Spleen biopsy, like lung and pancreatic biopsies, is in fact technically simple, but interventionalist are generally reluctant to do it. The reason for this is that the spleen contains blood-filled cavities, a relatively loose tissue, and therefore may have greater risk of bleeding. Because of this concern, splenic biopsy is not performed in many centers and instead, the spleen is surgically removed (splenectomy). Thus, many patients who can be diagnosed with a simple needle biopsy lose their spleen unnecessarily.
Spleen biopsy is performed under local anesthesia and ultrasound guidance, just like the liver biopsy. Since the risk of bleeding is slightly higher, the spleen capsule should be passed through the needle in one go, the suspicious mass should be reached. During this time, large vessels in the spleen should be avoided by using color Doppler. Then, with a smaller cutting needle, multiple biopsies are taken from the mass through this needle (coaxial technique). In some cases, there are no separate masses in the spleen, all of the spleen is widely involved (diffuse infiltration). In this case, it is sufficient to take a biopsy from the middle of the spleen. After the biopsies are taken, the inner needle is pulled out and the external needle is checked for bleeding. If there is no bleeding, the external needle is also taken out. If there is obvious bleeding, bleeding is stopped with plugs such as a clot (autologous clot) or coil, glue, and the external needle is then safely withdrawn.
Studies in the literature have shown that the risk of spleen biopsy is not higher than liver biopsy when performed in experienced centers in suitable patients. In our center, spleen biopsy has been routinely performed for years and no serious bleeding complications have been observed so far.
Interventional oncology in cancer management
Prof Saim Yilmaz, MD