Clinical Value of CT-Guided Needle Biopsy for Retroperitoneal Lesions

Yuki Tomozawa,Yoshitaka Inaba,Hidekazu Yamaura,Yozo Sato,Mina Kato,Takaaki Kanamoto,Makoto Sakane 대한영상의학회 2011 Korean Journal of Radiology Vol.12 No.3

Objective: The purpose of this study was to investigate retrospectively the clinical procedural performance of CT-guided needle biopsy for retroperitoneal lesions. Materials and Methods: CT-guided needle biopsy was performed in 74 consecutive patients (M:F = 44:30; mean age, 59.7 years) with retroperitoneal lesions between April 1998 and June 2009. The target lesion ranged from 1.5 to 12.5 cm in size. The biopsy access path ranged from 3.5 to 11.5 cm in depth. A biopsy specimen was obtained using an 18-gauge core needle under a CT or CT-fluoroscopy guidance and with the patient under local anesthesia. The histopathological diagnoses from the biopsies were obtained. The diagnostic confirmation of the subtype of lymphoma was evaluated. Results: Satisfactory biopsy samples were obtained in 73 (99%) of 74 patients and a pathological diagnosis was made in 70 (95%) of 74 patients. Sixty three lesions were malignant (45 lymphomas, nine primary tumors, nine lymph node metastases) and seven were benign. The subtype of lymphoma was specified in 43 (96%) of 45 patients who were diagnosed with lymphoma. Analysis of the value of CT-guided biopsy in this series indicated 63 true positives, zero false positive, six true negatives and five false negatives. This test had a sensitivity of 93%, a specificity of 100% and an accuracy of 93%. No major complications were seen and minor complications were noted in seven patients (five with local hematomas, two with transient pain at the puncture site). Conclusion: CT-guided needle biopsy for retroperitoneal lesions is highly practical and useful, and particularly for determining the subtypes in patients with lymphoma. Objective: The purpose of this study was to investigate retrospectively the clinical procedural performance of CT-guided needle biopsy for retroperitoneal lesions. Materials and Methods: CT-guided needle biopsy was performed in 74 consecutive patients (M:F = 44:30; mean age, 59.7 years) with retroperitoneal lesions between April 1998 and June 2009. The target lesion ranged from 1.5 to 12.5 cm in size. The biopsy access path ranged from 3.5 to 11.5 cm in depth. A biopsy specimen was obtained using an 18-gauge core needle under a CT or CT-fluoroscopy guidance and with the patient under local anesthesia. The histopathological diagnoses from the biopsies were obtained. The diagnostic confirmation of the subtype of lymphoma was evaluated. Results: Satisfactory biopsy samples were obtained in 73 (99%) of 74 patients and a pathological diagnosis was made in 70 (95%) of 74 patients. Sixty three lesions were malignant (45 lymphomas, nine primary tumors, nine lymph node metastases) and seven were benign. The subtype of lymphoma was specified in 43 (96%) of 45 patients who were diagnosed with lymphoma. Analysis of the value of CT-guided biopsy in this series indicated 63 true positives, zero false positive, six true negatives and five false negatives. This test had a sensitivity of 93%, a specificity of 100% and an accuracy of 93%. No major complications were seen and minor complications were noted in seven patients (five with local hematomas, two with transient pain at the puncture site). Conclusion: CT-guided needle biopsy for retroperitoneal lesions is highly practical and useful, and particularly for determining the subtypes in patients with lymphoma.

Cellular Density Evaluation for Malignant Lymphoma Using Equivalent Cross-Relaxation Rate Imaging - Initial Experience

Hideyuki Nishiofuku,Shigeru Matsushima,Yoshitaka Inaba,Hidekazu Yamaura,Yozo Sato,Yasuo Morishima,Kimihiko Kichikawa 대한영상의학회 2010 Korean Journal of Radiology Vol.11 No.3

