark Percutaneous needle biopsy is almost exclusively performed under imaging guidance, using either ultrasound or computed tomography. Although accepted as a relatively safe procedure, percutaneous needle biopsy is certainly not risk-free. One of the potential serious complications after a percutaneous biopsy is tumor seeding which is relatively poorly understood and documented. Neoplasm seeding is defined as a local implantation of tumor cells by contamination of instruments and surgical equipment resulting in local growth of the cells and tumor formation (according to the National Library of Medicine of the National Institutes of Health, USA). Frequency and mechanisms behind tumor seeding after biopsy are poorly elucidated. In the four largest surveys the range of the needle tract seeding after biopsy of abdominal lesions was miniscule (0 0.009%). Common to these relatively old studies was that they were based on patient and doctor reporting, without performing an active cross-sectional imaging verified tracing of seeding; and therefore the true seeding rate was probably greatly underestimated. Sparsely documented incidences in the more recent studies of the colorectal neoplasm seeding following liver biopsy vary between 10% and 19%. These data consist primarily of relative small case series and
Volume 45, Number S1, 2019 reports limited by small sample size. The reported high seeding rates are therefore probably greatly overestimated in these studies. Some authors suggest that invasive diagnostic procedures should be carefully considered due to risk of seeding which can change a potentially respectable localized cancer to an unrespectable one. Neoplasm seeding has been a subject of particular concern for liver surgeons. Tumor seeding is a well-known phenomenon after traditional open surgical procedures as well as after laparoscopic procedures. Tumor seeding has also been reported after ultrasound guided radiofrequency ablative procedures. Experimental studies have shown cancer cell leakage in the needle tract in the majority of biopsy cases. How do we reduce tumor seeding? The co-axial biopsy technique, whereby the biopsy needle is inserted through an introducing needle, is popular with many practitioners who cite improved needle stability and the ability to obtain multiple cores using only one initial puncture as strong advantages of this system. It has been suggested that the co-axial technique reduces the risk of needle tract seeding by isolating the biopsy specimen from the needle tract when the sample is withdrawn. Unfortunately no randomized studies have proved this yet. Furthermore, seeding after using the co-axial biopsy technique has been described. The use of contrast enhanced ultrasound can reduce the need for ultrasound guided liver biopsy in many cases, and this procedure should be reserved to unclear cases approved by the local multidisciplinary team and to cases where oncologic treatment is planned.
SESSION 11I: PAEDIATRICS Meningitis and complications Lino Piotto Tutor Sonographer, Women’s and Children’s Hospital, Adelaide, SA, Australia Meningitis is inflammation of the pia mater, arachnoid and subarachnoid space. Meningitis is caused by infection, by bacteria or viruses. The most common cause of meningitis is viral infection that usually resolves without treatment. Bacterial meningitis is an extremely serious illness which may affect children of any age, but the most susceptible are infants under one month of age and immunosuppressed children. Children who have had bacterial meningitis have a one in four chance of being left with a permanent disability such as deafness, blindness, cerebral palsy, seizures, hydrocephalus or cognitive impairment. The signs and symptoms of meningitis in babies and young children include fever, vomiting, irritability, drowsiness, skin rash and headache. Meningitis is sometimes difficult to diagnose and requires laboratory analysis of cerebrospinal fluid. The role of ultrasound in infants with meningitis is to evaluate for complications. In the early stages of bacterial meningitis the ultrasound findings are usually normal. However as the disease progresses there may be sonographic findings such as echogenic sulci or parenchyma, ventriculitis, ventriculomegaly, venous thrombosis, infarction and abscess formation. Subdural effusions may also be present over the frontal and parietal convexities. Late sequelae include hydrocephalus, brain atrophy and cystic encephalomalacia.
Paediatric hydrocephalus - size does matter! San Tran Sonographer, Royal Children’s Hospital, Melbourne, VIC, Australia Hydrocephalus refers to a pathological condition that occurs when there is an excessive accumulation of cerebrospinal fluid (CSF) in the head. Hydrocephalus can either be congenital, resulting from disturbance in the development of the CSF pathways or alternatively, it is acquired due to secondary events resulting in blockage to circulation