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Interventional Radiology in Cancer Patients - Brief Article

American Family Physician, July 1, 2000 by Charles E. Ray Jr.

Procedures performed by an interventional radiology specialist are becoming increasingly important in the management of patients with cancer. Although general interventional radiology procedures such as angiography and angioplasty are used in patients with and without cancer, certain procedures are reserved for the diagnosis and treatment of cancer or cancer-related complications. Interventional radiology procedures include imaging-guided biopsies to obtain samples for cytologic or pathologic testing without affecting adjacent structures. Transjugular liver biopsy is used to diagnose hepatic parenchymal abnormalities without traversing Glisson's capsule. This biopsy procedure is particularly useful in patients with coagulopathies. Because the transjugular liver biopsy obtains random samples, it is not recommended for biopsy of discrete hepatic masses. Fluid collections can also be sampled or drained using interventional radiology techniques. Transcatheter chemoembolization is a procedure that delivers a chemotherapeutic agent to a tumor along with sponge particles that have an ischemic effect on the mass. Tumor ablation, gene therapy and access of central veins for treatment are performed effectively under radiographic guidance. Cancer complications can also be treated with interventional radiology techniques. Examples include pain control procedures, vertebroplasty and drainage of obstructed organs. Interventional radiology techniques typically represent the least invasive definitive diagnostic or therapeutic options available for patients with cancer. They can often be performed at a lower cost and with less associated morbidity than other interventions. (Am Fam Physician 2000;62:95-102.)

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Interventional radiology offers minimally invasive diagnostic and therapeutic procedures for cancer and cancer-related processes. Surgery, chemotherapy and radiation therapy remain the mainstays of cancer treatment, but interventional radiology continues to grow in importance as an alternative mode of therapy or an altogether new form of treatment for patients with cancer.

Many interventional radiology procedures can be performed on an outpatient basis or during a short hospital stay. Consequently, these procedures tend to be less expensive than other forms of therapy and frequently are associated with less morbidity.(1,2) In one study,(1) for example, radiologic placement of long-term hemodialysis catheters resulted in a 50 percent savings in total hospital costs compared with surgical placement of the same type of catheter.

The primary goals of the procedures performed in the interventional radiology suite can be categorized based on the purpose of each procedure. These goals include the diagnosis of cancer or cancer-related diseases, the treatment of cancer and the treatment of complications arising from cancer (Table 1).

Diagnosis of Cancer or Cancer-Related Diseases

IMAGING-GUIDED BIOPSY

Many disease processes have a similar appearance on imaging studies. For example, a cavitary lung infection caused by tuberculosis or fungal disease may look identical to a cavitary neoplasm on a computed tomographic (CT) scan. Clearly, the need to differentiate these processes is vital to determining the most appropriate mode of therapy.

One of the most common interventional radiology procedures performed to diagnose or exclude cancer is imaging-guided biopsy. Under fluoroscopic, CT or ultrasound guidance, small needles can be placed in areas of abnormality, and samples can be taken for cytologic or pathologic testing. With imaging guidance, biopsies of an abnormality can be obtained while important adjacent structures, such as blood vessels or bowel, may be avoided. Often, imaging-guided biopsy is performed, instead of a surgical or open biopsy, to spare the patient a much more invasive procedure with its associated inherent risks.(3)

CT fluoroscopy, or real-time CT, is a new technologic development that aids in imaging-guided biopsies. Because this technique allows direct visualization of the needle during a procedure, it results in significant time savings.(4)

TRANSJUGULAR LIVER BIOPSY

Transjugular liver biopsy is a specialized procedure designed to decrease the risk of postbiopsy bleeding from the liver. This technique is particularly useful in patients with coagulopathies.

The procedure consists of the insertion of a long, thin (19- to 20-gauge) biopsy device into the right internal jugular vein and moving it into the right or middle hepatic vein. Random biopsy samples can then be obtained from the liver. Because the samples are essentially taken from the "inside-out," without traversing the liver capsule, the risk of extracapsular hemorrhage is decreased.(3,5)

Transjugular liver biopsy is especially useful in the diagnosis of diffuse hepatic parenchymal abnormalities, such as graft-versus-host disease in patients who have undergone bone marrow transplantation. Because of the random nature of the samples obtained with this procedure, biopsy samples of specific hepatic masses are best obtained with other percutaneous imaging-guided biopsy procedures.

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Interventional Radiology in Cancer Patients - Brief Article

American Family Physician, July 1, 2000 by Charles E. Ray Jr.

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