Objective: Equivalent cross-relaxation rate (ECR) imaging is an MRI technique used to evaluate quantitatively a change in the protein-water interaction. We aimed to evaluate retrospectively the usefulness of ECR imaging for the histologic classification of malignant lymphoma (ML). Materials and Methods: Institutional Review Board approval was obtained and all patients provided informed consent. The study subjects included 15 patients with untreated ML who were histologically diagnosed with follicular lymphoma (FL; n = 8) or diffuse large B-cell lymphoma (DLBCL; n = 7). All patients underwent ECR imaging and the offset frequency was set at 7 ppm. Results: The median ECR values were 71% (range; 60.7 to 75.5) in FL and 54% (50.8 to 59.4) in DLBCL (p = 0.001). The median cellular density was 1.5 0.17 × 106 / mm2 in FL and 1.0 ± 0.70 × 106 / mm2 in DLBCL (p = 0.001). The correlation coefficient between the ECR values and cellular density in ML was 0.88 (p = 0.001). In FL and DLBCL, assuming ECR value cut-off points of 60%, both sensitivity and specificity were 100%. Conclusion: A strong correlation between ECR and cellular density in ML is demonstrated and the ECR may be a useful technique to differentiate between FL and DLBCL. Objective: Equivalent cross-relaxation rate (ECR) imaging is an MRI technique used to evaluate quantitatively a change in the protein-water interaction. We aimed to evaluate retrospectively the usefulness of ECR imaging for the histologic classification of malignant lymphoma (ML). Materials and Methods: Institutional Review Board approval was obtained and all patients provided informed consent. The study subjects included 15 patients with untreated ML who were histologically diagnosed with follicular lymphoma (FL; n = 8) or diffuse large B-cell lymphoma (DLBCL; n = 7). All patients underwent ECR imaging and the offset frequency was set at 7 ppm. Results: The median ECR values were 71% (range; 60.7 to 75.5) in FL and 54% (50.8 to 59.4) in DLBCL (p = 0.001). The median cellular density was 1.5 0.17 × 106 / mm2 in FL and 1.0 ± 0.70 × 106 / mm2 in DLBCL (p = 0.001). The correlation coefficient between the ECR values and cellular density in ML was 0.88 (p = 0.001). In FL and DLBCL, assuming ECR value cut-off points of 60%, both sensitivity and specificity were 100%. Conclusion: A strong correlation between ECR and cellular density in ML is demonstrated and the ECR may be a useful technique to differentiate between FL and DLBCL.

Preoperative Estimation of Future Remnant Liver Function Following Portal Vein Embolization Using Relative Enhancement on Gadoxetic Acid Disodium-Enhanced Magnetic Resonance Imaging

Yozo Sato,Shigeru Matsushima,Yoshitaka Inaba,Tsuyoshi Sano,Hidekazu Yamaura,Mina Kato,Yasuhiro Shimizu,Yoshiki Senda,Tsuneo Ishiguchi 대한영상의학회 2015 Korean Journal of Radiology Vol.16 No.3

To retrospectively evaluate relative enhancement (RE) in the hepatobiliary phase of gadoxetic acid disodium-enhanced magnetic resonance (MR) imaging as a preoperative estimation of future remnant liver (FRL) function in a patients who underwent portal vein embolization (PVE). In 53 patients, the correlation between the indocyanine green clearance (ICG-K) and RE imaging was analyzed before hepatectomy (first analysis). Twenty-three of the 53 patients underwent PVE followed by a repeat RE imaging and ICG test before an extended hepatectomy and their results were further analyzed (second analysis). Whole liver function and FRL function were calculated on the MR imaging as follows: RE x total liver volume (RE Index) and FRL-RE x FRL volume (Rem RE Index), respectively. Regarding clinical outcome, posthepatectomy liver failure (PHLF) was evaluated in patients undergoing PVE. Indocyanine green clearance correlated with the RE Index (r = 0.365, p = 0.007), and ICG-K of FRL (ICG-Krem) strongly correlated with the Rem RE Index (r = 0.738, p < 0.001) in the first analysis. Both the ICG-Krem and the Rem RE Index were significantly correlated after PVE (r = 0.508, p = 0.013) at the second analysis. The rate of improvement of the Rem RE Index from before PVE to after PVE was significantly higher than that of ICG-Krem (p = 0.014). Patients with PHLF had a significantly lower Rem RE Index than patients without PHLF (p = 0.023). Relative enhancement imaging can be used to estimate FRL function after PVE.

Interventional management for postoperative arterial bleeding in gastrointestinal surgery

Yozo Sato,Kiyoshi Matsueda,Marie Osawa,Yoshitaka Inaba,Yu Takahashi,Yosuke Inoue,Atsushi Oba,Yosuke Fukunaga,Yasuhiro Shimizu 소화기인터벤션의학회 2022 International journal of gastrointestinal interven Vol.11 No.4

Postoperative arterial bleeding after gastrointestinal surgery is a potentially fatal complication. Transcatheter arterial embolization is considered the first-line treatment because of efficacy and less invasiveness despite the risk of organ infarction. With the recent advances in endovascular devices, stent-graft placement, which can preserve arterial flow, has been an alternative treatment option in patients with extrahepatic artery hemorrhage. Moreover, clinical outcomes of stent-graft placement for pseudoaneurysms in relative long term have been reported recently. Herein, we review the techniques and clinical outcomes for interventional management for postoperative arterial bleeding.

