IGPNBImage-Guided Percutaneous Needle Biopsy
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Computed tomography is well developed as an image guidance technique for IGPNB of all body regions.
However, scan times have been greatly reduced through the application of helical CT to IGPNB,[36] and dynamic needle imaging became possible with development of real-time CT fluoroscopy.[37] If radiation exposure is contraindicated, sonography may be a better choice for image guidance.
MR guidance for IGPNB is appropriate for lesions that are not visible on other techniques.
A variety of needles are available for IGPNB, some with broad applicability and some very specialized.
Techniques for performing IGPNB differ by the type of instrument used to retrieve the sample and the type of tissue specimen needed for diagnosis of the suspected lesion.
For IGPNB in the thorax, Tarver[59] recommends a coaxial system for smaller lesions and those that require extended imaging procedures for proper needle placement.
The final step in performing an IGPNB is proper handling, preparation and analysis of the specimen.
Although the procedural aspects discussed above represent the general IGPNB procedure, there are variations in technique for different body regions and organs.
The gold standard for breast biopsy is surgical excision of all or part of the lesion.[86] However, techniques for IGPNB of the breast have been developed to reduce the need for surgical biopsy in some categories of abnormalities identified on breast imaging studies.
PCNB can be used as the primary method of IGPNB in the breast or as an adjunct to FNAB when findings are equivocal.
The choice of imaging technique for IGPNB of the breast is based on characteristics of the lesion, such as visibility, location or presence of calcifications, and experience or preference of the practitioner.[94] Mammography, stereotactic mammography, sonography, CT, MR and radionuclide scanning have been used successfully as guidance techniques, with stereotactic mammography the most popular.
When sonography is used as a guidance technique for IGPNB of the breast, high-frequency (7.5 MHz or higher) transducers are recommended.[86]