Ultrasound Guided Percutaneous Splenic Biopsy: Diagnostic Accuracy and Complication

Aims: Ultrasound (US) guided percutaneous splenic biopsies are uncommon and are ordinarily done in the context of an indeterminate splenic lesion with a probable underlying malignancy, and where there is no other safe accessible site to obtain tissue, or where the diagnosis of a splenic metastasis would impact management. The authors aimed to assess the diagnostic accuracy and complication rate of US-guided percutaneous biopsy of the spleen. Materials and methods: The authors assembled a list of 43 biopsies between 2005–2023 at St. James’s University Hospital in Leeds, UK. Results: Twenty-two biopsies (51%) were performed to assess progression in the context of known or previous malignancy, 22 were performed to assess for malignancy in patients with no prior malignant history, and the remaining six (14%) biopsies were conducted to assess for infection. Three patients had a prior splenic biopsy, and 30 experienced one needle pass. Thirty-seven of the 43 samples (86%) proved to be diagnostic. Positive samples included both benign and malignant abnormal splenic tissue. Malignant diagnoses included diffuse large B cell lymphoma, Hodgkin’s lymphoma, leukaemia, and metastases. Benign conditions included non-specific reactive changes, infection, sarcoidosis, and haemangioma. The authors established there were 30 true positives and zero false positives. There were five true negative biopsies and one false negative. The overall diagnostic yield and accuracy are 86% and 84%, respectively. There were no major complications and two minor complications; two patients developed perisplenic haematomas, which were conservatively managed. Conclusion: The authors concluded that US-guided percutaneous splenic biopsy is a safe procedure with a high diagnostic yield and relatively high accuracy. Level of evidence: Level 4, retrospective cohort.