Introduction

• For use in the investigation of:

Liver

• Jaundice.
• Unexplained raised liver enzymes.
• Abnormal appearance of liver on ultrasonographic examination Ultrasonography: liver.
• Suspected congenital portosystemic shunts Congenital portosystemic shunt (CPSS).
• Diffuse liver disease Liver: chronic disease - overview (inflammatory, infiltrative, neoplastic).
• Mass lesions.

Kidney disease

• Diffuse diseases (acute or chronic nephritis).
• Protein losing nephropathy.
• Mass lesions.

Intestine

• Mass lesions.

Thorax

• Mass lesions of chest wall, mediastinum or lung.

Lymph nodes

• Lymphadenopathy Lymphadenopathy.

Prostate

• Diffuse or multifocal non-cystic prostatic disease Prostate disease.
• Solid prostatic masses.

Advantages

• Low cost.
• Minimally-invasive.
• Rapid.
• Straightforward in hands of experienced operator.
• Short time requirement.
• May be performed without general anesthesia under certain circumstances.

Disadvantages

• Requires patient's coat to be clipped.
• Difficult to obtain samples in obese patients, from deeply located structures, highly vascularized lesions and in the presence of a large amount of fluid.
• Samples may be non-diagnostic or non-representative of disease process.
• Risk of serious complications (bleeding, penetration of viscera, introduction or spread infection, seeding of neoplasia).
• Requires significant operator skill.
• General anesthesia General anesthesia: overview may be required.

Potential problems

• Hemorrhage:
  • Hemorrhage may be more likely with neoplastic lesions.
  • More complications reported following kidney biopsy.
  • Complications more likely with thrombocytopenia Hematology: packed cell volume , prolonged PT (dogs) Hematology: prothrombin time and APTT (cats).
• Penetration of other viscera.
• Inadequate patient restraint:
  • Movement could result in laceration of vessels or organ.
• Operator inexperience.
• Excess intestinal gas or large gall bladder may limit visibility of target tissue.
• Inadequate equipment (needle diameter too small or too long, blunt needle).
• Failure to visualize needle due to improper technique or patient factors (obese, excessive respiratory movement).
• Target may be too small to safely obtain sample (particularly in small dogs and cats).
• Non-diagnostic sample:
  • Fibrotic or cirrhotic livers may be very firm and difficult to penetrate serosal surface.
  • Fibrotic or cirrhotic livers may produce poor samples despite the use of new needles and be associated with fragmentation of sample.
  • Sample size may be too small.
  • Sample not from affected area (multifocal disease).

Alternatives

• Exploratory surgery, laparoscopy, ultrasound-guided fine needle aspirate Fine needle aspirate: ultrasound-guided.

Equipment

Patient preparation

Technique

Complications

Further Reading

Publications

Refereed papers

• Recent references from PubMed and VetMedResource.
• Groman R P, Bahr A, Berridge B R et al (2004) Effects of serial ultrasound-guided renal biopsies on kidneys of healthy adolescent dogs. Vet Radiol Ultrasound 45 (1), 62-69 PubMed.
• Rawlings C A, Diamond H, Howerth E W et al (2003) Diagnostic quality of percutaneous kidney biopsy specimens obtained with laparoscopy versus ultrasound guidance in dogs. JAVMA 223 (3), 317-321 PubMed.
• Bigge L A, Brown D J & Penninck D G (2001) Correlation between coagulation profile findings and bleeding complications after ultrasound-guided biopsies: 434 cases (1993-1996). J Am Anim Hosp Assoc 37 (3), 228-233 PubMed.
• Drost W T, Henry G A, Meinkoth J H et al (2000) The effects of a unilateral ultrasound-guided renal biopsy on renal function in healthy sedated cats. Vet Radiol Ultrasound 41 (1), 57-62 PubMed.
• de Rycke L M, van Bree H J, Simoens P J (1999) Ultrasound-guided tissue-core biopsy of liver, spleen and kidney in normal dogs. Vet Radiol Ultrasound 40 (3), 294-299 PubMed.
• Lamb C R, Trower N D, Gregory S P (1996) Ultrasound-guided catheter biopsy of the lower urinary tract: technique and results in 12 dogs. J Small Anim Pract 37 (9), 413-416 PubMed.
• Barr F (1995) Percutaneous biopsy of abdominal organs under ultrasound guidance. J Small Anim Pract 36 (3), 105-113 PubMed.
• Léveillé R, Partington B P, Biller D S et al (1993) Complications after ultrasound-guided biopsy of abdominal structures in dogs and cats: 246 cases (1984-1991). J Am Vet Med Assoc 203 (3), 413-415 PubMed.
• Yamamoto K, Ishiyama N, Yamaga Y et al (1991) Ultrasound-guided techniques for biopsy of the kidney of the medium-sized dog. J Vet Med Sci 53 (2), 345-346 PubMed.
• McNamara M P Jr. (1989) Percutaneous procedures guided by color-flow Doppler sonography. AJR Am J Roentgenol 152 (5), 1123-1125 PubMed.
• Smith S (1989) Ultrasound-guided biopsy. Semin Vet Med Surg (Small Anim) 4 (1), 95-104 PubMed.
• Smith S (1985) Ultrasound-guided biopsy. Vet Clin North Am Small Anim Pract 15 (6), 1249-1262 PubMed.