Focal splenic lesions: The value of ultrasound guided biopsies after contrast enhanced ultrasound in correlation with clinical informations

Purpose: Due to the high rate of benign splenic lesions which do not require whether further workup nor follow up it is necessary to preselect patients which benefit from a histological confirmation. We could show that hypoenhancement in the late phase of contrast enhanced ultrasound (CEUS) predicts malignancy in a high percentage of patients. Percutaneous biopsy poses a risk of severe complications but has shown to be similarly safe as liver biopsy. Splenectomy should not be considered as a first choice treatment since it is associated with a higher rate of complications than formerly assumed.

Material and methods: We investigated patients with splenic lesions showing hypoenhancement in the late phase of CEUS in which transabominal ultrasound guided biopsy with an 18 G trucut needle was used. We compare the histological results and the clinical informations.

Results: In 43 patients there were 3 (7%) complications of which 2 (5%) were major complications. There were no associated deaths and no splenectomy. The histological results were: Lymphoma 12 (28%), hemangioma 6 (14%), splenoma 5 (12%), metastasis 4 (9%), candida abscesses 3 (7%), tuberculosis, littoral cell angioma, unspecific granuloma 2 each (5%), histoplasmosis, sarcoidosis, atypical mycobacteriosis, amyloidosis, hemophagocytosis syndrome, pyogenic abscess, regenerative splenic tissue 1 each (2%). 63% of the lesions were benign, 72% were of clinical relevance. In detail, patients without clinical symptoms (n = 8) had 38% relevant lesions, patients with immunosuppression (stem cell transplantation, HIV, n = 5) had relevant lesions in 100%, patients with suspected infection (n = 7) had 100% relevant lesions, patients with suspected hematooncologic lesions (n = 13) had 77% relevant lesions, patients with known solid malignoma (n = 6) had relevant lesions in 33%.

Conclusion: Contrast enhanced ultrasound showing hypoenhancement in the late phase is a valuable tool to discriminate a cohort of patients with a high probability of relevant results thus preventing unnecessary biopsies.