Diagnostic performance of imaging-guided core needle biopsy of the mesentery and peritoneum

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La imagen A corresponde a la TC de abdomen con contraste, en la que se objetiva un nódulo pericecal (flecha). Se realizó una biopsia percutánea del nódulo guiada por TC en decúbito prono. Las imágenes B y la C son detalles de la TC. La imagen B corresponde a la TC realizada sin contraste para planificar la biopsia. Se colocan marcadores metálicos en la superficie cutánea y se localiza el nódulo pericecal (asterisco). La imagen C corresponde a un pase con aguja de 16 G×16cm de longitud. El resultado fue adenocarcinoma poco diferenciado mucosecretor de origen apendicular." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.E. Pérez Montilla, S. Lombardo Galera, J.J. Espejo Herrero, J.M. Sastoque, L. Zurera Tendero" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M.E." "apellidos" => "Pérez Montilla" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Lombardo Galera" ] 2 => array:2 [ "nombre" => "J.J." "apellidos" => "Espejo Herrero" ] 3 => array:2 [ "nombre" => "J.M." 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Schematic drawing showing the location of the MRI and other rooms (C)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. García-Baizán, A. Tomás-Biosca, P. Bartolomé Leal, P.D. Domínguez, R. García de Eulate Ruiz, S. Tejada, J.L. Zubieta" "autores" => array:7 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "García-Baizán" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Tomás-Biosca" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Bartolomé Leal" ] 3 => array:2 [ "nombre" => "P.D." "apellidos" => "Domínguez" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "García de Eulate Ruiz" ] 5 => array:2 [ "nombre" => "S." "apellidos" => "Tejada" ] 6 => array:2 [ "nombre" => "J.L." 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Transverse CT image showing one transverse fracture with involvement of the otic capsule (black arrow) and pneumolabyrinth in the anterior portion of the lateral semicircular canal (white arrow)–a finding that is highly specific of perilymphatic fistula. We can also see the occupation of the middle ear due to blood deposits or perilymph (asterisk), and one isolated pneumoencephalus bubble (arrow head)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Mazón, E. Pont, N. Albertz, J. Carreres-Polo, F. Más-Estellés" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Mazón" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Pont" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Albertz" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Carreres-Polo" ] 4 => array:2 [ "nombre" => "F." 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Pérez Montilla, S. Lombardo Galera, J.J. Espejo Herrero, J.M. Sastoque, L. Zurera Tendero" "autores" => array:5 [ 0 => array:4 [ "nombre" => "M.E." "apellidos" => "Pérez Montilla" "email" => array:1 [ 0 => "marigen_16@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Lombardo Galera" ] 2 => array:2 [ "nombre" => "J.J." "apellidos" => "Espejo Herrero" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Sastoque" ] 4 => array:2 [ "nombre" => "L." "apellidos" => "Zurera Tendero" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Radiología Vascular e Intervencionista, Hospital Universitario Reina Sofía, Córdoba, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Rentabilidad diagnóstica de la biopsia con aguja gruesa guiada por técnicas de imagen del mesenterio y del peritoneo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 810 "Ancho" => 1500 "Tamanyo" => 128076 ] ] "descripcion" => array:1 [ "en" => "Eighty (80) year old woman with constitutional syndrome. Image A corresponds to one abdominal CT scan with contrast showing one polylobulated mass centered in the gastrosplenic ligament that contacts the stomach and infiltrates the spleen (arrow head), and adenopathies in the gastrohepatic ligament. One ultrasound-guided percutaneous biopsy of the tumor represented in image B was performed. Echogenic mass confirmed (asterisk) and the 16 G hyperechogenic needle is one the passes made. The result was a diffuse large B-cell lymphoma." ] ] ] "textoCompleto" => "IntroductionBoth the mesentery and the peritoneum are home to a great variety of pathological processes, both benign and malignant, that may infiltrate them, distort their architecture, or cause thickening of the peritoneal covering. The most common neoplasms that affect the peritoneum are the metastatic carcinoma (of colon, ovary and stomach, and less frequently, of pancreas, bile duct, and uterus), and the lymphoma. Other even more rare etiologies are the bladder carcinoma, the gastrointestinal leiomyosarcomas, and metastatic melanomas. The primary mesenteric carcinoid tumor, the epyplon and peritoneum neoplams are less common and, in general, they have mesenchymal origin. Among the benign process we find granulomatous conditions, hematomas, infections or inflammatory processes–all of them much less commom.<a class="elsevierStyleCrossRefs" href="#bib0070">1–3</a>The metastatic damage may occur in the form of a mass or diffuse infiltration of fat due to contiguity, or lymphatic or hematogenous dissemination. Also, metastatic nodules can be seen both on the peritoneal surface and the mesentery, with variable sizes ranging from a few millimeters to several centimeters conguring genuine masses. In other cases, only the diffuse thickening of the peritoneum is evident. Both the primary peritoneal tumors and the benign processes described can show overlapping findings in the different imaging modalities.<a class="elsevierStyleCrossRefs" href="#bib0070">1–4</a> For all this, it is essential to obtain a specimen to conduct the histological study and know what the origin really is. The biopsy will be particularly important in patients with a history of a known tumor because we will be able to confirm the origin of tumor and know whether it is metastatic, a tumor of a different origin, or a benign lesion, so we can prescribe the most appropriate oncological treatment in each case.<a class="elsevierStyleCrossRef" href="#bib0090">5</a> The laparoscopy procedure allows us to detect peritoneal lesions and obtain tissues, even from different areas of the lesion, in order to be able to make a diagnosis with high diagnostic reliability. However, it is an invasive technique that requires anesthesia and elevates the patient's risk. Today, because of all its complications, it is not the first technique of choice.<a class="elsevierStyleCrossRefs" href="#bib0095">6,7</a>The process of obtaining imaging-guided biopsies is considered a safe procedure that is performed using local anesthesia, has a low incidence of complications and high diagnostic reliability. There are very few publications of series of patients with peritoneal or omental lesions biopsized using ultrasound or computed tomography (CT)-guided core needles, although this technique has a high diagnostic performance and a low rate of complications.<a class="elsevierStyleCrossRefs" href="#bib0090">5,7–11</a>The goal of our work was to evaluate the diagnostic performance of imaging-guided (ultrasound or CT scan) percutaneous core needle biopsies of nodular and diffuse infiltration of the omentum or the peritoneum, and emphasize the diagnostic reliability of this procedure, the imaging modality used, and type of peritoneal damage sustained by each patient.Materials and methodsSelection of patientsWe retrospectively analyzed 57 consecutive patients who had undergone imaging-guided percutaneous biopsies of the peritoneum and the omentum between March 2014 and January 2017. We did not deem it necessary to obtain the approval from our hospital ethics committee given the retrospective and cross-sectional nature of the study. The biopsies were performed by four (4) different radiologists from our hospital Vascular and Interventional Radiology Unit who had between 2 and 30 years of experience.Peritoneal damage was confirmed in all patients after conducting abdominal and pelvic CT scans (Philips Brillance CT 16-slice scanner and General Electric Optima CT 64-slice scanner) after the administration of IV contrast (120ml at a flow rate of 2ml/s) in portal venous phase. Among all the patients with peritoneal damage confirmed through the diagnostic CT scans, ten (10) patients (17.5%) had a prior history of tumors, and forty-seven (47) (82.5%) had non-specific symptoms (fever, or abdominal pain, and no prior history of neoplasms). After clinical-radiologic assessment conducted in multidisciplinary session, or tumor subcommitte held at our center, it was decided to biopsize the patients.Procedure for the performance of ultrasound or CT-guided percutaneous biopsiesThe CT scan conducted for diagnostic purposes was evaluated in order to plan the percutaneous biopsy and decide what imaging modality was going to be used (ultrasound or CT scan) and which was the most reliable access route, while prioritizing avoiding the trajectories of hollow viscera and blood vessels. In general, for deep lesions and interposed loops, we used CT scans. In all the cases, before performing the biopsy, the procedure was explained to the patient and prior written informed consent was obtained; we also studied coagulation (prothrombin activity>60%), and the number of platelets (>50,000/ml).The percutaneous biopsy was conducted under sterile conditions, with local anesthesia (lidocaine) in order to infiltrate the abdominal wall, and in the cases where it was deemed necessary we used conscious sedation (IV administration of diazepam and fentanyl).The imaging modalities used to guide the biopsies were the ultrasound (M-Turbo probe 5–2MHz Curved, Sonosite, Bothell Washington, United States) using the hands-free technique (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and the CT scan (Asteion 4, Toshiba Medical System, Tokyo, Japan). When it comes to the CT scans, several slices of the area of interest were acquired after positioning the patient in order to have a more direct access to the lesion. A decision was made on the most adequate cut and location, and a mark was left on the patient's skin. Prior to obtaining the tissue sample, the location of the biopsy needle was confirmed using one control CT scan, being the core-needle trajectory corrected, or re-placed whenever necessary (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In all patients, one 16G or 18G core needle (Max-Core® Bard® Tempe, Arizona, United States) with lengths between 10 and 16cm was used to perform the biopsy based on the relation between the biopsy and adjacent structures (colon, intestinal loops, or blood vessels), and the deep location of the lesion. The length of the cut was 22mm and four (4) passes were made.