Diagnostic Value of Image-Guided Percutaneous Omental, Peritoneal, and Mesenteric Biopsy: A Single-Center Study in a Tertiary Care Hospital in India

Abstract

Purpose

The purpose was to assess the technique, technical success rate, and diagnostic value of image-guided percutaneous biopsy of omental, peritoneal, and mesenteric lesions.

Materials and Methods

This was a combined prospective and retrospective study conducted at our center from January 2019 to April 2021. Retrospective data were obtained by retrospective review of the institutional database from January 2017 to January 2019. For the prospective data, all patients referred to the interventional radiology department for image-guided peritoneal, omental, or mesenteric biopsy during the study period were included in the study. Patients not willing to participate in the study, cases lost to follow-up, and those in whom imaging data could not be retrieved in the picture archiving and communication system were excluded from the study. A total of 207 patients who underwent computed tomography-guided biopsies were the final study cohort, including 134 prospective cases and 73 retrospective cases. Various technical aspects, like technical success rate, diagnostic yield, and diagnostic performance of the procedure, were calculated and tabulated.

Results

The technical success rate and diagnostic yield of all biopsies were 100 and 98.06%, respectively. The overall sensitivity, specificity, positive predictive value, and negative predictive value of all biopsies to diagnose pathology were found to be 84.62, 91.46, 70.21, and 96.15%, respectively, while the accuracy to detect malignant pathology was 90.15%.

Conclusion

The image-guided percutaneous biopsy of omental, mesenteric, and peritoneal lesions has a high technical success rate and diagnostic yield irrespective of lesion size and lesion depth.

 

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Keywords

diagnostic value - image-guided percutaneous omental - peritoneal - mesenteric biopsy - technical success rate

Introduction

The peritoneum is the largest serous membrane in the body and forms anatomic reflections that give rise to the omentum and mesentery. The peritoneum, omentum, and mesentery can be affected by a variety of diseases that include both neoplastic and nonneoplastic lesions.[1] Ovarian and gastrointestinal malignancies are the most common neoplasms that seed the peritoneum. In a patient with a known malignancy, the presence of an omental or peritoneal lesion usually indicates metastasis; however, a biopsy is often necessary to confirm the diagnosis. Cross-sectional imaging, including computed tomography (CT) or magnetic resonance imaging, is the mainstay of modalities in evaluating these lesions. Traditionally, open surgical biopsy under general anesthesia has been the gold standard method, but it entails additional hospitalization expenditure and anesthesia risks. Diagnostic laparoscopy and biopsy can be performed safely and are often favored, especially in young, healthy individuals. In cases of clinical and diagnostic uncertainty, image-guided biopsy of these lesions and tissue sampling represent the best option for the evaluation of disease pathology.[2] [3] [4] Obtaining tissue for genetic and molecular analysis is becoming increasingly essential for directing cancer therapy and assessing response to treatment. Therefore, tissue histopathological diagnosis remains extremely important, since potential treatment options differ significantly for various malignancies and benign diseases.[5] [6] Percutaneous image-guided biopsy is a minimally invasive, safe, effective, and proven procedure, which has been applied throughout the body for tissue sampling and can be done either under ultrasound (US) or CT guidance.[7] [8] [9] Image-guided biopsy of omental, peritoneal, and mesenteric lesions can be technically challenging owing to the variable depth of lesions from the skin surface; proximity of lesions to vital structures, including vessels, gastrointestinal tract, or solid organs; and relative mobility of these lesions in the intra-abdominal fat as opposed to lesions within solid organs.[10] [11] [12] [13] The US has several advantages, including wide availability, portability, lack of ionizing radiation, relatively short procedure time, real-time visualization of the biopsy needle and target lesion during the procedure, ability to guide the procedure in almost any anatomic plane, fewer false-negative biopsies, and fewer false-positive biopsies.[14] [15] [16] However, in deep lesions, as in the case of mesenteric lesions or extremely obese patients, the US has limitations of lesion visibility due to bowel gases and abdominal wall fat, and in these cases, CT-guided biopsies can be performed.[17] [18] [19] [20] [21] The purpose of this study was to assess the technique, technical success rate, and predictive value of image-guided percutaneous biopsy of omental, peritoneal, and mesenteric lesions.

