Update on Imaging-Guided Needle Biopsy

By Lynn A. Brody, MD  |  Thursday, November 14, 2013

While needle biopsy may not be the most glamorous procedure performed in our Center for Image-Guided Intervention (CIGI), it is surely one of the most important. As the oncologic community embraces the quest for personalized cancer treatment, information regarding the genetic profile of each patient’s tumor(s) is increasingly essential. Providing adequate tissue for analysis has become critical. It is also crucial that the tissue be acquired as safely, accurately, and comfortably as possible.

Fortunately, as indications for needle biopsy have grown, the imaging equipment used to guide these biopsies has improved and the scope of lesions now amenable to needle biopsy has broadened. We are now able to reliably diagnose malignant lung nodules as small as 6 or 7 mm and to sample tumors visible only by PET or MRI.

We owe our high diagnostic rate to many factors. One is our state-of-the-art imaging equipment, including PET, MRI, ultrasound, CT, and image-fusion technology. Another is the fact that there is a representative from the cytopathology laboratory on-site to review every biopsy specimen to determine the likelihood that diagnostic material has been acquired. Finally, the extremely high volume of biopsy procedures — nearly 3,000 per year, including more than 1,000 lung biopsies — ensures that the team involved in every biopsy is extremely experienced.

As important as obtaining diagnostic material is making sure that every patient is safe and comfortable throughout the procedure and the recovery period. Sedation is provided for every biopsy, and general anesthesia can be arranged. Patients are monitored during the procedure by a nurse with special training and experience in interventional radiology or by a certified registered nurse anesthetist.

After the procedure, patients recover in individual recovery pods, overseen by several physician assistants, nurse practitioners, and nurses with specialty experience in post-procedure care and interventional radiology.

Some of our recent biopsy-related research has focused on validating imaging biomarkers for diagnosis as well as treatment response, quantifying DNA and RNA obtained in biopsy specimens to help guide both needle selection and number of biopsies performed, and studying the relationship between PET activity and tumor cells in biopsy specimens.