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>The tissue samples obtained (three or four cylinders from each patient) were sent to our hospital Unit of Pathological Anatomy while preserved inside a sterile container, with liquid formaldehyde, and correctly identified for histological and immunohistological studies.All patients were placed in observation and remained at the hospital for, at least, 24h with monitoring of their vital signs; signs of bleeding; appearance of pain or fever; or any other possible complications derived from the procedure they had undergone.Data mining and statistical analysisAn Excel 2010 database was opened where each patient's demographic data (age and sex), prior history of tumors, radiologic findings of the biopsized peritoneal lesion, histological results of the percutaneous biopsy, histological result from the specimen obtained through surgery, and clinical-radiologic follow-up were collected (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The CT findings were classified into nodules (n=17), masses (n=24), or diffuse infiltration (n=16), being the nodules defined as tumors ≤3cm, and the masses as sizes >3cm. The tumors were measured on the axial plane both in the transverse and anteroposterior axes, and the largest one was taken into consideration. The diffuse infiltration was defined as the confirmation of an alteration in the architecture of the omentum/peritoneum with increased fat density, trabeculation of fat density, or “omental cake”.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Based on the results obtained from the Unit of Pathological Anatomy, the results were classified as benign, malignant, or inconclusive.The biopsy diagnosis was confirmed with the results coming from the surgery (diagnostic surgical biopsy, or oncological surgery, or both), or after the clinical-radiologic follow-up. In a protocolized way, patients were followed through clinical examination and imaging modalities every 3–6 months.For the statistical analysis, the IBM SPSS software was used (August 2013; IBM SPSS Statistics for Window; version 22.0), and the sensitivity, specificity, and negative predictive values were estimated. Also, it was determined if it was a diagnostic sample, or not, by subgroups. The subgroups were analyzed by type of lesion biopsized (tumor [nodule or mass] and diffuse infiltration), and imaging modality used to guide the procedure (ultrasound or CT scan).ResultsFifty-seven (57) percutaneous biopsies were conducted in 57 patients (6 males and 51 women; average age: 64.05 years old; age range: 23–87 years old). All the samples obtained were diagnostic. One patient was excluded from the follow-up because she died during the biopsy, whose results, although diagnostic, could not be correlated with the results from the surgical biopsy or clinical-radiologic follow-up.Of the remaining 56 biopsies, the result was malignant in 54 (96.42%), and benign in 2 biopsies (3.57%). In none of the cases were the results from the tissue sample obtained in the percutaneous biopsy inconclusive, or insufficient. The histopathological diagnosis achieved during the biopsy is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. In all the cases of percutaneous biopsy with malignant result, the malignant etiology of the peritoneal/omental damage was confirmed: in 23 patients (23/54, 42.59%) after the surgical biopsy, and in the remaining patients (31/54, 57.40%) after the clinical-radiologic follow-up that lasted between 4 and 37 months. In none of the cases whose surgical biopsy we performed, the specific diagnosis of the tumor histology was changed.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The two (2) patients with benign results in the percutaneous biopsy were operated. In one of the patients, the surgical biopsy confirmed this result, but in the other patient it confirmed the malignant origin of the lesion (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Both were male patients, without a prior history of neoplasms, with one mass in the peritoneum. The benign origin of this finding is exceptional because of the histological diagnosis obtained and because, since there were no complications given the location of the surgery, the multidisciplinary committee decided to perform the surgery and the biopsy at the same time.<elsevierMultimedia ident="fig0015"></elsevierMultimedia>The imaging-guided percutaneous core needle biopsy of the peritoneum or the omentum had a 98.18% sensitivity rate (95% confidence interval [95%CI]: 89.3–100%), and a 100% specificity rate (95%CI: 17–100%). The rate of false negatives was 0.018. The negative predictive value was 50% (95%CI: 0–100%), and the positive predictive value was 100% (95%CI: 99.07–100%) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Taking into consideration the pattern of peritoneal damage (diffuse infiltration [n=16], nodule [n=16], or mass [n=24]) from which the biopsy was taken in all the subgroups, the diagnosis was achieved. Taking into consideration the imaging modality used to guide the biopsy (CT scan [n=9], or ultrasound [n=47]), the sample turned out diagnostic in all the patients, with a 100% sensitivity rate (95%CI: 62.2–100%) and a 97.9% sensitivity rate (95%CI: 87.7–100%) for each one of the groups, respectively.No cases of minor complications were reported after the biopsy. One patient suffered from sweating, hypotension, and dropping hematocrit levels six (6) hours after undergoing the procedure. The angio-CT scan performed confirmed an active bleeding in the anterior rectus muscle, probably coming from the epigastric artery. An embolization procedure was attempted through endocascular access, but the patient died. This made the rate of complications go up to 1.75%.DiscussionBased on our own results, the core needle biopsy of the peritoneum allows achieving adequate diagnoses of true peritoneal masses, small nodules, and diffuse infiltration. The sensitivity rate is very high: 98.18% (95%CI: 89.3–100%), and the specificity rate is 100% (95%CI: 17–100%, with the limitations associated with this huge confidence interval).The rate of complications is very low (1.75%), although they may be serious. Both the ultrasound and the CT scan may be used interchangeable to guide the biopsy.Historically, patients with peritoneal carcinomatosis have been operated through laparotomy procedures, or exploratory laparoscopies that allowed obtaining surgical biopsies and assessing the criteria for resectability. Both techniques allow us to detect peritoneal lesions, and even obtain biopsies of different areas of the lesion, but they require anesthesia and have a higher rate of complications.<a class="elsevierStyleCrossRefs" href="#bib0095">6,7</a>Ever since Pombo et al.<a class="elsevierStyleCrossRef" href="#bib0125">12</a> published their series on CT-guided percutaneous biopsies back in 1997, other series of imaging-guided (through CT scans or ultrasounds) percutaneous biopsies of omental lesions have been published. Both the sensitivity and specificity rates have been very high, and there have not been many complications.In our own experience, the percutaneous biopsy has a 98.18% sensitivity rate, and a 100% specificity rate – similar percentage to the one previously published by other authors for this technique, with sensitivity and specificity rates of 92–99% and 86–100%, respectively.<a class="elsevierStyleCrossRefs" href="#bib0090">5,7–11</a>The definitive diagnosis is possible whenever we have a diagnosis of malignity from the percutaneous biopsy. However, with diagnoses of benignity, the possibility of one false negative (50% in our series) cannot be excluded, being this the main limitation of percutaneous biopsies. In our study, the results of malignity from the percutaneous biopsy (both ultrasound and CT-guided) are very reliable comparted to the results of benignity. Since the chances of malignant etiology are high, particulary in patients with a prior history of neoplasms, one result of benignity in the percutaneous biopsy would make us undecided about its true value, which is why it would be advisable to re-evaluate the case, re-obtain the percutaneous or surgical biopsy, or keep a narrow follow-up.Therefore, the imaging-guided percutaneous biopsy is one procedure with a high rate of diagnostic reliability, and a low rate of complications that, even in our hospital, has taken over the laparoscopy procedure, and the exploratory laparotomy.<a class="elsevierStyleCrossRefs" href="#bib0095">6,7</a>Due to the risk of puncturing the small bowel and the colon, and how difficult it is to see adjacent lesions, the CT scan has been the most widely accepted imaging modality to perform biopsies of the peritoneum and the omentum. However, compared to the ultrasound, it is more expensive, less fast, and uses ionizing radiation.<a class="elsevierStyleCrossRef" href="#bib0115">10</a> The main benefit of the ultrasound is that it allows us to see, real time, both the lesion and the trajectory of the needle while conducting the biopsy and, also, with the Doppler study, allows us to identify the vascular structures we should be avoiding during the puncture. For all these reason, it is a widely used imaging modality when performing biopsies of peritoneal lesions.<a class="elsevierStyleCrossRefs" href="#bib0115">10,11</a>In our series, in 47 biopsies the ultrasound was used, and in 10 biopsies, the CT scan was used. In all the biopsies, the samples obtained were diagnostic regardless of the imaging modality used. Thus, based on everything that has been published so far, and based on our own experience, and taking into consideration the benefits of the ultrasound, we reserve the CT scan for the guidance of deeply located lesions (root of the mesentery), with interposed loops, or lesions of pelvic location that will require posterior access (whether translumbar or transgluteal access).The peritoneal/omental damage has several patterns: masses or nodules, diffuse infiltration, or “omental cake”. Souza et al.<a class="elsevierStyleCrossRef" href="#bib0090">5</a> obtained a 96% and 93% sensitivity rate, and a 67% and 100% specificity rates in groups of masses >4cm, and <4cm, respectively, not finding any significant differences among the groups. In our series, in all the biopsies of masses ≤3cm (n=17), or >3cm (n=24), the material obtained was diagnostic.Sometimes, the pattern of diffuse damage or “omental cake” can be more difficult to assess. The availability, in all cases, of the abdominal CT scan facilitates the location, identification, and individualization of the lesion (particularly, in those of superficial location), and its association with adjacent structures. Back in 1998, Gottlieb et al.<a class="elsevierStyleCrossRef" href="#bib0115">10</a> published their series of 52 patients who underwent ultrasound-guided percutaneous biopsy procedures, in all cases after prior CT assessment, with a similar diagnostic reliability than the one reported by the series published of CT-guided biopsies; only in two (2) patients, the sample obtained was insufficient to establish the diagnosis.The first series of percutaneous biopsies of diffuse infiltrations of the peritoneum with no mass or nodularity was published back in 2011. Lee et al.