The percentage of tumor cells in the biopsy sample is greater with a higher number of collected biopsy samples [23]. Furthermore, for lesions not seen on grayscale US, the success rate for CEUS-guided biopsy can be as high as 88% to 96% [24,25]. US fusion with CT or MRI, can be used for percutaneous biopsy of lesions with poor sonographic conspicuity, with a 96% technical success rate [25]. Lesions that are isointense on CT can also present a challenge for CT-guided biopsy; however, use of anatomic landmarks or IV contrast can achieve accuracy of 96% to 98% [26]. Image-guided biopsies carry a risk of postbiopsy bleeding, which may be as high as 9% to 12%, particularly with hypervascular lesions [27,28]. In addition, a very small risk of needle-track seeding exists. RBC Scan Abdomen and Pelvis There is no relevant literature to support the use of a Tc-99m RBC scan in this clinical scenario. Liver Spleen Scan There is no relevant literature to support the use of a Tc-99m sulfur colloid scan in this clinical scenario. US Abdomen Diagnostic accuracy of grayscale US is 41% to 68% for specific diagnosis and 86% for differentiation between malignant and benign lesions [9,29]. US can be helpful in some cases due to its ability to characterize a lesion as a Liver Lesion-Initial Characterization cyst. Doppler evaluation of flow is an integral part of the clinical grayscale US examination. However, none of the reviewed studies specifically compared performance of US examinations with and without the addition of Doppler. US Abdomen with Contrast In a small retrospective study of solid indeterminate lesions detected on contrast-enhanced CT in patients without parenchymal liver disease, addition of CEUS improves diagnostic accuracy from 43% to 49% to 89% to 92% [39]. CEUS is able to provide correct diagnosis in 89% of cases and can distinguish between benign and malignant lesions in 97% of cases [9].
Liver Lesion Initial Characterization. The percentage of tumor cells in the biopsy sample is greater with a higher number of collected biopsy samples [23]. Furthermore, for lesions not seen on grayscale US, the success rate for CEUS-guided biopsy can be as high as 88% to 96% [24,25]. US fusion with CT or MRI, can be used for percutaneous biopsy of lesions with poor sonographic conspicuity, with a 96% technical success rate [25]. Lesions that are isointense on CT can also present a challenge for CT-guided biopsy; however, use of anatomic landmarks or IV contrast can achieve accuracy of 96% to 98% [26]. Image-guided biopsies carry a risk of postbiopsy bleeding, which may be as high as 9% to 12%, particularly with hypervascular lesions [27,28]. In addition, a very small risk of needle-track seeding exists. RBC Scan Abdomen and Pelvis There is no relevant literature to support the use of a Tc-99m RBC scan in this clinical scenario. Liver Spleen Scan There is no relevant literature to support the use of a Tc-99m sulfur colloid scan in this clinical scenario. US Abdomen Diagnostic accuracy of grayscale US is 41% to 68% for specific diagnosis and 86% for differentiation between malignant and benign lesions [9,29]. US can be helpful in some cases due to its ability to characterize a lesion as a Liver Lesion-Initial Characterization cyst. Doppler evaluation of flow is an integral part of the clinical grayscale US examination. However, none of the reviewed studies specifically compared performance of US examinations with and without the addition of Doppler. US Abdomen with Contrast In a small retrospective study of solid indeterminate lesions detected on contrast-enhanced CT in patients without parenchymal liver disease, addition of CEUS improves diagnostic accuracy from 43% to 49% to 89% to 92% [39]. CEUS is able to provide correct diagnosis in 89% of cases and can distinguish between benign and malignant lesions in 97% of cases [9].