Is the presence of onsite pathology necessary for percutaneous core biopsy?

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

TB

Timothy Brown, DO

Resident
University of Minnesota

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Donna D'Souza, MD, FSIR

Associate Professor
University of Minnesota

Disclosure(s):

Timothy Brown, DO: No financial relationships to disclose

Donna D'Souza, MD: No relevant disclosure to display

Purpose: The presence of onsite pathology (OSP) is believed to improve the diagnostic yield of percutaneous core biopsies (PCB). We previously presented preliminary 1-year data comparing lesional PCB with and without OSP showing no statistically significant difference in diagnostic yield, but longer procedure and sedation times {1}. The purpose of this study is to evaluate a larger sample at the same satellite hospital over 4 years with subanalysis of biopsy location and tissue type.

Materials and Methods:
Records of adult patients who underwent PCB from 2018-2022 were retrospectively reviewed. Only biopsies that would typically qualify for OSP were included - lesional biopsies (87%) and random kidney and transplant pancreas biopsies (13%). Primary endpoints were diagnostic yield and procedure time. Secondary data included location of biopsy and tissue type. Statistical analysis was performed using Fisher exact or one tailed T tests.

Results: A total of 271 adult biopsies were included. Mean patient age was 57. 139 biopsies with OSP present, and 132 without OSP present. Overall diagnostic yield was not statistically significant between the OSP and non-OSP groups (p=0.43). When analyzed separately, there was no difference in diagnostic yield for lesional biopsies (p=0.49) or random kidney and transplant biopsies (p=0.20) whether or not OSP was present. The most common location for non-diagnostic biopsy (NDB) was bone lesions (43% of NDB) but there was also no difference in diagnostic yield whether or not OSP was present (p=0.191). Lesional PCB mostly resulted in carcinoma (45%), benign tumor (19%), mesenchymal (17%), and lymphoma (12%). Carcinoma diagnostic yield with OSP and without OSP was not statistically significant (p=0.49). Mean procedure time with OSP was 35.5 min vs 27.9 min without OSP (P=< 0.001).

Conclusion: Our results show a significantly increased procedure time with the use of OSP for PCBs, without commensurate improvement in diagnostic yield. This holds true for both lesional biopsies and random kidney and transplant pancreas biopsies, where OSP is commonly used, and also for bone lesions which had the largest percent of NDB results. In this current climate of healthcare worker shortages, it may be prudent to consider whether the routine use of on-site pathology is necessary, and further evaluation is needed to identify when OSP might be most beneficial.