 

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Material and Methods

Study Design and Sample Size

The combined prospective and retrospective study was conducted in the Department of Interventional Radiology, Max Super Specialty Hospital, New Delhi, India, from January 2019 to April 2021. Retrospective data was also obtained. The sample size calculation was done from the study by Vadvala et al, where the sensitivity of biopsy was 0.955 (95.5%) and prevalence was 0.511 (51.1%).[10] A maximum error of 4% was allowed since the sensitivity was already 95.5%, and an error of 4% made it 99.5% (100% is the limit). Thus, L = 0.04.

The calculation was based on the following formula:

By substituting the above values, we got a minimum sample size of 202 when an error of 4% was allowed on either side of the estimate of the sensitivity with a confidence level of 95%.

 

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Study Population and Intervention

Retrospective data was obtained by retrospective review of the institutional database to identify patients who underwent percutaneous biopsy of the omentum, peritoneum, or mesentery guided by CT scan and US between January 2019 and April 2021, which was done using the keywords “peritoneal,” “omental,” and “mesenteric.” All the histopathological reports were retrieved and analyzed for those patients whose imaging data were obtained in the picture archiving and communication system (PACS). All the biopsy procedure scans were reviewed, and the data required for the study were obtained. For prospective data, all patients referred to the interventional radiology department for image-guided peritoneal, omental, or mesenteric biopsy during the study period were included in the study. Patients not willing to participate in the study (n = 1) and cases lost to follow-up (n = 3) were excluded from the study. Patients in whom imaging data could not be retrieved in the PACS were also excluded (n = 12).

A total of 235 patients were initially enrolled in the study. 16 patients were excluded from the study due to various reasons mentioned above. Out of the remaining 219 patients, 207 patients underwent CT-guided biopsies and 12 patients underwent US-guided biopsies. US-guided biopsies, being real-time procedures, were not evaluated for technical and diagnostic performance assessment. The final study cohort included 207 patients, including 134 prospective cases and 73 retrospective cases.

Preprocedure checklist pro forma was filled out for all the patients. Complete blood counts and coagulation profiles were observed. Biopsies were performed after the correction of coagulation parameters in patients with deranged coagulation profiles—any platelet count below 80000/μL and prothrombin time with an international normalized ratio more than 1.4. A partial thromboplastin time value of 23.8 to 37.4 seconds was considered acceptable for the procedure. Patient medication history was obtained, and those patients who were on anticoagulants and antiplatelet drugs were advised to stop the medications for a certain time, as per the standard guidelines (3–5 days). All biopsies were scheduled as CT-guided procedures. If the initial US identifies the target lesion clearly, the biopsy is performed under US guidance. The rest of the biopsies were performed under CT guidance (128-slice CT scanner, Siemens).

All biopsies were performed with a coaxial technique using a 17-gauge coaxial introducer system and an 18-gauge cutting needle for core specimens (BARD MISSION Disposable Core Biopsy Instrument Kit). Patients were placed in a CT scanner in the supine position, and preliminary axial images were acquired to localize the target lesion. Few patients were turned to the right/left oblique/lateral decubitus position to obtain safe passage and better lesion targeting. Under aseptic precautions, the 17-gauge coaxial introducer needle was advanced into the lesion. Repeat scans were performed to confirm the needle position. Needle adjustments were done until the tip of the needle was centered on the target lesion. The number of needle adjustments was recorded. Once the coaxial needle was satisfactorily within the target lesion, the 18-gauge cutting needle was advanced through the 17-gauge coaxial introducer needle, and 3 to 4 core tissue specimens were obtained in different trajectories. In a few cases of mesenteric lesions that were located deep, a safe passage was created using hydrodissection along the needle tract in the mesentery. Procedure time in minutes was calculated from the time of acquisition of the preliminary images to the time of acquisition of images after the procedure. Complications during and postprocedure were recorded.

Technical aspects were described based on the lesion size in long axis/thickness, short axis, depth of lesion from the skin surface, average time of the procedure, and number of needle repositionings or adjustments. Technical success is defined as the completion of the planned biopsy by obtaining core tissue biopsy specimens. Diagnostic yield of a procedure was determined based on the diagnostic biopsy result of the procedure. Diagnostic performance was defined in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

 

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Methods of Outcome Measurement

The lesions were considered diagnostic if the report included one of the following terms: malignant, suspicious, benign, and atypical for neoplastic lesions, or inflammatory, infective, fibrosis, or normal tissue for nonneoplastic lesions. Unless the sample was interpreted as nondiagnostic (insufficient/inadequate sample for interpretation), it was considered diagnostic for this study. The histopathology result obtained from the biopsy procedure was considered a reference standard, and wherever possible, additional pathology from surgery was correlated. The biopsy result was considered true-positive if the initial clinical diagnosis correlated with the histopathology result. A biopsy result was considered true-negative if either a repeat biopsy or surgery confirmed a benign or atypical result of the biopsy or if there was no change in lesion size or disappearance of the lesion on follow-up imaging. The biopsy result was considered false-negative if, after a benign or atypical finding or inconclusive, repeat percutaneous biopsy or surgery yields malignant tissue.

