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Z Gastroenterol 2021; 59(08): 879-885
DOI: 10.1055/a-1404-3926
DOI: 10.1055/a-1404-3926
Übersicht
„Pro und contra Milzpunktion“ oder besser „wann und wann nicht?“
Spleen biopsy: “pros and cons” or better “when and when not?”
Zusammenfassung
Aufgrund der relativ hohen Komplikationsrate wird die Notwendigkeit einer Milzbiopsie kontrovers diskutiert. Bei der Indikationsstellung sind der klinische Hintergrund und die bereits erfolgte Diagnostik zu berücksichtigen. Anhand der Anamnese, der bildgebenden Verfahren und des sonografischen Verlaufs sind unterschiedliche klinische Szenarien vorstellbar. Das Ziel der Arbeit ist es, die Indikation einer Milzbiopsie unter Beachtung unterschiedlicher klinischer Szenarien zu beschreiben.
Abstract
Due to the relatively high complication rate, the necessity of a spleen biopsy is controversially discussed. In establishing its indication, the clinical background and performed diagnostics must be considered. Based on the medical history, imaging procedures and sonographic course, different clinical scenarios are conceivable. The aim of this review is to describe the indications of splenic biopsy considering various clinical scenarios.
Publication History
Received: 23 November 2020
Accepted: 24 February 2021
Article published online:
22 March 2021
© 2021. Thieme. All rights reserved.
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References
- 1 Deurdulian C, French N. Ultrasound-Guided Intervention in the Abdomen and Pelvis. Ultrasound Clinics 2014; 9: 793-820 DOI: 10.1016/j.cult.2014.07.012.
- 2 Potthoff A, Gebel MJ, Rifai K. Diagnostische und interventionelle Abdomensonografie. Internist (Berl) 2012; 53: 261-270 DOI: 10.1007/s00108-011-2957-6.
- 3 Becker D, Beuscher-Willems B, Jakobeit C. et al Kursbuch Ultraschall. Nach den Richtlinien der DEGUM und der KBV. 6. Aufl.. Stuttgart, New York: Georg Thieme Verlag; 2015
- 4 Amann-Vesti B, Bönhof JA, Görg C. Sonografie kompetent. Von der Indikation zur Interpretation. Stuttgart, New York: Georg Thieme Verlag; 2016
- 5 Ekeh AP, Walusimbi M, Brigham E. et al The prevalence of incidental findings on abdominal computed tomography scans of trauma patients. The Journal of emergency medicine 2010; 38: 484-489 DOI: 10.1016/j.jemermed.2008.11.019.
- 6 Ozao-Choy J, Kim U, Vieux U. et al Incidental findings on computed tomography scans for acute appendicitis: prevalence, costs, and outcome. Am Surg 2011; 77: 1502-1509
- 7 Paluska TR, Sise MJ, Sack DI. et al Incidental CT findings in trauma patients: incidence and implications for care of the injured. The Journal of trauma 2007; 62: 157-161 DOI: 10.1097/01.ta.0000249129.63550.cc.
- 8 Caremani M, Occhini U, Caremani A. et al Focal splenic lesions: US findings. J Ultrasound 2013; 16: 65-74 DOI: 10.1007/s40477-013-0014-0.
- 9 Strobel D, Bernatik T, Blank W. et al Incidence of bleeding in 8172 percutaneous ultrasound-guided intraabdominal diagnostic and therapeutic interventions – results of the prospective multicenter DEGUM interventional ultrasound study (PIUS study). Ultraschall in der Medizin – European Journal of Ultrasound 2015; 36: 122-131 DOI: 10.1055/s-0034-1399282.
- 10 Görg C, Kunsch S, Neesse A. Zufallsbefunde in der Abdomensonografie: Charakteristika und klinische Interpretation. Internist (Berl) 2014; 55 998, 1000-2, 1004-6 passim DOI: 10.1007/s00108-014-3454-5.
- 11 Rosling M, Trenker C, Neesse A. et al Spontaneous and Traumatic Splenic Rupture: Retrospective Clinical, B-Mode and CEUS Analysis in 62 Patients. Ultrasound Int Open 2018; 4: E30-E34 DOI: 10.1055/s-0043-125311.
- 12 Civardi G, Vallisa D, Bertè R. et al Ultrasound-guided fine needle biopsy of the spleen: high clinical efficacy and low risk in a multicenter Italian study. Am J Hematol 2001; 67: 93-99 DOI: 10.1002/ajh.1085.