<a class="elsevierStyleCrossRef" href="#bib0120">11</a> conducted the ultrasound-guided percutaneous biopsy of 45 patients with 84% diagnostic reliability. In all the patients, the area of maximum diffuse infiltration of the peritoneum according to the CT scan was used as the target for the ultrasound-guided sampling. In the ultrasound it looked like an area of increased mobile echogenicity during the puncture, but through ultrasound guidance, they managed to place the needle in the area of interest, avoiding blood vessels and small-bowell loops. In our own experience, even the cases of diffuse infiltration (n=16) may be eligible for ultrasound-guided biopsy procedures. There were no perioperative complications (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<elsevierMultimedia ident="fig0020"></elsevierMultimedia>The goal of the percutaneous biopsy is to obtain a sufficient sample for diagnostic purposes while reducing the rate of complications as much as possible. The choice of the biopsy area, and the trajectory of the needle is essential. In order to obtain better material, it is important to make a right choice of the solid areas of the mass or nodule, or the areas whose structure is mostly altered in the diffuse infiltration. Similarly, choosing correctly the angle of the biopsy needle in relation to the biopsy area will, also, allow us to obtain good samples, particularly from the smallest lesions.The fine needle biopsy (usually 20-25 G) allows us to obtain tissues for cytological studies. In the sample obtained through biopsy with core needles (18-16-14 G) we can also conduct histological, immunohistochemical and genetic studies that will be essential for the diagnosis and treatment of the patient.<a class="elsevierStyleCrossRefs" href="#bib0090">5,13</a> Souza et al.<a class="elsevierStyleCrossRef" href="#bib0090">5</a> obtained 91% and 80% sensitivity and specificity rates, respectively, for the fine needle biopsy group, and 97% and 100% sensitivity and specificity rates, respectively, for the core needle biopsy group. No statistically significant differences were found between both groups.<a class="elsevierStyleCrossRef" href="#bib0090">5</a> In our own experience and based on former studies, a 22mm-long specimen is insufficient for diagnostic purposes.<a class="elsevierStyleCrossRef" href="#bib0100">7</a> Although no study has ever compared the use of the 16 G and 18 G tru-cut biopsy needles to the collection of sufficient material for diagnostic purposes, the 16 G needle allows us to obtain thicker specimens, thus reducing the number of punctures and not increasing the rate of complications.<a class="elsevierStyleCrossRef" href="#bib0100">7</a>After conducting the percutaneous biopsy, some of the complications we may find are the perforation of bowel loops, bleeding, and cellulitis/infection of the needle trajectory. These complications are due to puncturing one loop, artery, or vein, but they are rare.<a class="elsevierStyleCrossRefs" href="#bib0100">7,9</a> In their series of 181 patients, Hill et al.<a class="elsevierStyleCrossRef" href="#bib0105">8</a> reported no complications whatsoever–whether major or minor.Hemorrhage is the most common complication. Back in 2003, Ho et al.<a class="elsevierStyleCrossRef" href="#bib0110">9</a> published, in their series of 25 patients, one case of mesenteric hematoma following the biopsy of one lymphatic nodule that resolved with conservative measures. They think it was due to blood vessel laceration during the biopsy, since the patient showed no alterations in coagulation, there were no more passess than the usual, or technical difficulties. They wish to emphasize the importance of the Doppler ultrasound assessment of blood vessels in order to avoid them during the puncture. Until that date, only one case of mesenteric hemorrhage due to one CT-guided percutaneous biopsy had been reported. Then back in 2013, Wang et al.<a class="elsevierStyleCrossRef" href="#bib0100">7</a> published their series of 153 ultrasound-guided biopsies, in which, in two cases, the postoperative ultrasound confirmed bleeding that resolved with transducer compression. In our series, we had one case (1.75%) of major complication due to bleeding from the anterior abdominal wall after puncturing the inferior epigastric artery. Given the associated hemodynamic instability, the patient required endovascular treatment through arterial embolization, but eventually died. It was one single 15mm long-nodule of superficial location in the omentum that was CT-guided biopsized. The biopsy was conducted using the standard procedure, and no more passes than usual were made. Probably, in these cases of small, mobile nodules of superficial location, the ultrasound guidance of the procedure, with the advantages already mentioned here (real time assessment of the lesion and vascularization), is extremely useful and allows us to reduce the rate of complications due to arterial punctures.Among the limitations worth mentioning here is the single-center retrospective nature of the study, and with a sample where the prevalence of malignant etiology of the biopsy was very high (only one benign lesion was biopsized).In sum, we consider the percutaneous core needle biopsy a highly sensitive technique regardless of the imaging modality used to guide the puncture (CT scan or ultrasound), and the type of lesion biopsized (mass, nodule, or diffuse infiltration). The rate of true positives is extremely high, whereas the rate of false negatives is low, which makes a result of malignity very reliable compared to a result of benignity. The rate of complications is low, although sometimes they can be serious.Authors’ contributionManager of the integrity of the study: MEPM and LZT. Study Idea: MEPM, SLG, JJEH and LZT. Study Design: MEPM, SLG, JJEH and LZT. Data Mining: MEPM and JMS. Data Analysis and Interpretation: MEPM, SLG, JMS and LZT. Statistical Analysis: MEPM. Reference: MEPM, SLG, JMS and LZT. Writing: MEPM, SLG, JJEH, JMS and LZT. Critical review of the manuscript with intellectually relevant remarks: MEPM, SLG, JJEH, JMS and LZT. Approval of final version: MEPM, SLG, JJEH, JMS and LZT.Conflicts of interestsThe authors declare no conflict of interests associated with this article whatsoever." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1006448" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec966158" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1006449" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec966157" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Selection of patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Procedure for the performance of ultrasound or CT-guided percutaneous biopsies" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Data mining and statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Authors’ contribution" ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-06-07" "fechaAceptado" => "2017-12-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec966158" "palabras" => array:6 [ 0 => "Percutaneous biopsy" 1 => "Omental lesions" 2 => "Peritoneal masses" 3 => "Imaging-guided biopsy" 4 => "Sensitivity" 5 => "Specificity" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec966157" "palabras" => array:6 [ 0 => "Biopsia percutánea" 1 => "Lesiones omentales" 2 => "Masas peritoneales" 3 => "Biopsia guiada por técnicas de imagen" 4 => "Sensibilidad" 5 => "Especificidad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo evaluate the diagnostic performance of imaging-guided core needle biopsy of nodules and diffuse infiltration of the omentum or of the peritoneum. Materials and methodsWe retrospectively evaluated 57 patients who underwent core needle biopsy of the peritoneum or of the omentum between March 2014 and January 2017. We used computed tomography (CT) to plan the biopsy. Biopsies were guided by CT or ultrasonography (US). We classified the results as diagnostic (benign/malignant) or inconclusive (inadequate sample). We calculated the sensitivity, specificity, positive-predictive value, and negative predictive value. We analyzed whether the specimen was diagnostic depending on the imaging technique used (CT or US) and on the type of omental or peritoneal involvement from which the specimen was obtained (mass, nodule, or diffuse involvement). ResultsAll (100%) the percutaneous biopsies were diagnostic. The sensitivity of the technique was 98.18% and the specificity was 100%. The positive predictive value was 100% and the negative predictive value was 50%. Both the specimens obtained under CT guidance (n=10) and those obtained under US guidance (n=47) were diagnostic. Likewise, biopsies of masses (n=24), of nodules (n=17), and even of diffuse infiltration (n=16) of the peritoneum or omentum enabled the histologic diagnosis. The rate of complications was 1.75% (one death). ConclusionPercutaneous core needle biopsy has high sensitivity regardless of the imaging technique used to guide the technique (CT or US) and of the type of lesion biopsied (mass, nodule, diffuse infiltration). It is a useful technique with a very low rate of complications, although severe complications can occur." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoEvaluar la rentabilidad de la biopsia percutánea con aguja gruesa guiada por técnicas de imagen de nódulos e infiltración difusa del omento o del peritoneo. Material y métodosSe evalúan retrospectivamente 57 pacientes a los que se realizó una biopsia con aguja gruesa del peritoneo o del omento entre marzo de 2014 y enero de 2017. La tomografía computarizada (TC) al diagnóstico se empleó para planificar la biopsia. Los resultados se clasificaron en diagnósticos (benignos/malignos) o no concluyentes (muestra insuficiente). Se calcularon la sensibilidad, la especificidad y el valor predictivo positivo y negativo. Se analizó si la muestra fue diagnóstica según la técnica de imagen empleada (TC o ecografía) y el tipo de afectación del omento-peritoneo biopsiada (masa, nódulo o infiltración difusa). ResultadosEl 100% de las biopsias percutáneas fueron diagnósticas. La sensibilidad de la técnica fue del 98,18% y la especificidad fue del 100%. El valor predictivo positivo fue del 100% y el negativo fue del 50%. Tanto las muestras obtenidas con guía por TC (10) como las guiadas por ecografía (47) fueron diagnósticas. Así mismo, las biopsias de masas (24), nódulos (17) e incluso de infiltración difusa (16) del peritoneo-omento permitieron el diagnóstico histológico. La tasa de complicaciones fue del 1,75% (una muerte). ConclusiónLa biopsia percutánea con aguja gruesa es una técnica con una alta sensibilidad independientemente de la técnica de imagen empleada como guía de la punción (TC o ecografía) y del tipo de lesión biopsiada (masa, nódulo o infiltración difusa). Es una técnica útil con escasa tasa de complicaciones, aunque a veces pueden ser graves." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Pérez Montilla ME, Lombardo Galera S, Espejo Herrero JJ, Sastoque JM, Zurera Tendero L. Rentabilidad diagnóstica de la biopsia con aguja gruesa guiada por técnicas de imagen del mesenterio y del peritoneo. Radiología. 2018;60:128–135." ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 810 "Ancho" => 1500 "Tamanyo" => 128076 ] ] "descripcion" => array:1 [ "en" => "Eighty (80) year old woman with constitutional syndrome. Image A corresponds to one abdominal CT scan with contrast showing one polylobulated mass centered in the gastrosplenic ligament that contacts the stomach and infiltrates the spleen (arrow head), and adenopathies in the gastrohepatic ligament. One ultrasound-guided percutaneous biopsy of the tumor represented in image B was performed. Echogenic mass confirmed (asterisk) and the 16 G hyperechogenic needle is one the passes made. The result was a diffuse large B-cell lymphoma." