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Ultrasound-guided biopsy
Last reviewed: 05.07.2025
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Ultrasound guidance is especially important when performing biopsies of small tumors or aspiration of small fluid collections or abscesses whose location is difficult to determine clinically. Not every effusion or abscess needs to be aspirated under ultrasound guidance, but it is important to use sonography when aspirating formations located near vital organs. Ultrasound is used to select the shortest distance to the object and the safest trajectory for the needle.
Echography is an ideal method for monitoring the passage of the needle, since the needle reflects ultrasound and is therefore visualized after passing through the skin. However, only part of the needle may be visualized. This occurs when the front part of the needle passes through the scanning plane and becomes invisible. The bright dot on the screen in the scanning plane is not actually the tip of the needle. This not only prevents the needle from reaching the area needed for the puncture, but can also cause damage to other tissues.
Warning: Only the portion of the needle that is in the scanning plane is visualized on the screen. Make sure you can actually see the tip of the needle. A significant portion of the needle may be outside the scanning plane.
There are special devices to hold the needle in the scanning plane. Once the needle is in the correct position, the sensor can be removed.
It is much easier to visualize the needle in fluid-containing structures (amniotic sac, against the background of ascitic fluid, in a cyst, in an abscess cavity, against the background of pleural effusion) than in solid formations. The tip of the needle is not always well visualized in a solid structure: it can be seen only when the needle is moving and very difficult when it is stationary.
If possible, fluid should be aspirated from the cyst cavity, but avoiding the necrotic center of the tumor. When performing a pleural puncture, the area with the largest amount of fluid should be selected. After the needle is inserted, ultrasound is used to monitor the process of removing fluid or cyst contents.
It is very important that the needle biopsy is performed under sterile conditions.