Ultrasound-guided core needle biopsy of nodular lesions of the spleen in hematology clinical practice.

Background: Solid splenic lesions may be the expression of a lymphoproliferative disease spreading to the spleen or appear as the only manifestation of possible neoplastic diseases, mainly hematologic malignancies. Therefore, biopsy is of uttermost importance in clarifying their nature.

Patients and methods: Forty-four patients with splenic nodular lesions suspected of hematologic disease underwent spleen contrast-enhanced ultrasonography and contextual biopsy using an 18-gauge needle. All procedures were performed on an outpatient basis. Patients with inconclusive findings or with a diagnosis of unaffected splenic tissue were followed up to discriminate between true and false-negative results.

Results: All procedures ended up with sampling of splenic tissue without severe complications requiring hospitalization or supportive countermeasures. None was interrupted because of adverse event (AE)s. Out of 44 samples, a final diagnosis was accomplished in 39 cases, with a diagnostic yield of 88.6%. A diagnosis of lymphoma was made in 22 cases. Other diagnoses included: splenic metastases and splenic sarcoma (3 cases each), non-neoplastic lesions (3 cases), and unaffected splenic tissue (8 cases). Among the latter 8 patients, 1 received a diagnosis of Hodgkin lymphoma by marrow biopsy. All the other 7 patients never received a diagnosis of neoplasm and were true negative. Among the 5 patients with insufficient sampling, 3 were never diagnosed with a neoplasm during follow-up; 1 had myelofibrosis and 1 angiosarcoma. The sensitivity of the procedure was 96.6%; specificity was 100% and accuracy was 86.4%.

Conclusions: Ultrasound-guided core needle biopsy of splenic nodular lesions can be safely performed on an outpatient basis with no severe AEs.