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 447 "Ancho" => 1800 "Tamanyo" => 119682 ] ] "descripcion" => array:1 [ "en" => "Fifty-two (52) year old male with constitutional syndrome. Image A corresponds to one abdominal CT scan with contrast showing one pericecal nodule (arrows). One CT-guided percutaneous biopsy was performed in the decubitus prone position. Images B and C are details from the CT scan. Image B corresponds to the CT scan performed without contrast to plan the biopsy procedure. Metallic surface markers are placed on the skin and the pericecal nodule is found (asterisk). Image C corresponds to a pass made using one 16G×16cm-long needle. The result was a poorly differentiated mucosecretory adenocarcinoma of appendicular origin." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 534 "Ancho" => 1500 "Tamanyo" => 125278 ] ] "descripcion" => array:1 [ "en" => "Seventy-five (75) year old male with abdominal pain. Image A corresponds to one abdominal CT scan with contrast showing one polylobulated mass in the mesentery of heterogeneous density (asterisk). Image B shows one of the passes of the percutaneous biopsy performed using CT control (16G×10cm-long needle). The result was a tissue without any evidence of malignity. The patient underwent one surgical biopsy with the result of follicular lymphoma." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1197 "Ancho" => 1500 "Tamanyo" => 220101 ] ] "descripcion" => array:1 [ "en" => "Eighty (80) year old woman with abdominal distension. Image A corresponds to one abdominal CT scan with administration of contrast showing ascites and, in the greater omentum, one area of diffuse infiltration. Image B shows an area of increased density and trabeculation of fat without formation of nodules or masses. One ultrasound-guided percutaneous biopsy was performed. Image C corresponds to the ultrasound focused on the area of diffuse infiltration of the omentum identified as an area of increased echogenicity (asterisk). Image D corresponds to one of the passes made with a 16 G needle (arrow). The result was high grade mucinous ovarian adenocarcinoma." ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Sex</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (10.52%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 (89.48%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.16±9.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Known neoplasm</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">History of cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (17.54%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No history of cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (82.46%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Pattern of peritoneal/omental damage</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diffuse infiltration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (28.07%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nodule (<3cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (29.83%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mass (>3cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (42.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Imaging modality used as guidance</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ultrasound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (82.46%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Computed tomography \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (17.54%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Histological diagnosis</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inconclusive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diagnostic biopsy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Benign \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (3.51%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Malignant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 (96.49%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Complications</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Minor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Major (death) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.75%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1704372.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic data of the population studied." ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgery \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical and radiologic follow-up \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Match \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Malignant result \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 (96.42%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (42.57%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (51.40%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lymphoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (5.36%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ovarian carcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (67.85%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Colon adenocarcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (5.36%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Endometrioid adenocarcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (5.36%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pancreatic adenocarcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.78%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Breast carcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.78%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gastrointestinal stromal tumor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.78%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gastric adenocarcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (3.57%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Appendicular carcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.78%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nephroblastoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.78%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Benign result \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (3.57%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fibrous tissue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.78%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acute inflammatory tissue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.78%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1704374.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Histopathological diagnosis of the percutaneous biopsy." ] ] 6 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CNB: core needle biopsy; CL/RX: clinical-radiologic; SX: surgery.Imaging guided-CNB of omentum and peritoneum: sensitivity 98.18%; specificity 100%; positive predictive value 100%; and negative predictive value 50%.The female patient who was lost to follow-up was not included here." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Malignant follow-up</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Benign follow-up</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SX \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL/RX \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SX \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL/RX \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">CNB</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Malignant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">CNB</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Benign \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1704373.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Results of the imaging-guided core needle biopsies of the omentum and the peritoneum and correlation to the surgical biopsy or clinical-radiologic follow-up." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0070" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neoplastic diseases of the peritoneum and mesentery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.D. McLaughlin" 1 => "A. Filippone" 2 => "M.M. Maher" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "2013" "volumen" => "200" "paginaInicial" => "420" "paginaFinal" => "430" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0075" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mesenteric neoplasms: CT appearances of primary and secondary tumors and differential diagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Sheth" 1 => "K.M. Horton" 2 => "M.R. Garland" 3 => "E.K. Fishman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/rg.232025081" "Revista" => array:6 [ "tituloSerie" => "Radiographics" "fecha" => "2003" "volumen" => "23" "paginaInicial" => "457" "paginaFinal" => "473" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12640160" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0080" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Greater and lesser omenta: normal anatomy and pathologic processes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Yoo" 1 => "J.H. Kim" 2 => "M.J. Kim" 3 => "J.S. Yu" 4 => "J.J. Chung" 5 => "H.S. 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Rentabilidad diagnóstica de la biopsia con aguja gruesa guiada por técnicas de imagen del mesenterio y del peritoneo

M.E. Pérez Montilla

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marigen_16@hotmail.com

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, S. Lombardo Galera, J.J. Espejo Herrero, J.M. Sastoque, L. Zurera Tendero

Unidad de Radiología Vascular e Intervencionista, Hospital Universitario Reina Sofía, Córdoba, Spain