- 13 Patel N, Dawe G, Tung K. Ultrasound-guided percutaneous splenic biopsy using an 18-G core biopsy needle: our experience with 52 cases. The British Journal of Radiology 2015; 88: 20150400 DOI: 10.1259/bjr.20150400.
- 14 Olson MC, Atwell TD, Harmsen WS. et al Safety and Accuracy of Percutaneous Image-Guided Core Biopsy of the Spleen. American Journal of Roentgenology 2016; 206: 655-659 DOI: 10.2214/Am J Roentgenol.15.15125.
- 15 McInnes MDF, Kielar AZ, Macdonald DB. Percutaneous image-guided biopsy of the spleen: systematic review and meta-analysis of the complication rate and diagnostic accuracy. Radiology 2011; 260: 699-708 DOI: 10.1148/radiol.11110333.
- 16 Wan YL, Cheung YC, Lui KW. et al Ultrasonographic findings and differentiation of benign and malignant focal splenic lesions. Postgraduate Medical Journal 2000; 76: 488-493 DOI: 10.1136/pmj.76.898.488.
- 17 Dietrich CF, Nürnberg D. Interventioneller Ultraschall. Lehrbuch und Atlas für die Interventionelle Sonografie. Georg Thieme Verlag KG; 2011. DOI: 10.1055/b-002-8307
- 18 A L H, Sindhuram V S, S S, et al. Ultrasound guided fnac of abdominal-pelvic masses-the pathologists' perspective. J Clin Diagn Res 2013; 7: 273-277 DOI: 10.7860/JCDR/2013/4514.2745.
- 19 Kloeckner R, dos Santos DP, Schneider J. et al Radiation exposure in CT-guided interventions. European Journal of Radiology 2013; 82: 2253-2257 DOI: 10.1016/j.ejrad.2013.08.035.
- 20 Tokue H, Hirasawa S, Morita H. et al Percutaneous image-guided biopsy for non-mass-forming isolated splenomegaly and suspected malignant lymphoma. PLoS One 2014; 9: e111657 DOI: 10.1371/journal.pone.0111657.
- 21 Tam A, Krishnamurthy S, Pillsbury EP. et al Percutaneous image-guided splenic biopsy in the oncology patient: an audit of 156 consecutive cases. J Vasc Interv Radiol 2008; 19: 80-87 DOI: 10.1016/j.jvir.2007.08.025.
- 22 Venkataramu NK, Gupta S, Sood BP. et al Ultrasound guided fine needle aspiration biopsy of splenic lesions. The British Journal of Radiology 1999; 72: 953-956 DOI: 10.1259/bjr.72.862.10673946.
- 23 Keogan MT, Freed KS, Paulson EK. et al Imaging-guided percutaneous biopsy of focal splenic lesions: update on safety and effectiveness. Am J Roentgenol 1999; 172: 933-937 DOI: 10.2214/ajr.172.4.10587123.
- 24 Gómez-Rubio M, López-Cano A, Rendón P. et al Safety and diagnostic accuracy of percutaneous ultrasound-guided biopsy of the spleen: a multicenter study. J Clin Ultrasound 2009; 37: 445-450 DOI: 10.1002/jcu.20608.
- 25 Solbiati L, Bossi MC, Bellotti E. et al Focal lesions in the spleen: sonographic patterns and guided biopsy. Am J Roentgenol 1983; 140: 59-65 DOI: 10.2214/ajr.140.1.59.
- 26 López JI, Del Cura JL, de Larrinoa AF. et al Role of ultrasound-guided core biopsy in the evaluation of spleen pathology. APMIS 2006; 114: 492-499 DOI: 10.1111/j.1600-0463.2006.apm_378.x.
- 27 Lindgren PG, Hagberg H, Eriksson B. et al Excision biopsy of the spleen by ultrasonic guidance. The British Journal of Radiology 1985; 58: 853-857 DOI: 10.1259/0007-1285-58-693-853.
- 28 Mosquera-Klinger G, de La Serna Higuera C, Bazaga S. et al Endoscopic ultrasound-guided fine-needle aspiration for splenomegaly and focal splenic lesion: is it safe, effective and necessary?. Rev Esp Enferm Dig 2020; 112: 355-359 DOI: 10.17235/reed.2020.6667/2019.