 

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Statistical Methods

The data was entered in a Microsoft Excel spreadsheet, and analysis was done using Statistical Package for Social Sciences (SPSS) version 21. Univariate analysis was done initially, and the results were presented with the help of tables and text. Descriptive statistics were used to calculate frequencies of categorical variables, and measures of central tendency and dispersion were used to describe continuous variables. Calculation of technical success rate and diagnostic yield was performed for all biopsies as a group and separately for omental, peritoneal, and mesenteric biopsies. Sensitivity, specificity, PPV, and NPV were calculated for patients with diagnostic lesions, malignant and suspicious results classified as positive, and benign and atypical results classified as negative. Bivariate analyses were done using the chi-square test/Fisher's exact test. For quantitative variables, the unpaired analysis of variance test or the Kruskal–Wallis test was used. A p-value of < 0.05 was considered statistically significant.

 

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Results

The mean age of study participants in the study was 56.6 ± 14.6 years. Out of the 207 participants, 93 (44.9%) were above the age of 60 years, followed by 42.5% in the age range of 41 to 60 years. In the study, 76.3% of participants were male while 23.7% were female. In the study, out of the 207 participants, 81.2% were known cases of malignancy, and 18.8% were benign with no known malignancy. The biopsy from 207 participants was taken from the omentum, peritoneum, and mesentery in 76.8, 14.5, and 8.7%, respectively. [Figs. 1] to [3] show CT images of CT-guided biopsies performed from omentum thickening, peritoneal nodules, and mesenteric lesions, respectively, in our patients. According to biopsy, 75.8% were diagnosed with malignant pathology and 24.2% were diagnosed with benign pathology. All the biopsy procedure details and complications are summarized in [Table 1]. There was no statistically significant procedure time difference found between different biopsy sites (p-value 0.91). A statistically significant difference was found in the comparison of lesion size on the long axis and short axis between different sites (p-value 0.001) and lesion depth from the skin surface (p-value 0.0001). On comparison of several needle repositionings between different biopsy sites, there was no statistically significant difference (p-value 0.377). The technical success rate was found in 100% of all biopsies. The diagnostic yield of all the biopsies was 98.06%, and the nondiagnostic rate was 1.93%. No major complications occurred in the study population, and only 11 patients had minor complications.

Fig. 1 Omental thickening with ascites. A 56-year-old female suspected case of carcinoma ovary. Computed tomography (CT)-guided biopsy was done from the omental thickening. (A) CT image showing omental thickening with ascites. The coaxial needle was advanced (B, C), with the cutting biopsy needle can be seen across the thickened omentum (D). Note can be made of ascites. Histopathology showed metastatic adenocarcinoma with possible ovarian origin.

Fig. 2 Peritoneal nodule with complication. A 70-year-old male patient with a mass lesion in the pancreas with elevated CA 19–9 (> 1982 U/mL). Computed tomography (CT)-guided biopsy was performed from the peritoneal nodule measuring 10 × 6 mm (A). The needle was repositioned three times to get adequate cores in this case (B, C). Postprocedure check CT scan (axial and sagittal views) showing minimal contained hyperdensity (white arrows) posterior to the nodule—suggestive of hemorrhage (D, E). No progression of hemorrhage noted in follow-up scan. Histopathology showed metastatic adenocarcinoma.

Fig. 3 Mesenteric lesion. A 40-year-old male patient with abdominal pain and low-grade fever. CT abdomen showed a lesion at the root of mesentry (A) measuring 3.1 × 2.8 cm (B). The desired path to advance the needle was planned (C). The coaxial biopsy needle was advanced toward the lesion after multiple needle repositionings (D–F). Coaxial cutting needle through the lesion (G). Biopsy pathology showed necrotizing granulomatous inflammation, suggestive of tuberculosis. Follow-up contrast CT scan of abdomen (H) after 12 months of antitubercular therapy (ATT) showing complete resolution of the lesion.