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            "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Perilymphatic fistula&#44; pneumolabyrinth and transverse fracture&#46; Transverse CT image showing one transverse fracture with involvement of the otic capsule &#40;black arrow&#41; and pneumolabyrinth in the anterior portion of the lateral semicircular canal &#40;white arrow&#41;&#8211;a finding that is highly specific of perilymphatic fistula&#46; We can also see the occupation of the middle ear due to blood deposits or perilymph &#40;asterisk&#41;&#44; and one isolated pneumoencephalus bubble &#40;arrow head&#41;&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Eighty &#40;80&#41; year old woman with constitutional syndrome&#46; Image A corresponds to one abdominal CT scan with contrast showing one polylobulated mass centered in the gastrosplenic ligament that contacts the stomach and infiltrates the spleen &#40;arrow head&#41;&#44; and adenopathies in the gastrohepatic ligament&#46; One ultrasound-guided percutaneous biopsy of the tumor represented in image B was performed&#46; Echogenic mass confirmed &#40;asterisk&#41; and the 16 G hyperechogenic needle is one the passes made&#46; The result was a diffuse large B-cell lymphoma&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Both the mesentery and the peritoneum are home to a great variety of pathological processes&#44; both benign and malignant&#44; that may infiltrate them&#44; distort their architecture&#44; or cause thickening of the peritoneal covering&#46; The most common neoplasms that affect the peritoneum are the metastatic carcinoma &#40;of colon&#44; ovary and stomach&#44; and less frequently&#44; of pancreas&#44; bile duct&#44; and uterus&#41;&#44; and the lymphoma&#46; Other even more rare etiologies are the bladder carcinoma&#44; the gastrointestinal leiomyosarcomas&#44; and metastatic melanomas&#46; The primary mesenteric carcinoid tumor&#44; the epyplon and peritoneum neoplams are less common and&#44; in general&#44; they have mesenchymal origin&#46; Among the benign process we find granulomatous conditions&#44; hematomas&#44; infections or inflammatory processes&#8211;all of them much less commom&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The metastatic damage may occur in the form of a mass or diffuse infiltration of fat due to contiguity&#44; or lymphatic or hematogenous dissemination&#46; Also&#44; metastatic nodules can be seen both on the peritoneal surface and the mesentery&#44; with variable sizes ranging from a few millimeters to several centimeters conguring genuine masses&#46; In other cases&#44; only the diffuse thickening of the peritoneum is evident&#46; Both the primary peritoneal tumors and the benign processes described can show overlapping findings in the different imaging modalities&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">1&#8211;4</span></a> For all this&#44; it is essential to obtain a specimen to conduct the histological study and know what the origin really is&#46; The biopsy will be particularly important in patients with a history of a known tumor because we will be able to confirm the origin of tumor and know whether it is metastatic&#44; a tumor of a different origin&#44; or a benign lesion&#44; so we can prescribe the most appropriate oncological treatment in each case&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> The laparoscopy procedure allows us to detect peritoneal lesions and obtain tissues&#44; even from different areas of the lesion&#44; in order to be able to make a diagnosis with high diagnostic reliability&#46; However&#44; it is an invasive technique that requires anesthesia and elevates the patient&#39;s risk&#46; Today&#44; because of all its complications&#44; it is not the first technique of choice&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The process of obtaining imaging-guided biopsies is considered a safe procedure that is performed using local anesthesia&#44; has a low incidence of complications and high diagnostic reliability&#46; There are very few publications of series of patients with peritoneal or omental lesions biopsized using ultrasound or computed tomography &#40;CT&#41;-guided core needles&#44; although this technique has a high diagnostic performance and a low rate of complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">5&#44;7&#8211;11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The goal of our work was to evaluate the diagnostic performance of imaging-guided &#40;ultrasound or CT scan&#41; percutaneous core needle biopsies of nodular and diffuse infiltration of the omentum or the peritoneum&#44; and emphasize the diagnostic reliability of this procedure&#44; the imaging modality used&#44; and type of peritoneal damage sustained by each patient&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Selection of patients</span><p id="par0025" class="elsevierStylePara elsevierViewall">We retrospectively analyzed 57 consecutive patients who had undergone imaging-guided percutaneous biopsies of the peritoneum and the omentum between March 2014 and January 2017&#46; We did not deem it necessary to obtain the approval from our hospital ethics committee given the retrospective and cross-sectional nature of the study&#46; The biopsies were performed by four &#40;4&#41; different radiologists from our hospital Vascular and Interventional Radiology Unit who had between 2 and 30 years of experience&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Peritoneal damage was confirmed in all patients after conducting abdominal and pelvic CT scans &#40;Philips Brillance CT 16-slice scanner and General Electric Optima CT 64-slice scanner&#41; after the administration of IV contrast &#40;120<span class="elsevierStyleHsp" style=""></span>ml at a flow rate of 2<span class="elsevierStyleHsp" style=""></span>ml&#47;s&#41; in portal venous phase&#46; Among all the patients with peritoneal damage confirmed through the diagnostic CT scans&#44; ten &#40;10&#41; patients &#40;17&#46;5&#37;&#41; had a prior history of tumors&#44; and forty-seven &#40;47&#41; &#40;82&#46;5&#37;&#41; had non-specific symptoms &#40;fever&#44; or abdominal pain&#44; and no prior history of neoplasms&#41;&#46; After clinical-radiologic assessment conducted in multidisciplinary session&#44; or tumor subcommitte held at our center&#44; it was decided to biopsize the patients&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedure for the performance of ultrasound or CT-guided percutaneous biopsies</span><p id="par0035" class="elsevierStylePara elsevierViewall">The CT scan conducted for diagnostic purposes was evaluated in order to plan the percutaneous biopsy and decide what imaging modality was going to be used &#40;ultrasound or CT scan&#41; and which was the most reliable access route&#44; while prioritizing avoiding the trajectories of hollow viscera and blood vessels&#46; In general&#44; for deep lesions and interposed loops&#44; we used CT scans&#46; In all the cases&#44; before performing the biopsy&#44; the procedure was explained to the patient and prior written informed consent was obtained&#59; we also studied coagulation &#40;prothrombin activity<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>60&#37;&#41;&#44; and the number of platelets &#40;&#62;50&#44;000&#47;ml&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The percutaneous biopsy was conducted under sterile conditions&#44; with local anesthesia &#40;lidocaine&#41; in order to infiltrate the abdominal wall&#44; and in the cases where it was deemed necessary we used conscious sedation &#40;IV administration of diazepam and fentanyl&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The imaging modalities used to guide the biopsies were the ultrasound &#40;M-Turbo probe 5&#8211;2<span class="elsevierStyleHsp" style=""></span>MHz Curved&#44; Sonosite&#44; Bothell Washington&#44; United States&#41; using the hands-free technique &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; and the CT scan &#40;Asteion 4&#44; Toshiba Medical System&#44; Tokyo&#44; Japan&#41;&#46; When it comes to the CT scans&#44; several slices of the area of interest were acquired after positioning the patient in order to have a more direct access to the lesion&#46; A decision was made on the most adequate cut and location&#44; and a mark was left on the patient&#39;s skin&#46; Prior to obtaining the tissue sample&#44; the location of the biopsy needle was confirmed using one control CT scan&#44; being the core-needle trajectory corrected&#44; or re-placed whenever necessary &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; In all patients&#44; one 16G or 18G core needle &#40;Max-Core<span class="elsevierStyleSup">&#174;</span> Bard<span class="elsevierStyleSup">&#174;</span> Tempe&#44; Arizona&#44; United States&#41; with lengths between 10 and 16<span class="elsevierStyleHsp" style=""></span>cm was used to perform the biopsy based on the relation between the biopsy and adjacent structures &#40;colon&#44; intestinal loops&#44; or blood vessels&#41;&#44; and the deep location of the lesion&#46; The length of the cut was 22<span class="elsevierStyleHsp" style=""></span>mm and four &#40;4&#41; passes were made&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The tissue samples obtained &#40;three or four cylinders from each patient&#41; were sent to our hospital Unit of Pathological Anatomy while preserved inside a sterile container&#44; with liquid formaldehyde&#44; and correctly identified for histological and immunohistological studies&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">All patients were placed in observation and remained at the hospital for&#44; at least&#44; 24<span class="elsevierStyleHsp" style=""></span>h with monitoring of their vital signs&#59; signs of bleeding&#59; appearance of pain or fever&#59; or any other possible complications derived from the procedure they had undergone&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Data mining and statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">An Excel 2010 database was opened where each patient&#39;s demographic data &#40;age and sex&#41;&#44; prior history of tumors&#44; radiologic findings of the biopsized peritoneal lesion&#44; histological results of the percutaneous biopsy&#44; histological result from the specimen obtained through surgery&#44; and clinical-radiologic follow-up were collected &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The CT findings were classified into nodules &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41;&#44; masses &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41;&#44; or diffuse infiltration &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41;&#44; being the nodules defined as tumors &#8804;3<span class="elsevierStyleHsp" style=""></span>cm&#44; and the masses as sizes &#62;3<span class="elsevierStyleHsp" style=""></span>cm&#46; The tumors were measured on the axial plane both in the transverse and anteroposterior axes&#44; and the largest one was taken into consideration&#46; The diffuse infiltration was defined as the confirmation of an alteration in the architecture of the omentum&#47;peritoneum with increased fat density&#44; trabeculation of fat density&#44; or &#8220;omental cake&#8221;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Based on the results obtained from the Unit of Pathological Anatomy&#44; the results were classified as benign&#44; malignant&#44; or inconclusive&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The biopsy diagnosis was confirmed with the results coming from the surgery &#40;diagnostic surgical biopsy&#44; or oncological surgery&#44; or both&#41;&#44; or after the clinical-radiologic follow-up&#46; In a protocolized way&#44; patients were followed through clinical examination and imaging modalities every 3&#8211;6 months&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">For the statistical analysis&#44; the IBM SPSS software was used &#40;August 2013&#59; IBM SPSS Statistics for Window&#59; version 22&#46;0&#41;&#44; and the sensitivity&#44; specificity&#44; and negative predictive values were estimated&#46; Also&#44; it was determined if it was a diagnostic sample&#44; or not&#44; by subgroups&#46; The subgroups were analyzed by type of lesion biopsized &#40;tumor &#91;nodule or mass&#93; and diffuse infiltration&#41;&#44; and imaging modality used to guide the procedure &#40;ultrasound or CT scan&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">Fifty-seven &#40;57&#41; percutaneous biopsies were conducted in 57 patients &#40;6 males and 51 women&#59; average age&#58; 64&#46;05 years old&#59; age range&#58; 23&#8211;87 years old&#41;&#46; All the samples obtained were diagnostic&#46; One patient was excluded from the follow-up because she died during the biopsy&#44; whose results&#44; although diagnostic&#44; could not be correlated with the results from the surgical biopsy or clinical-radiologic follow-up&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Of the remaining 56 biopsies&#44; the result was malignant in 54 &#40;96&#46;42&#37;&#41;&#44; and benign in 2 biopsies &#40;3&#46;57&#37;&#41;&#46; In none of the cases were the results from the tissue sample obtained in the percutaneous biopsy inconclusive&#44; or insufficient&#46; The histopathological diagnosis achieved during the biopsy is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; In all the cases of percutaneous biopsy with malignant result&#44; the malignant etiology of the peritoneal&#47;omental damage was confirmed&#58; in 23 patients &#40;23&#47;54&#44; 42&#46;59&#37;&#41; after the surgical biopsy&#44; and in the remaining patients &#40;31&#47;54&#44; 57&#46;40&#37;&#41; after the clinical-radiologic follow-up that lasted between 4 and 37 months&#46; In none of the cases whose surgical biopsy we performed&#44; the specific diagnosis of the tumor histology was changed&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The two &#40;2&#41; patients with benign results in the percutaneous biopsy were operated&#46; In one of the patients&#44; the surgical biopsy confirmed this result&#44; but in the other patient it confirmed the malignant origin of the lesion &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Both were male patients&#44; without a prior history of neoplasms&#44; with one mass in the peritoneum&#46; The benign origin of this finding is exceptional because of the histological diagnosis obtained and because&#44; since there were no complications given the location of the surgery&#44; the multidisciplinary committee decided to perform the surgery and the biopsy at the same time&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The imaging-guided percutaneous core needle biopsy of the peritoneum or the omentum had a 98&#46;18&#37; sensitivity rate &#40;95&#37; confidence interval &#91;95&#37;CI&#93;&#58; 89&#46;3&#8211;100&#37;&#41;&#44; and a 100&#37; specificity rate &#40;95&#37;CI&#58; 17&#8211;100&#37;&#41;&#46; The rate of false negatives was 0&#46;018&#46; The negative predictive value was 50&#37; &#40;95&#37;CI&#58; 0&#8211;100&#37;&#41;&#44; and the positive predictive value was 100&#37; &#40;95&#37;CI&#58; 99&#46;07&#8211;100&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Taking into consideration the pattern of peritoneal damage &#40;diffuse infiltration &#91;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#93;&#44; nodule &#91;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#93;&#44; or mass &#91;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#93;&#41; from which the biopsy was taken in all the subgroups&#44; the diagnosis was achieved&#46; Taking into consideration the imaging modality used to guide the biopsy &#40;CT scan &#91;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#93;&#44; or ultrasound &#91;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>47&#93;&#41;&#44; the sample turned out diagnostic in all the patients&#44; with a 100&#37; sensitivity rate &#40;95&#37;CI&#58; 62&#46;2&#8211;100&#37;&#41; and a 97&#46;9&#37; sensitivity rate &#40;95&#37;CI&#58; 87&#46;7&#8211;100&#37;&#41; for each one of the groups&#44; respectively&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">No cases of minor complications were reported after the biopsy&#46; One patient suffered from sweating&#44; hypotension&#44; and dropping hematocrit levels six &#40;6&#41; hours after undergoing the procedure&#46; The angio-CT scan performed confirmed an active bleeding in the anterior rectus muscle&#44; probably coming from the epigastric artery&#46; An embolization procedure was attempted through endocascular access&#44; but the patient died&#46; This made the rate of complications go up to 1&#46;75&#37;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">Based on our own results&#44; the core needle biopsy of the peritoneum allows achieving adequate diagnoses of true peritoneal masses&#44; small nodules&#44; and diffuse infiltration&#46; The sensitivity rate is very high&#58; 98&#46;18&#37; &#40;95&#37;CI&#58; 89&#46;3&#8211;100&#37;&#41;&#44; and the specificity rate is 100&#37; &#40;95&#37;CI&#58; 17&#8211;100&#37;&#44; with the limitations associated with this huge confidence interval&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The rate of complications is very low &#40;1&#46;75&#37;&#41;&#44; although they may be serious&#46; Both the ultrasound and the CT scan may be used interchangeable to guide the biopsy&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Historically&#44; patients with peritoneal carcinomatosis have been operated through laparotomy procedures&#44; or exploratory laparoscopies that allowed obtaining surgical biopsies and assessing the criteria for resectability&#46; Both techniques allow us to detect peritoneal lesions&#44; and even obtain biopsies of different areas of the lesion&#44; but they require anesthesia and have a higher rate of complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Ever since Pombo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a> published their series on CT-guided percutaneous biopsies back in 1997&#44; other series of imaging-guided &#40;through CT scans or ultrasounds&#41; percutaneous biopsies of omental lesions have been published&#46; Both the sensitivity and specificity rates have been very high&#44; and there have not been many complications&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In our own experience&#44; the percutaneous biopsy has a 98&#46;18&#37; sensitivity rate&#44; and a 100&#37; specificity rate &#8211; similar percentage to the one previously published by other authors for this technique&#44; with sensitivity and specificity rates of 92&#8211;99&#37; and 86&#8211;100&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">5&#44;7&#8211;11</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The definitive diagnosis is possible whenever we have a diagnosis of malignity from the percutaneous biopsy&#46; However&#44; with diagnoses of benignity&#44; the possibility of one false negative &#40;50&#37; in our series&#41; cannot be excluded&#44; being this the main limitation of percutaneous biopsies&#46; In our study&#44; the results of malignity from the percutaneous biopsy &#40;both ultrasound and CT-guided&#41; are very reliable comparted to the results of benignity&#46; Since the chances of malignant etiology are high&#44; particulary in patients with a prior history of neoplasms&#44; one result of benignity in the percutaneous biopsy would make us undecided about its true value&#44; which is why it would be advisable to re-evaluate the case&#44; re-obtain the percutaneous or surgical biopsy&#44; or keep a narrow follow-up&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Therefore&#44; the imaging-guided percutaneous biopsy is one procedure with a high rate of diagnostic reliability&#44; and a low rate of complications that&#44; even in our hospital&#44; has taken over the laparoscopy procedure&#44; and the exploratory laparotomy&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Due to the risk of puncturing the small bowel and the colon&#44; and how difficult it is to see adjacent lesions&#44; the CT scan has been the most widely accepted imaging modality to perform biopsies of the peritoneum and the omentum&#46; However&#44; compared to the ultrasound&#44; it is more expensive&#44; less fast&#44; and uses ionizing radiation&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a> The main benefit of the ultrasound is that it allows us to see&#44; real time&#44; both the lesion and the trajectory of the needle while conducting the biopsy and&#44; also&#44; with the Doppler study&#44; allows us to identify the vascular structures we should be avoiding during the puncture&#46; For all these reason&#44; it is a widely used imaging modality when performing biopsies of peritoneal lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">10&#44;11</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">In our series&#44; in 47 biopsies the ultrasound was used&#44; and in 10 biopsies&#44; the CT scan was used&#46; In all the biopsies&#44; the samples obtained were diagnostic regardless of the imaging modality used&#46; Thus&#44; based on everything that has been published so far&#44; and based on our own experience&#44; and taking into consideration the benefits of the ultrasound&#44; we reserve the CT scan for the guidance of deeply located lesions &#40;root of the mesentery&#41;&#44; with interposed loops&#44; or lesions of pelvic location that will require posterior access &#40;whether translumbar or transgluteal access&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The peritoneal&#47;omental damage has several patterns&#58; masses or nodules&#44; diffuse infiltration&#44; or &#8220;omental cake&#8221;&#46; Souza et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> obtained a 96&#37; and 93&#37; sensitivity rate&#44; and a 67&#37; and 100&#37; specificity rates in groups of masses &#62;4<span class="elsevierStyleHsp" style=""></span>cm&#44; and &#60;4<span class="elsevierStyleHsp" style=""></span>cm&#44; respectively&#44; not finding any significant differences among the groups&#46; In our series&#44; in all the biopsies of masses &#8804;3<span class="elsevierStyleHsp" style=""></span>cm &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41;&#44; or &#62;3<span class="elsevierStyleHsp" style=""></span>cm &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41;&#44; the material obtained was diagnostic&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Sometimes&#44; the pattern of diffuse damage or &#8220;omental cake&#8221; can be more difficult to assess&#46; The availability&#44; in all cases&#44; of the abdominal CT scan facilitates the location&#44; identification&#44; and individualization of the lesion &#40;particularly&#44; in those of superficial location&#41;&#44; and its association with adjacent structures&#46; Back in 1998&#44; Gottlieb et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a> published their series of 52 patients who underwent ultrasound-guided percutaneous biopsy procedures&#44; in all cases after prior CT assessment&#44; with a similar diagnostic reliability than the one reported by the series published of CT-guided biopsies&#59; only in two &#40;2&#41; patients&#44; the sample obtained was insufficient to establish the diagnosis&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The first series of percutaneous biopsies of diffuse infiltrations of the peritoneum with no mass or nodularity was published back in 2011&#46; Lee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a> conducted the ultrasound-guided percutaneous biopsy of 45 patients with 84&#37; diagnostic reliability&#46; In all the patients&#44; the area of maximum