- 29 Rana SS, Sharma V, Sharma R. et al Safety and utility of endoscopic ultrasound-guided fine-needle aspiration of focal splenic lesions: a retrospective analysis. Ann Gastroenterol 2017; 30: 559-563
- 30 Fritscher-Ravens A, Mylonaki M, Pantes A. et al Endoscopic ultrasound-guided biopsy for the diagnosis of focal lesions of the spleen. Am J Gastroenterol 2003; 98: 1022-1027 DOI: 10.1111/j.1572-0241.2003.07399.x.
- 31 Werner T, Koch J, Denzer UW. Effectiveness and safety of minilaparoscopy-guided spleen biopsy: a retrospective series of 57 cases. Surg Endosc 2013; 27: 4743
- 32 Lehne G, Hannisdal E, Langholm R. et al A 10-year experience with splenectomy in patients with malignant non-Hodgkin's lymphoma at the Norwegian Radium Hospital. Cancer 1994; 74: 933-939 DOI: 10.1002/1097-0142(19940801)74:3<933::AID-CNCR2820740322>3.0.CO;2-P.
- 33 Machado NO, Grant CS, Alkindi S. et al Splenectomy for haematological disorders: a single center study in 150 patients from Oman. Int J Surg 2009; 7: 476-481 DOI: 10.1016/j.ijsu.2009.08.004.
- 34 Cadili A, de Gara C. Complications of splenectomy. Am J Med 2008; 121: 371-375 DOI: 10.1016/j.amjmed.2008.02.014.
- 35 Targarona EM, Espert JJ, Bombuy E. et al Complications of laparoscopic splenectomy. Arch Surg 2000; 135: 1137-1140 DOI: 10.1001/archsurg.135.10.1137.
- 36 von Herbay A, Barreiros AP, Ignee A. et al Contrast-enhanced ultrasonography with SonoVue: differentiation between benign and malignant lesions of the spleen. J Ultrasound Med 2009; 28: 421-434 DOI: 10.7863/jum.2009.28.4.421.
- 37 Ignee A, Cui X, Hirche T. et al Percutaneous biopsies of splenic lesions – a clinical and contrast enhanced ultrasound based algorithm. Clin Hemorheol Microcirc 2014; 58: 529-541 DOI: 10.3233/CH-141813.
- 38 de La Pinta C, Fernández Lizarbe E, Montero Luis Á. et al Treatment of symptomatic splenomegaly with low doses of radiotherapy: Retrospective analysis and review of the literature. Tech Innov Patient Support Radiat Oncol 2017; 3-4: 23-29 DOI: 10.1016/j.tipsro.2017.08.002.
- 39 Ebright JR, Alam E, Ahmed H. et al Splenic Infarction and Abscess in the Setting of Infective Endocarditis. Infectious Diseases in Clinical Practice 2007; 15: 17-21 DOI: 10.1097/IPC.0b013e31802b6894.
- 40 Fotiadis C, Lavranos G, Patapis P. et al Abscesses of the spleen: report of three cases. World Journal of Gastroenterology 2008; 14: 3088-3091 DOI: 10.3748/wjg.14.3088.
- 41 Kocael PC, Simsek O, Bilgin IA. et al Characteristics of patients with spontaneous splenic rupture. Int Surg 2014; 99: 714-718 DOI: 10.9738/INTSURG-D-14-00143.1.
- 42 Fotiadis C, Georgopoulos I, Stoidis C. et al Primary tumors of the spleen. Int J Biomed Sci 2009; 5: 85-91
- 43 Fiorentino MD, Monteiro JMC, de Siqueira REB. et al Primary splenic angiosarcoma: a rare entity often associated with rupture and hemoperitoneum. Autops Case Rep 2019; 9: e2019100 DOI: 10.4322/acr.2019.100.
- 44 Gnassingbe K, Akakpo-Numado GK, Attipou K. et al Peut-on envisager une splénectomie préventive des complications des splénomagalies chez l’enfant drépanocytaire?. Sante 2007; 17: 207-211 DOI: 10.1684/san.2007.0082.
- 45 Dietrich CF, Schreiber-Dietrich D, Nürnberg D. Abdominelle Sonografie. CME 2014; 11: 61-74 DOI: 10.1007/s11298-014-0007-0.