Table 1 Biopsy procedure details and lesion characteristics

	Frequency		Omental	Peritoneal	Mesenteric
CT guided	207		159/207	30/207	18/207
US guided	12		10/12	2/12	Nil
Lesion size (in mm)		Average
	Long axis	19.19	18.935	16.637	25.77
	Short axis	16.48	15.674	13.964	22.333
Average depth from skin surface (mm)			40	35	61
Average number of needle repositioning			2.82	2.56	3.16
Average procedure time (in min)			21.308	20.83	21.389
Ascites on CT scan	27/207		22/27	4/27	1/27
Complications (minor)	11/207		4/11	5/11	2/11

Abbreviations: CT, computed tomography; US, ultrasound.

In the study, sensitivity, specificity, PPV, and NPV of omental biopsy to diagnose benign pathology were found to be 83.9, 94.3, 78.8, and 95.9.%, respectively. The sensitivity, specificity, PPV, and NPV of peritoneal biopsy to diagnose benign pathology were found to be 50, 82.1, 16.7, and 95.8%, respectively, and that of mesenteric biopsy was 100, 83.33, 75, and 100%, respectively. The accuracy of omental biopsy, peritoneal biopsy, and mesenteric biopsy to diagnose malignancy was found to be 92.26, 80, and 88.89%, respectively. A statistically significant difference was found between the initial diagnosis and the diagnosis made by all biopsies. [Table 2] shows the comparison of total biopsies (omental, peritoneal, and mesenteric biopsies) with final histology. The overall accuracy and predictive values of all the biopsies to diagnose pathology are shown in [Table 3]. The overall sensitivity, specificity, PPV, and NPV of all biopsies to diagnose pathology were found to be 84.62, 91.46, 70.21, and 96.15%, respectively, while the accuracy to detect malignant pathology was 90.15%. [Table 4] summarizes the diagnostic performance of percutaneous biopsies.

Table 2 Comparison of Total biopsies with final diagnosis:

		Total
		Final diagnosis
		Benign		Malignant
		No.	%	No.	%
	Benign	33	66.00	6	3.80
Initial diagnosis	Malignancy	14	34.00	150	96.20
	Total	50	100.00	157	100.00

Table 3 Accuracy and predictive values of total biopsies

Statistic	Value	95% CI
Sensitivity	84.62%	69.47–94.14%
Specificity	91.46%	86.09–95.25%
Positive likelihood ratio	9.91	5.90–16.65
Negative likelihood ratio	0.17	0.08–0.35
Disease prevalence (*)	19.21%	14.03–25.31%
Positive predictive value (*)	70.21%	58.39–79.83%
Negative predictive value (*)	96.15%	92.28–98.12%
Accuracy (*)	90.15%	85.19–93.88%

Abbreviation: PPV, positive predictive value; NPV, negative predictive value; CI, confidence interval.

Table 4 Summary of diagnostic performance of percutaneous biopsies

Diagnostic yield	Sensitivity	Specificity	PPV	NPV	Accuracy
Overall	84.62%	91.46%	70.21%	96.15%	90.15%
Omental	83.9%	94.3%	78.8%	95.9%	92.26%
Mesenteric	100%	88.3%	75%	100%	88.9%
Peritoneal	50%	82.14%	16.67%	95.83%	80%

 