diffuse infiltration of the peritoneum according to the CT scan was used as the target for the ultrasound-guided sampling&#46; In the ultrasound it looked like an area of increased mobile echogenicity during the puncture&#44; but through ultrasound guidance&#44; they managed to place the needle in the area of interest&#44; avoiding blood vessels and small-bowell loops&#46; In our own experience&#44; even the cases of diffuse infiltration &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41; may be eligible for ultrasound-guided biopsy procedures&#46; There were no perioperative complications &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">The goal of the percutaneous biopsy is to obtain a sufficient sample for diagnostic purposes while reducing the rate of complications as much as possible&#46; The choice of the biopsy area&#44; and the trajectory of the needle is essential&#46; In order to obtain better material&#44; it is important to make a right choice of the solid areas of the mass or nodule&#44; or the areas whose structure is mostly altered in the diffuse infiltration&#46; Similarly&#44; choosing correctly the angle of the biopsy needle in relation to the biopsy area will&#44; also&#44; allow us to obtain good samples&#44; particularly from the smallest lesions&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">The fine needle biopsy &#40;usually 20-25 G&#41; allows us to obtain tissues for cytological studies&#46; In the sample obtained through biopsy with core needles &#40;18-16-14 G&#41; we can also conduct histological&#44; immunohistochemical and genetic studies that will be essential for the diagnosis and treatment of the patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">5&#44;13</span></a> Souza et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> obtained 91&#37; and 80&#37; sensitivity and specificity rates&#44; respectively&#44; for the fine needle biopsy group&#44; and 97&#37; and 100&#37; sensitivity and specificity rates&#44; respectively&#44; for the core needle biopsy group&#46; No statistically significant differences were found between both groups&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> In our own experience and based on former studies&#44; a 22<span class="elsevierStyleHsp" style=""></span>mm-long specimen is insufficient for diagnostic purposes&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a> Although no study has ever compared the use of the 16 G and 18 G tru-cut biopsy needles to the collection of sufficient material for diagnostic purposes&#44; the 16 G needle allows us to obtain thicker specimens&#44; thus reducing the number of punctures and not increasing the rate of complications&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">After conducting the percutaneous biopsy&#44; some of the complications we may find are the perforation of bowel loops&#44; bleeding&#44; and cellulitis&#47;infection of the needle trajectory&#46; These complications are due to puncturing one loop&#44; artery&#44; or vein&#44; but they are rare&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#44;9</span></a> In their series of 181 patients&#44; Hill et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a> reported no complications whatsoever&#8211;whether major or minor&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Hemorrhage is the most common complication&#46; Back in 2003&#44; Ho et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> published&#44; in their series of 25 patients&#44; one case of mesenteric hematoma following the biopsy of one lymphatic nodule that resolved with conservative measures&#46; They think it was due to blood vessel laceration during the biopsy&#44; since the patient showed no alterations in coagulation&#44; there were no more passess than the usual&#44; or technical difficulties&#46; They wish to emphasize the importance of the Doppler ultrasound assessment of blood vessels in order to avoid them during the puncture&#46; Until that date&#44; only one case of mesenteric hemorrhage due to one CT-guided percutaneous biopsy had been reported&#46; Then back in 2013&#44; Wang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a> published their series of 153 ultrasound-guided biopsies&#44; in which&#44; in two cases&#44; the postoperative ultrasound confirmed bleeding that resolved with transducer compression&#46; In our series&#44; we had one case &#40;1&#46;75&#37;&#41; of major complication due to bleeding from the anterior abdominal wall after puncturing the inferior epigastric artery&#46; Given the associated hemodynamic instability&#44; the patient required endovascular treatment through arterial embolization&#44; but eventually died&#46; It was one single 15<span class="elsevierStyleHsp" style=""></span>mm long-nodule of superficial location in the omentum that was CT-guided biopsized&#46; The biopsy was conducted using the standard procedure&#44; and no more passes than usual were made&#46; Probably&#44; in these cases of small&#44; mobile nodules of superficial location&#44; the ultrasound guidance of the procedure&#44; with the advantages already mentioned here &#40;real time assessment of the lesion and vascularization&#41;&#44; is extremely useful and allows us to reduce the rate of complications due to arterial punctures&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Among the limitations worth mentioning here is the single-center retrospective nature of the study&#44; and with a sample where the prevalence of malignant etiology of the biopsy was very high &#40;only one benign lesion was biopsized&#41;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">In sum&#44; we consider the percutaneous core needle biopsy a highly sensitive technique regardless of the imaging modality used to guide the puncture &#40;CT scan or ultrasound&#41;&#44; and the type of lesion biopsized &#40;mass&#44; nodule&#44; or diffuse infiltration&#41;&#46; The rate of true positives is extremely high&#44; whereas the rate of false negatives is low&#44; which makes a result of malignity very reliable compared to a result of benignity&#46; The rate of complications is low&#44; although sometimes they can be serious&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Authors&#8217; contribution</span><p id="par0200" class="elsevierStylePara elsevierViewall">Manager of the integrity of the study&#58; MEPM and LZT&#46; Study Idea&#58; MEPM&#44; SLG&#44; JJEH and LZT&#46; Study Design&#58; MEPM&#44; SLG&#44; JJEH and LZT&#46; Data Mining&#58; MEPM and JMS&#46; Data Analysis and Interpretation&#58; MEPM&#44; SLG&#44; JMS and LZT&#46; Statistical Analysis&#58; MEPM&#46; Reference&#58; MEPM&#44; SLG&#44; JMS and LZT&#46; Writing&#58; MEPM&#44; SLG&#44; JJEH&#44; JMS and LZT&#46; Critical review of the manuscript with intellectually relevant remarks&#58; MEPM&#44; SLG&#44; JJEH&#44; JMS and LZT&#46; Approval of final version&#58; MEPM&#44; SLG&#44; JJEH&#44; JMS and LZT&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interests</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests associated with this article whatsoever&#46;</p></span></span>"
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          "identificador" => "xres1006448"
          "titulo" => "Abstract"
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              "titulo" => "Objective"
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          "titulo" => "Resumen"
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          "titulo" => "Palabras clave"
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          "titulo" => "Introduction"
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          "titulo" => "Materials and methods"
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            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Selection of patients"
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              "identificador" => "sec0020"
              "titulo" => "Procedure for the performance of ultrasound or CT-guided percutaneous biopsies"
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              "titulo" => "Data mining and statistical analysis"
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          "titulo" => "Results"
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          "titulo" => "Discussion"
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    "fechaRecibido" => "2017-06-07"
    "fechaAceptado" => "2017-12-12"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec966158"
          "palabras" => array:6 [
            0 => "Percutaneous biopsy"
            1 => "Omental lesions"
            2 => "Peritoneal masses"
            3 => "Imaging-guided biopsy"
            4 => "Sensitivity"
            5 => "Specificity"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec966157"
          "palabras" => array:6 [
            0 => "Biopsia percut&#225;nea"
            1 => "Lesiones omentales"
            2 => "Masas peritoneales"
            3 => "Biopsia guiada por t&#233;cnicas de imagen"
            4 => "Sensibilidad"
            5 => "Especificidad"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the diagnostic performance of imaging-guided core needle biopsy of nodules and diffuse infiltration of the omentum or of the peritoneum&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We retrospectively evaluated 57 patients who underwent core needle biopsy of the peritoneum or of the omentum between March 2014 and January 2017&#46; We used computed tomography &#40;CT&#41; to plan the biopsy&#46; Biopsies were guided by CT or ultrasonography &#40;US&#41;&#46; We classified the results as diagnostic &#40;benign&#47;malignant&#41; or inconclusive &#40;inadequate sample&#41;&#46; We calculated the sensitivity&#44; specificity&#44; positive-predictive value&#44; and negative predictive value&#46; We analyzed whether the specimen was diagnostic depending on the imaging technique used &#40;CT or US&#41; and on the type of omental or peritoneal involvement from which the specimen was obtained &#40;mass&#44; nodule&#44; or diffuse involvement&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">All &#40;100&#37;&#41; the percutaneous biopsies were diagnostic&#46; The sensitivity of the technique was 98&#46;18&#37; and the specificity was 100&#37;&#46; The positive predictive value was 100&#37; and the negative predictive value was 50&#37;&#46; Both the specimens obtained under CT guidance &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41; and those obtained under US guidance &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>47&#41; were diagnostic&#46; Likewise&#44; biopsies of masses &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41;&#44; of nodules &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41;&#44; and even of diffuse infiltration &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41; of the peritoneum or omentum enabled the histologic diagnosis&#46; The rate of complications was 1&#46;75&#37; &#40;one death&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Percutaneous core needle biopsy has high sensitivity regardless of the imaging technique used to guide the technique &#40;CT or US&#41; and of the type of