Image-guided percutaneous cutting needle biopsy in difficult locations

During the last 30 years, the techniques of percutaneous biopsy have evolved dramatically and its indications have expanded accordingly. Additionally, recent treatments in oncology have made it necessary to use larger cutting needles in biopsies for tissue analysis. These developments force radiologists to perform biopsies in areas they are not very familiar with. However, lesions in such organs and regions are traditionally considered to be dangerous because of the risk of bleeding and trauma to the critical structures along the needle tract. As a result, radiologists are generally reluctant to perform image-guided biopsies in such locations particularly using cutting needles. We present the images of nine cases from our archive, in whom we performed image-guided percutaneous cutting needle biopsy (PCNB) for lesions located in larynx, tongue, intestines, stomach, deep pelvis, uterus, pancreas, penis and spleen. For each specific location, we also mention alternative biopsy methods, the indications of PCNB, its potential risks and special techniques to avoid complications.