- 46 Goerg C, Schwerk WB. Splenic infarction: sonographic patterns, diagnosis, follow-up, and complications. Radiology 1990; 174: 803-807 DOI: 10.1148/radiology.174.3.2406785.
- 47 Maresca G, Mirk P, de Gaetano A. et al Sonographic patterns in splenic infarct. J Clin Ultrasound 1986; 14: 23-28 DOI: 10.1002/jcu.1870140106.
- 48 Sutherland T, Temple F, Galvin A. et al Contrast-enhanced ultrasound of the spleen: an introduction and pictorial essay. Insights Imaging 2011; 2: 515-524 DOI: 10.1007/s13244-011-0106-3.
- 49 Omar A, Freeman S. Contrast-enhanced ultrasound of the spleen. Ultrasound 2016; 24: 41-49 DOI: 10.1177/1742271X15617214.
- 50 Jaroch MT, Broughan TA, Hermann RE. The natural history of splenic infarction. Surgery 1986; 100: 743-750
- 51 Bates AT, Svestka MG. Management of Splenic Abscess. In: Docimo Jr S, Pauli EM. eds. Clinical Algorithms in General Surgery: A Practical Guide. Cham: Springer International Publishing; 2019: 409-411 DOI: 10.1007/978-3-319-98497-1_101
- 52 Lucey BC, Boland GW, Maher MM. et al Percutaneous nonvascular splenic intervention: a 10-year review. Am J Roentgenol 2002; 179: 1591-1596 DOI: 10.2214/ajr.179.6.1791591.
- 53 Seitz K, Schuler A, Rettenmaier G. Hrsg Klinische Sonografie und sonografische Differentialdiagnose. Band 1: Leber. 2. Aufl.. Stuttgart: Thieme; 2008
- 54 Barsness KA, Reynolds M. The Spleen. In: Coran AG, Adzick NS. eds. Pediatric surgery. 7th ed.. Philadelphia, PA: Elsevier Mosby; 2012: 1385-1392 DOI: 10.1016/B978-0-323-07255-7.00110-0
- 55 DeMasi CJ, Akdamar K, Sparks RD. et al Splenic cyst diagnosed by percutaneous needle aspiration and splenography. Report of a case. Am J Dig Dis 1966; 11: 819-825 DOI: 10.1007/BF02233844.
- 56 Li M, Zhang L, Wu N. et al Imaging findings of primary splenic lymphoma: a review of 17 cases in which diagnosis was made at splenectomy. PLoS One 2013; 8: e80264 DOI: 10.1371/journal.pone.0080264.
- 57 Görg C, Weide R, Schwerk WB. Sonografische Befallsmuster der Milz bei Nicht-Hodgkin-Lymphomen. Ultraschall in Med 1995; 16: 104-108 DOI: 10.1055/s-2007-1003164.
- 58 Vanhoenacker F, de Schepper AM. The Spleen in Systemic Disorders. In: de Schepper AM, Vanhoenacker F, Baert AL. Hrsg. Medical Imaging of the Spleen. Medical Radiology – Diagnostic Imaging and Radiation Oncology. Berlin: Springer Berlin; 2013: 49-66 DOI: 10.1007/978-3-642-57045-2_6
- 59 Ito K, Mitchell DG. The Spleen in Hematologic Disorders. In: de Schepper AM, Vanhoenacker F, Baert AL. Hrsg. Medical Imaging of the Spleen. Medical Radiology – Diagnostic Imaging and Radiation Oncology. Berlin: Springer Berlin; 2013: 37-47 DOI: 10.1007/978-3-642-57045-2_5
- 60 Saboo SS, Krajewski KM, O'Regan KN. et al Spleen in haematological malignancies: spectrum of imaging findings. The British Journal of Radiology 2012; 85: 81-92 DOI: 10.1259/bjr/31542964.
- 61 Paes FM, Kalkanis DG, Sideras PA. et al FDG PET/CT of extranodal involvement in non-Hodgkin lymphoma and Hodgkin disease. RadioGraphics 2010; 30: 269-291 DOI: 10.1148/rg.301095088.
- 62 Goerg C, Schwerk WB, Goerg K. et al Sonographic patterns of the affected spleen in malignant lymphoma. J Clin Ultrasound 1990; 18: 569-574 DOI: 10.1002/jcu.1870180708.
