Image-Guided Biopsy

Tissue sampling may be required to confirm a diagnosis, or to identify certain molecular markers for targeted therapy. Image-guided biopsy is safer and more accurate than blind biopsy. A wide range of imaging modalities are available to guide tissue sampling, including ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), contrast-enhanced ultrasound (CEUS) and mammography. Ultrasound has the advantages of real-time visualization, low cost and wide availability. CT scores over ultrasound for targeting bone, lung, mediastinal and retroperitoneal lesions. MRI and CEUS are used when the lesion is not visible on grayscale ultrasound or CT. Pre-procedure review of imaging is required for selecting the target lesion, choosing the guiding modality and planning the approach. In most cases, the shortest path with the least amount of intervening tissue is the most appropriate choice. Recent advances include fusion imaging and artificial intelligence to guide biopsy.