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Discussion

The peritoneum, omentum, and mesentery can be involved in a variety of neoplastic, inflammatory, infectious, and traumatic diseases. Patients with ovarian, gastric, colonic, or pancreatic cancer are termed as having advanced malignancy when peritoneum involvement is present. In some cases of ovarian cancer, treatment includes neoadjuvant chemotherapy followed by cytoreductive surgery; therefore, detecting metastases before treatment is critical for proper clinical care. When the omentum or mesentery is suspected to be a location of metastasis, a biopsy becomes relevant in establishing a diagnosis and determining management. In our study, the mean age of study participants was 56.6 ± 14.6 years, and out of the 207 participants, a maximum of 93 (44.9%) patients were above the age of 60 years, followed by 88 (42.5%) were in the age group of 41 to 60 years. A similar study was done by Vadvala et al on a total of 186 participants and found the mean age of the participants was 63.0 ± 13.8 years, male participants were 47.8%, and female participants were 52.2%. In a similar study done by Iqbal et al[15] on 60 patients to determine the diagnostic value and safety of US-guided percutaneous biopsy of omental thickening, the mean age of the patients was 46.33 ± 13.81 years (range: 25–71 years), female preponderance was found to be higher at 40 (66.7%) as compared with males at 20 (33.3%), like the current study. In our study, a statistically significantly larger lesion size in the long axis (25.7 ± 9.9 mm), short axis (22.3 ± 8.9 mm), and lesion depth (6.1 ± 2.0) was found in mesenteric lesions compared with omental and peritoneal lesions. Vadvala et al[10] also found similar results with larger lesion sizes in the long axis (52.9 ± 33.99 mm), short axis (35.8 ± 21.6 mm), and lesion depth (70.0 ± 29.3) in mesenteric lesions compared with omental lesions. Consistent with the study conducted by Vadvala et al, there was no difference in diagnostic yield obtained by percutaneous biopsy between omental, peritoneal, and mesenteric groups, suggesting that diagnostic yield is independent of lesion size and depth of lesion from the skin surface.[10]

In our study, technical success was found to be 100% for all biopsies. Minor complications occurred in 11 out of 207 patients (5.3%). All the minor complications were self-limiting, postprocedural hemorrhage that were not clinically significant. Similar to the current study, Vadvala et al[10] also found that the technical success rate was 99.5% overall, 100% for omental biopsies, and 98.9% for mesenteric biopsies, and only one CT-guided mesenteric biopsy was deemed technically unsuccessful. The overall complication rate was also low (2.7%) in this study.

The present study shows a higher biopsy success rate (100%) compared with the minimally acceptable success rate (90%) suggested by the “Quality Improvement Guidelines for Percutaneous Needle Biopsy.”[12] The present study had a complication rate of 5.3%, which is within the acceptable complication of up to 6% as recommended by the “Quality Improvement Guidelines for Percutaneous Needle Biopsy.”[16] A recent randomized clinical trial for renal and prostate biopsies using a coaxial technique by Babaei Jandaghi et al observed not only low complication rates but also shorter procedure duration, similar to our results.[17] [18]

In the present study, out of the 207 participants, 168 (81.2%) patients have a history of a proven malignancy, and 39 (18.8%) were considered benign with no known malignant disease. The biopsy site was omentum in 159 (76.8%) patients, peritoneum in 30 (14.5%) patients, and mesentery in 18 (8.7%) patients. A total of 203 patients had a diagnostic histopathology report: 156 (75.36%) malignant pathology, 47 (22.7%) benign pathology, and 4 (1.93%) samples were inconclusive/nondiagnostic according to biopsy. In our study, among the 164 patients with a known primary malignancy and a diagnostic result on histopathology, 89% (146 patients) had metastatic disease from the known cancer; in 2.4% (4 patients), the biopsy result yielded second primary cancer ([Fig. 4]). Out of these four patients, in two patients with primary carcinoma breast, the histopathology report along with immunohistochemistry showed metastatic disease from possible ovarian malignancy. Both patients underwent surgery after chemotherapy, and the diagnosis of ovarian malignancy was confirmed on surgical pathology. One patient had a retroperitoneal sarcoma, in whom the omental biopsy report showed a neuroendocrine tumor. This patient underwent a DOTONOC scan, which revealed avidity within the omentum, suggestive of a neuroendocrine tumor. The last patient was a known postoperative case of carcinoma colon on follow-up, presented with abdominal distension, and contrast-enhanced CT scan of the abdomen revealed omental thickening and bilateral bulky ovaries. Histopathology, along with immunohistochemistry, showed metastatic papillary adenocarcinoma deposits from a possible serous carcinoma of the ovary. The patient was started on chemotherapy for ovarian malignancy, and follow-up imaging done after 4 months showed significant resolution of the omental thickening. In our study, out of the 39 patients with no known cancer or with a known benign disease, new malignancies were detected in 6 patients (15.3%). The new cancers that were diagnosed include one each of metastatic colonic adenocarcinoma, metastatic ovarian carcinoma, well-differentiated adenocarcinoma, metastatic cecal adenocarcinoma, poorly differentiated adenocarcinoma, and pseudomyxoma peritonei ([Fig. 5]).

Fig. 4 Diagram showing outcomes of the histopathology report in the study population.

Fig. 5 Distribution of biopsy histopathology outcome in patients with known cancer.

