The role of computed tomography-guided needle biopsy in an oncology service

Sixty percutaneous biopsies have been carried out on patients with known or suspected malignant disease, using computed tomography (CT) for needle guidance. We describe our technique of obtaining material for histological or cytological examination using four types of needle. The results in 50 patients have been analysed to show the accuracy of the technique and evaluate its role in management. Malignancy was correctly diagnosed in 27 patients and correctly excluded in 12 patients, with one technical failure. The technique failed to demonstrate malignancy in 11 patients, all of whom proceeded to an alternative biopsy technique on clinical grounds. All false negative examinations occurred when fine-needle aspiration provided material for cytological examination only. The technique had an overall accuracy of 78%. Biopsy of retroperitoneal lymph nodes may be difficult technically. False negative examinations are particularly likely when fine-needle aspiration is used in patients with lymphoma. Chemotherapy or radiotherapy was started in 21 patients as a result of the procedure and chemotherapy changed to an appropriate regime in two patients. Treatment, including surgery, was deferred in 14 patients. Surgery was avoided when CT showed an inoperable lesion and where biopsy confirmed active metastases. Computed tomography-guided biopsy is an accurate, safe and effective technique: CT should be used for needle guidance in those situations where fluoroscopy or ultrasound are less reliable.