- 63 Trenker C, Görg C, Jenssen C. et al Stellenwert der Abdomensonografie in der Hämatologie. Z Gastroenterol 2018; 56: 1063-1076 DOI: 10.1055/a-0603-4240.
- 64 Singer A, Maldjian P, Simmons MZ. Extramedullary hematopoiesis presenting as a focal splenic mass: a case report. Abdom Imaging 2004; 29: 710-712 DOI: 10.1007/s00261-003-0164-1.
- 65 Schön CA, Görg C, Ramaswamy A. et al Splenic metastases in a large unselected autopsy series. Pathol Res Pract 2006; 202: 351-356 DOI: 10.1016/j.prp.2005.12.008.
- 66 Siewert B, Millo NZ, Sahi K. et al The Incidental Splenic Mass at CT: Does It Need Further Work-up? An Observational Study. Radiology 2018; 287: 156-166 DOI: 10.1148/radiol.2017170293.
- 67 Sauer J, Sobolewski K, Dommisch K. Splenic metastases – not a frequent problem, but an underestimate location of metastases: epidemiology and course. J Cancer Res Clin Oncol 2009; 135: 667-671 DOI: 10.1007/s00432-008-0502-3.
- 68 Yoshizawa J, Kubo N, Ishizone S. et al Curative resection by splenectomy for solitary splenic metastasis from early gastric cancer: a case report and literature review. BMC Cancer 2017; 17: 436 DOI: 10.1186/s12885-017-3434-y.
- 69 Görg C, Hoffmann A. Milzmetastasen bei 59 Patienten mit Karzinomen: Eine klinisch sonografische Studie über einen Zeitraum von 14 Jahren. Ultraschall in Med 2008; 29: 173-178 DOI: 10.1055/s-2007-963024.
- 70 Christian Görg. Milzdiagnostik mit Ultraschallkontrastmitteln. Konstanz: Schnetztor-Verlag Gmbh; 2006
- 71 Görg C. The forgotten organ: contrast enhanced sonography of the spleen. European Journal of Radiology 2007; 64: 189-201 DOI: 10.1016/j.ejrad.2007.06.036.
- 72 Neiman RS, Orazi A, Wolf BC. Disorders of the spleen. v. 38. Major problems in pathology. 2. Aufl.. Philadelphia: W.B. Saunders; 1999
- 73 Ingle SB, Hinge Ingle CR. Primary splenic lymphoma: Current diagnostic trends. World J Clin Cases 2016; 4: 385-389 DOI: 10.12998/wjcc.v4.i12.385.
- 74 Wernecke K, Peters PE, Krüger KG. Ultrasonographic patterns of focal hepatic and splenic lesions in Hodgkin's and non-Hodgkin's lymphoma. The British Journal of Radiology 1987; 60: 655-660 DOI: 10.1259/0007-1285-60-715-655.
- 75 Benter T, Klühs L, Teichgräber U. Sonography of the spleen. J Ultrasound Med 2011; 30: 1281-1293 DOI: 10.7863/jum.2011.30.9.1281.
- 76 Dennhardt N, Görg C, Neubauer A. Häufigkeit, Dignität und Differenzialdiagnose echoreicher Milzveränderungen: Eine sonografische Verlaufsstudie. Ultraschall in Med 2000; 21: 151-159 DOI: 10.1055/s-2000-6925.
- 77 Stang A, Keles H, Hentschke S. et al Incidentally detected splenic lesions in ultrasound: does contrast-enhanced ultrasonography improve the differentiation of benign hemangioma/hamartoma from malignant lesions?. Ultraschall in Med 2011; 6: 582-592
- 78 Gore RM, Ecanow JS. Management of splenic “incidentalomas” found on ultrasound and computed tomography. Cancer Imaging 2015; 15: O11 DOI: 10.1186/1470-7330-15-S1-O11.
- 79 Bert T, Tebbe J, Görg C. What should be done with echoic splenic tumors incidentally found by ultrasound?. Z Gastroenterol 2010; 48: 465-471 DOI: 10.1055/s-0028-1109784.
- 80 de Jong PA, van Ufford HMQ, Baarslag HJ. et al CT and 18F-FDG PET for noninvasive detection of splenic involvement in patients with malignant lymphoma. American Journal of Roentgenology 2009; 192: 745-753 DOI: 10.2214/Am J Roentgenol.08.1160.