The overall nondiagnostic rate was 1.93% (4 out of 207). Follow-up of these four patients was done. All four were known malignant patients, including carcinoma ovary (2 cases), operated cases of carcinoma gallbladder, and carcinoma endometrium. Surgery was performed in both the carcinoma ovary cases, which revealed no malignancy on surgical histopathology. No increase in omental thickening was noted at 1-year follow-up imaging in the carcinoma gallbladder patient. Patients with carcinoma endometrium responded well to chemotherapy at 4-month follow-up imaging, suggesting that the omental thickening was a metastatic disease. Vadvala et al in their study (80) included 186 image-guided percutaneous biopsies of omental (n = 95) and mesenteric (n = 91) lesions. Based on the biopsy results, metastatic disease was confirmed in 82 of 114 (44.1%) patients, and a new diagnosis of a second primary tumor was made by biopsy in 11 of 114 (5.9%) patients. A nonneoplastic tissue diagnosis was obtained in 21.5% of biopsies. Souza et al[3] found no statistically significant differences between patients with and without known cancer.

Our study found a statistically significant difference between initial and histopathological diagnoses from biopsies from individual sites and the total. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of total biopsies (combined omental, mesenteric, and peritoneal) for diagnosing pathology were 84.62%, 91.46%, 70.21%, and 96.15%, respectively. For individual biopsy types, the values were as follows: Omental biopsy: 83.9%, 94.3%, 78.8%, and 95.9%, respectively. Mesenteric biopsy: 100%, 83.3%, 75%, and 100%, respectively. Peritoneal biopsy: 50%, 82.1%, 16.7%, and 95.8%, respectively. The accuracy of total biopsies, omental, mesenteric, and peritoneal biopsies, to diagnose the malignancy was found to be 90.15, 92.26, 88.9, and 80%, and was found to be statistically significant. Similarly, a study conducted by Vadvala et al[10] found overall sensitivity of 95.5%, specificity of 100%, NPV of 78.3%, and PPV of 100%. Core biopsies had higher diagnostic yields compared with fine needle aspiration: 98.4% versus 84% overall, 99% versus 88% for omental biopsies, and 97.7% versus 80% for mesenteric biopsies. Souza et al,[3] in their study, found that the overall diagnostic rate was 89%, with a sensitivity of 93%, specificity of 86%, and NPV of 50%. Hill et al[14] found the diagnostic accuracy to be 99% (181 patients). Biopsy was positive for malignancy in 95% of patients with omental caking, 92% with omental nodularity, 80% with a single omental nodule, and 20% with omental thickening. In this study, both US- and CT-guided procedures were evaluated together. Yu et al[20] found the accuracy rate of CT-guided percutaneous fine-needle aspiration biopsy was 95.1%.

The overall sensitivity and specificity in our study were high (84.6 and 91.4%). However, compared with the previously mentioned studies, these values are relatively on the lower side. This may be attributed to a larger study population, diagnosis based only on biopsy specimen, with no additional use of FNA sampling, which was done in most of the previously mentioned studies. Most of the previous studies included both US- and CT-guided biopsies for the evaluation of diagnostic value, which was not the case in our current study, where we evaluated only the percutaneous biopsies performed exclusively under CT guidance. This might have influenced our results. In our study, accuracy in diagnosing a malignant disease based on a histopathology report is 90.15% when compared with the initial clinical diagnosis. However, when we compared the histopathology diagnosis obtained from biopsy with the final diagnosis (after follow-up imaging or surgical pathology), there was high diagnostic accuracy (100%), indicating that percutaneous biopsy reports were highly accurate in diagnosing both benign and malignant diseases.

 

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Conclusion

The study concluded that image-guided percutaneous biopsy of omental, mesenteric, and peritoneal lesions has a high technical success rate and diagnostic yield irrespective of lesion size and lesion depth. This implies that image-guided percutaneous biopsy of the omentum, mesentery, and peritoneum is a less expensive, safe, and effective method with high diagnostic accuracy to diagnose lesions.

 

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Conflict of Interest

None declared.

Ethical Considerations

This study was approved by the Scientific and Ethics Committee of the hospital participating in the study as per guidelines. The written informed consents were taken from all the participants. Participant identification number (Participant ID) was used to maintain patient confidentiality for any data, form, report, or other record that was used for analysis. Confidentiality of the subjects was maintained throughout the process.

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Artikel online veröffentlicht:
12. August 2025