Image-Guided Percutaneous Biopsy of Gastric Lesions

Hello Believers!

Yesterday I performed USG guided percutaneous biopsy on a case of endoscopy negative gastric mass. Here are some take aways.

- Gastric lesions are most commonly evaluated via "endoscopy with biopsy".

- However, in certain cases — especially when the lesion is "submucosal, extrinsic, or inaccessible endoscopically" — "image-guided percutaneous biopsy" becomes necessary.

- These techniques are increasingly used in "interventional radiology" with good diagnostic yield and safety profiles.

1. Indications for Percutaneous Biopsy

- Endoscopy failure (due to poor access or inadequate sampling)

- Large exophytic gastric masses

- Suspicion of GISTs (Gastrointestinal Stromal Tumors)with extragastric growth

- Lymphomas or metastases presenting as gastric wall thickening

Reference:* Kim JH et al. Radiology*. 2014. CT-guided biopsy for gastrointestinal masses showed high diagnostic accuracy and minimal complications.

 2. Imaging Modalities Used

- CT-guided biopsy: Most common due to superior lesion localization, especially for posterior or extragastric components.

- Ultrasound-guided biopsy: Useful when lesion is superficial or adjacent to the anterior abdominal wall.

📖 *Reference:* Gupta S et al. AJR Am J Roentgenol*. 2002. CT-guided biopsies of intra-abdominal masses, including gastric lesions, demonstrated over 90% diagnostic accuracy.

3. Techniques and Safety

- Coaxial needle systems often used to reduce bleeding risk and allow multiple passes.

- Needle gauge: usually 18G or 20G core needles

- Pre-biopsy planning includes checking for coagulopathy, fasting, and safe needle tract.

- Complications: Rare, but may include bleeding, perforation, or peritonitis.

📖 *Reference:* Silva AC et al. *Abdom Imaging*. 2015. Reported <1% complication rate in over 500 abdominal biopsies including gastric masses.

4. Pathological Yield

- High yield when:

  - Core biopsy used (vs fine-needle aspiration alone)

  - If targets enhancing or solid areas of the lesion

  - Adequate number of passes made

- GISTs, adenocarcinomas, and lymphomas are commonly diagnosed entities.

 📖 *Reference:* Kim MY et al. *World J Gastroenterol*. 2010. Percutaneous biopsy for suspected gastric lymphoma had >90% accuracy and influenced therapy significantly.

Clinical Relevance

- Especially important for "pre-treatment diagnosis in unresectable or metastatic disease".

- Allows for "genetic and immunohistochemical testing" (e.g., c-KIT, DOG1 for GISTs).

- Plays a key role when "surgery is not immediately planned", and systemic therapy decisions hinge on histology.

Dr. Upasana Y