[Abdominal mass in childhood: characterization with fine needle percutaneous biopsy guided with computerized...

CT-guided fine needle aspiration biopsy (FNAB) is known to improve diagnosis of expansile abdominal lesions, especially relative to more invasive procedures like explorative laparotomy. FNAB is not commonly used in pediatric patients because of their poor collaboration and of associated risks. We investigated the feasibility of FNAB in the pediatric age.

Over a 2-year period, we performed CT-guided FNAB of 21 abdominal lesions in a series of pediatric patients ranging in age 10 days to 14 years. Thirteen lesions were in intraperitoneal and 8 in retroperitoneal sites. CT had been performed in all patients but had failed to make a diagnosis. Cytologic samples were obtained with 22-23 G needles; the cytologist was always present to ensure adequate sampling. Follow-up CT was performed to assess the possible onset of complications.

First-pass diagnosis was made in 14 of 21 biopsies and second-pass diagnosis in 5; histology was needed in three cases. Cytologic findings were compared with postoperative histologic results in 13 cases; clinical follow-up and further instrumental studies confirmed the diagnosis in nonsurgical patients.

CT-guided FNAB can be performed in pediatric patients with accuracy and confidence. These patients' age calls for great skills of the operator and possible contraindications must be accurately evaluated; complications must not be neglected. FNAB should be performed during CT examination because young patients often require anesthesia. The pathologist's presence during biopsy permits to repeat sampling, if necessary, without repeating the anesthesia. CT-guided FNAB is a valid alternative to explorative laparotomy in the workup of expansile abdominal masses also in pediatric patients.