Interventional management for postoperative arterial bleeding in gastrointestinal surgery

Yozo Sato,Kiyoshi Matsueda,Marie Osawa,Yoshitaka Inaba,Yu Takahashi,Yosuke Inoue,Atsushi Oba,Yosuke Fukunaga,Yasuhiro Shimizu 소화기인터벤션의학회 2022 Gastrointestinal Intervention Vol.11 No.4

Postoperative arterial bleeding after gastrointestinal surgery is a potentially fatal complication. Transcatheter arterial embolization is considered the first-line treatment because of efficacy and less invasiveness despite the risk of organ infarction. With the recent advances in endovascular devices, stent-graft placement, which can preserve arterial flow, has been an alternative treatment option in patients with extrahepatic artery hemorrhage. Moreover, clinical outcomes of stent-graft placement for pseudoaneurysms in relative long term have been reported recently. Herein, we review the techniques and clinical outcomes for interventional management for postoperative arterial bleeding.

Techniques for percutaneous transesophageal gastrotubing

Yozo Sato,Shohei Chatani,Takaaki Hasegawa,Shinichi Murata,Yoshitaka Inaba 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.2

Percutaneous transesophageal gastrotubing (PTEG) procedure was developed in Japan as an alternative access route into the gastrointestinal tract, and it has been performed for patients in whom percutaneous endoscopic gastrostomy would be technically difficult to place or is contraindicated, such as in a prior gastrectomy and massive ascites. In the PTEG procedure, an indwelling tube is inserted through the cervical esophagus, which gives the patient a slight discomfort after the tube placement. Therefore, PTEG is performed not only for enteral feeding, but also for bowel decompression as a palliative care in patients with malignant gastrointestinal obstruction. Recently, several reports of PTEG from countries outside Japan indicated a high technical success rate without major complications. Furthermore, the usefulness of PTEG for bowel decompression as a palliative care was reported in prospective studies. In fact, PTEG is a technically feasible and safe procedure worldwide.

Regional Differences in Efficacy, Safety, and Biomarkers for Second-Line Axitinib in Patients with Advanced Hepatocellular Carcinoma: From a Randomized Phase II Study

Kudo, Masatoshi,Kang, Yoon-Koo,Park, Joong-Won,Qin, Shukui,Inaba, Yoshitaka,Assenat, Eric,Umeyama, Yoshiko,Lechuga, Maria José,Valota, Olga,Fujii, Yosuke,Martini, Jean-Francois,Williams, J. Andr S. Karger AG 2018 Liver cancer Vol.7 No.2

<P><B><I>Background:</I></B> An unmet need exists for treatment of patients with advanced hepatocellular carcinoma (HCC) who progress on or are intolerant to sorafenib. A global randomized phase II trial (ClinicalTrial.gov No. NCT01210495) of axitinib, a vascular endothelial growth factor receptor 1-3 inhibitor, in combination with best supportive care (BSC) did not prolong overall survival (OS) over placebo/BSC, but showed improved progression-free survival in some patients. Subgroup analyses were conducted to identify potential predictive/prognostic factors. <B><I>Methods:</I></B> The data from this phase II study were analyzed for the efficacy and safety of axitinib/BSC in patients from Asia versus non-Asia versus Asian subgroups (Japan, Korea, or mainland China/Hong Kong/Taiwan) and predictive/prognostic values of baseline microRNAs and serum soluble proteins, using the Cox proportional hazards model. <B><I>Results:</I></B> Of 202 patients, 78 were from non-Asia and 124 from Asia (37 Japanese, 36 Korean, and 51 Chinese). No significant differences in OS were found between axitinib/BSC and placebo/BSC in non-Asians, Asians, or Asian subgroups. However, in an exploratory analysis, axitinib/BSC showed favorable OS in Asians, especially Japanese, when patients intolerant to prior antiangiogenic therapy were excluded from the data set. Axitinib/BSC was well tolerated by non-Asians and Asians alike. The presence of 4 circulating microRNAs, including miR-5684 and miR-1224-5p, or a level lower than or equal to the median protein level of stromal cell-derived factor 1 at baseline was significantly associated with longer OS in axitinib/BSC-treated Asians or non-Asians. <B><I>Conclusions:</I></B> Axitinib/BSC did not prolong survival over placebo/BSC in non-Asians, Asians, or Asian subgroups, but favorable OS with axitinib/BSC was observed in a subset of Japanese patients. A patient population that excludes sorafenib-intolerant patients might potentially be more suitable for clinical trials of new agents in advanced HCC. Since these results are very preliminary, further investigation is warranted. The potential predictive/prognostic value of several baseline microRNAs and soluble proteins identified in this study would require validation in prospective studies on a large cohort of patients.</P>