lesion biopsied &#40;mass&#44; nodule&#44; diffuse infiltration&#41;&#46; It is a useful technique with a very low rate of complications&#44; although severe complications can occur&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar la rentabilidad de la biopsia percut&#225;nea con aguja gruesa guiada por t&#233;cnicas de imagen de n&#243;dulos e infiltraci&#243;n difusa del omento o del peritoneo&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se eval&#250;an retrospectivamente 57 pacientes a los que se realiz&#243; una biopsia con aguja gruesa del peritoneo o del omento entre marzo de 2014 y enero de 2017&#46; La tomograf&#237;a computarizada &#40;TC&#41; al diagn&#243;stico se emple&#243; para planificar la biopsia&#46; Los resultados se clasificaron en diagn&#243;sticos &#40;benignos&#47;malignos&#41; o no concluyentes &#40;muestra insuficiente&#41;&#46; Se calcularon la sensibilidad&#44; la especificidad y el valor predictivo positivo y negativo&#46; Se analiz&#243; si la muestra fue diagn&#243;stica seg&#250;n la t&#233;cnica de imagen empleada &#40;TC o ecograf&#237;a&#41; y el tipo de afectaci&#243;n del omento-peritoneo biopsiada &#40;masa&#44; n&#243;dulo o infiltraci&#243;n difusa&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El 100&#37; de las biopsias percut&#225;neas fueron diagn&#243;sticas&#46; La sensibilidad de la t&#233;cnica fue del 98&#44;18&#37; y la especificidad fue del 100&#37;&#46; El valor predictivo positivo fue del 100&#37; y el negativo fue del 50&#37;&#46; Tanto las muestras obtenidas con gu&#237;a por TC &#40;10&#41; como las guiadas por ecograf&#237;a &#40;47&#41; fueron diagn&#243;sticas&#46; As&#237; mismo&#44; las biopsias de masas &#40;24&#41;&#44; n&#243;dulos &#40;17&#41; e incluso de infiltraci&#243;n difusa &#40;16&#41; del peritoneo-omento permitieron el diagn&#243;stico histol&#243;gico&#46; La tasa de complicaciones fue del 1&#44;75&#37; &#40;una muerte&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La biopsia percut&#225;nea con aguja gruesa es una t&#233;cnica con una alta sensibilidad independientemente de la t&#233;cnica de imagen empleada como gu&#237;a de la punci&#243;n &#40;TC o ecograf&#237;a&#41; y del tipo de lesi&#243;n biopsiada &#40;masa&#44; n&#243;dulo o infiltraci&#243;n difusa&#41;&#46; Es una t&#233;cnica &#250;til con escasa tasa de complicaciones&#44; aunque a veces pueden ser graves&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Resultados"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; P&#233;rez Montilla ME&#44; Lombardo Galera S&#44; Espejo Herrero JJ&#44; Sastoque JM&#44; Zurera Tendero L&#46; Rentabilidad diagn&#243;stica de la biopsia con aguja gruesa guiada por t&#233;cnicas de imagen del mesenterio y del peritoneo&#46; Radiolog&#237;a&#46; 2018&#59;60&#58;128&#8211;135&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Eighty &#40;80&#41; year old woman with constitutional syndrome&#46; Image A corresponds to one abdominal CT scan with contrast showing one polylobulated mass centered in the gastrosplenic ligament that contacts the stomach and infiltrates the spleen &#40;arrow head&#41;&#44; and adenopathies in the gastrohepatic ligament&#46; One ultrasound-guided percutaneous biopsy of the tumor represented in image B was performed&#46; Echogenic mass confirmed &#40;asterisk&#41; and the 16 G hyperechogenic needle is one the passes made&#46; The result was a diffuse large B-cell lymphoma&#46;</p>"
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      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 447
            "Ancho" => 1800
            "Tamanyo" => 119682
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Fifty-two &#40;52&#41; year old male with constitutional syndrome&#46; Image A corresponds to one abdominal CT scan with contrast showing one pericecal nodule &#40;arrows&#41;&#46; One CT-guided percutaneous biopsy was performed in the decubitus prone position&#46; Images B and C are details from the CT scan&#46; Image B corresponds to the CT scan performed without contrast to plan the biopsy procedure&#46; Metallic surface markers are placed on the skin and the pericecal nodule is found &#40;asterisk&#41;&#46; Image C corresponds to a pass made using one 16<span class="elsevierStyleHsp" style=""></span>G<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>16<span class="elsevierStyleHsp" style=""></span>cm-long needle&#46; The result was a poorly differentiated mucosecretory adenocarcinoma of appendicular origin&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 534
            "Ancho" => 1500
            "Tamanyo" => 125278
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Seventy-five &#40;75&#41; year old male with abdominal pain&#46; Image A corresponds to one abdominal CT scan with contrast showing one polylobulated mass in the mesentery of heterogeneous density &#40;asterisk&#41;&#46; Image B shows one of the passes of the percutaneous biopsy performed using CT control &#40;16<span class="elsevierStyleHsp" style=""></span>G<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>cm-long needle&#41;&#46; The result was a tissue without any evidence of malignity&#46; The patient underwent one surgical biopsy with the result of follicular lymphoma&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1197
            "Ancho" => 1500
            "Tamanyo" => 220101
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Eighty &#40;80&#41; year old woman with abdominal distension&#46; Image A corresponds to one abdominal CT scan with administration of contrast showing ascites and&#44; in the greater omentum&#44; one area of diffuse infiltration&#46; Image B shows an area of increased density and trabeculation of fat without formation of nodules or masses&#46; One ultrasound-guided percutaneous biopsy was performed&#46; Image C corresponds to the ultrasound focused on the area of diffuse infiltration of the omentum identified as an area of increased echogenicity &#40;asterisk&#41;&#46; Image D corresponds to one of the passes made with a 16 G needle &#40;arrow&#41;&#46; The result was high grade mucinous ovarian adenocarcinoma&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;10&#46;52&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;89&#46;48&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Known neoplasm</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>History of cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;17&#46;54&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No history of cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;82&#46;46&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Pattern of peritoneal&#47;omental damage</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diffuse infiltration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;28&#46;07&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nodule &#40;&#60;3<span class="elsevierStyleHsp" style=""></span>cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;29&#46;83&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mass &#40;&#62;3<span class="elsevierStyleHsp" style=""></span>cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;42&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Imaging modality used as guidance</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ultrasound&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;82&#46;46&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Computed tomography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;17&#46;54&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Histological diagnosis</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Inconclusive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diagnostic biopsy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Benign&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;3&#46;51&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Malignant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55 &#40;96&#46;49&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Complications</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Minor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Major &#40;death&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;75&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1704372.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Demographic data of the population studied&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical and radiologic follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Match&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Malignant result</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54 &#40;96&#46;42&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;42&#46;57&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;51&#46;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;5&#46;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ovarian carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;67&#46;85&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Colon adenocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;5&#46;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Endometrioid adenocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;5&#46;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pancreatic adenocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;78&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Breast carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;78&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gastrointestinal stromal tumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;78&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gastric adenocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;3&#46;57&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Appendicular carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;78&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nephroblastoma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fibrous tissue&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">CNB&#58; core needle biopsy&#59; CL&#47;RX&#58; clinical-radiologic&#59; SX&#58; surgery&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Imaging guided-CNB of omentum and peritoneum&#58; sensitivity 98&#46;18&#37;&#59; specificity 100&#37;&#59; positive predictive value 100&#37;&#59; and negative predictive value 50&#37;&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">The female patient who was lost to follow-up was not included here&#46;</p>"
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Article information

ISSN: 21735107
Original language: English

DOI:10.1016/j.rxeng.2018.02.006

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Year/Month	Html	Pdf	Total

2024 October	1	2	3
2024 August	2	0	2
2024 July	2	1	3
2024 May	1	2	3
2024 April	1	0	1
2024 March	5	0	5
2024 February	1	0	1
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2023 December	3	0	3
2023 November	1	0	1
2023 October	2	0	2
2023 September	2	0	2
2023 August	1	0	1
2023 June	6	2	8
2023 May	2	2	4
2023 March	1	2	3
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2022 December	1	0	1
2018 December	0	2	2
2018 April	4	0	4

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