Objective: In the United States, CT is generally considered the guidance technique of choice for biopsy of abdominal, pelvic, and retroperitoneal lymph nodes. The aim of this study was to evaluate the efficacy of sonography for this purpose.
Subjects and methods: We attempted 26 sonographically guided biopsies of five abdominal, six pelvic, and 12 retroperitoneal lymph nodes in 23 patients. The patients included 19 women and four men who were 26-76 years old (mean, 50 years old). The nodes were less than 2 cm in 16 patients, 2-3 cm in four patients, and greater than 3 cm in three patients. Biopsies were considered successful if the nodes could be visualized and biopsied using sonographic guidance and the pathologist's final report indicated that the tissue specimens obtained were adequate for diagnosis. The length of the procedures and the number of complications were recorded.
Results: Lymph nodes were visualized and biopsied with sonographic guidance in 23 (88%) of the 26 attempts. Three biopsies could not be performed with sonography because of poor visualization of the nodes. Adequate tissue for cytologic or histologic evaluation was obtained in 21 (91%) of the 23 sonographically guided procedures. In the 21 successful procedures, clinical and imaging follow-up showed no evidence of false-negative diagnoses. The time from the placement of the patient in the interventional sonography room to completion of the procedure ranged from 25 to 60 min (mean, 35 min) for sonographically guided biopsies. We had no procedure-related complications.
Conclusion: Sonography is an accurate and safe guidance technique for lymph node biopsies in the abdomen, pelvis, and retroperitoneum. This technique is efficacious for deep nodes as small as 1 cm in diameter. The advantages of sonography over CT include no need for ionizing radiation, portability, shorter procedure time, and real-time visualization of the needle throughout the procedure. These advantages, and the fact that sonography costs less than CT, suggest that sonography is a more appropriate guidance technique in this era of cost containment.