Techniques for percutaneous transesophageal gastrotubing

Yozo Sato,Shohei Chatani,Takaaki Hasegawa,Shinichi Murata,Yoshitaka Inaba 소화기인터벤션의학회 2021 Gastrointestinal Intervention Vol.10 No.2

Percutaneous transesophageal gastrotubing (PTEG) procedure was developed in Japan as an alternative access route into the gastrointestinal tract, and it has been performed for patients in whom percutaneous endoscopic gastrostomy would be technically difficult to place or is contraindicated, such as in a prior gastrectomy and massive ascites. In the PTEG procedure, an indwelling tube is inserted through the cervical esophagus, which gives the patient a slight discomfort after the tube placement. Therefore, PTEG is performed not only for enteral feeding, but also for bowel decompression as a palliative care in patients with malignant gastrointestinal obstruction. Recently, several reports of PTEG from countries outside Japan indicated a high technical success rate without major complications. Furthermore, the usefulness of PTEG for bowel decompression as a palliative care was reported in prospective studies. In fact, PTEG is a technically feasible and safe procedure worldwide.

Endoscopic necrosectomy through a self-expandable metallic stent placed percutaneously for walled-off pancreatic necrosis

Yozo Sato,Kazuo Hara,Nozomi Okuno,Shinichi Murata,Takaaki Hasegawa,Hiroyuki Morinaga,Yuki Kimbara,Yugo Imai,Hidekazu Yamaura,Yoshitaka Inaba 소화기인터벤션의학회 2020 Gastrointestinal Intervention Vol.9 No.3

Walled-off pancreatic necrosis (WOPN) is defined as encapsulated necrotic tissue after severe acute pancreatitis. Treatment strategies for WOPN can be challenging. Although open surgical necrosectomy is the standard treatment for WOPN, it is associated with high rates of morbidity and mortality. Endoscopic necrosectomy, introduced recently, is a treatment option that produces lower rates of morbidity than does open surgery. We report a case of severe WOPN that could not be treated with the usual procedures. Although endoscopic necrosectomy of the left subphrenic and prepancreatic spaces was technically impossible, these spaces could be percutaneously drained. Finally, sufficient drainage of these spaces was achieved with endoscopic necrosectomy through the internal lumen of the self-expandable metallic stent placed percutaneously. This procedure was performed by an endoscopist and an interventional radiologist, and the multidisciplinary approach was useful.

Percutaneous transsplenic obliteration of ectopic varices following pancreaticoduodenectomy with portal vein resection and splenic vein ligation

Shohei Chatani,Yozo Sato,Nozomi Okuno,Takaaki Hasegawa,Shinichi Murata,Hidekazu Yamaura,Kazuo Hara,Yasuhiro Shimizu,Yoshitaka Inaba 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.2

Left-sided portal hypertension following pancreaticoduodenectomy (PD) with portal vein resection and splenic vein ligation may cause ectopic variceal formation, potentially resulting in life-threatening bleeding. We report of a 79-year-old male suffering from severe anemia and melena after PD. Emergency endoscopy and contrast-enhanced computed tomography (CECT) revealed ectopic varices at the anastomosis site of pancreaticojejunostomy. An interventional radiology approach was preferred over surgical and endoscopic treatment because of the poor general condition and altered anatomy. In the first procedure, percutaneous transhepatic retrograde obliteration was performed using the coaxial double balloon-occlusion technique. Although hemostasis was obtained, re-bleeding occurred two months later. CECT revealed the development of another collateral pathway and the recurrence of varices. Insufficient embolization of the afferent vein was considered the cause of recurrence. Therefore, a percutaneous transsplenic approach was used, and complete embolization of varices was achieved. When transhepatic retrograde obliteration is not effective, transsplenic antegrade obliteration can be a useful therapeutic option.