Diagnostic Yield of Ultrasound-Guided Omental Biopsy for Omental Thickening Using Histopathology As the Reference Standard

TL;DR

This study shows that ultrasound-guided omental biopsy is a safe and effective way to diagnose the cause of omental thickening seen on CT scans.

Contribution

The study demonstrates the diagnostic accuracy of ultrasound-guided omental biopsy as a minimally invasive alternative to surgical procedures.

Findings

Ultrasound-guided omental biopsy provided a definitive diagnosis in 144 out of 167 patients.

Peritoneal carcinomatosis was the most common diagnosis (64.6%) followed by tuberculous peritonitis (18.1%).

Age was significantly associated with peritoneal carcinomatosis and tuberculous peritonitis.

Abstract

Background

Histopathological evaluation is vital in distinguishing between benign and malignant lesions. Assessment of the different patterns of peritoneal lesions on CT scans may help to differentiate inflammation and malignancy. It utilizes various imaging modalities, among them, ultrasound-guided percutaneous biopsies are minimally invasive, have low complications, and are cost-effective.

Objective

To assess different disease patterns by ultrasound-guided omental biopsy in patients with solitary peritoneal thickening found on CT scans, using histopathology as the reference standard.

Study design, setting, and duration

This was a prospective, cross-sectional study, carried out for over 2.5 years in the Department of Radiology at Liaquat National Hospital, Karachi, Pakistan.

Material and methods

The study included a total of 167 patients. Biopsies were conclusive in 144 patients, so they were included in the study. In 23 patients, biopsies were non-conclusive, so they were excluded. The thickness, echo-texture configuration, and presence of nodules within the thickened larger omentum were all investigated and appraised under ultrasound supervision. A local anesthetic was infiltrated into the abdominal wall. The biopsy needle path was carefully assessed with the color Doppler ultrasound to avoid blood vessels. Biopsy samples were taken, and considered successful if the definitive diagnosis of whether benign or malignant was made on histopathology.

Results

Of the total patients, 54 (37.5%) were men and 90 (62.5%) were women. The mean age was 48.69±16.17 years. Disease pattern showed 93 (64.6%) peritoneal carcinomatosis, 26 (18.1%) tuberculous peritonitis, 15 (10.4%) chronic inflammation, seven (4.9%) mesothelial hyperplasia, and five (3.5%) panniculitis. There was a highly significant association between age group and peritoneal carcinomatosis (p<0.001) and tuberculous peritonitis (p<0.001). Similarly, chronic inflammation was significantly associated with the duration of symptoms (p=0.014).

Conclusion

Ultrasound-guided omental biopsy is a safe, minimally invasive, and highly effective diagnostic tool for evaluating omental thickening. It provides a high diagnostic yield with minimal complications, often precluding the need for more invasive surgical procedures like diagnostic laparoscopy. Our findings support its use as a primary diagnostic modality for obtaining a definitive histopathological diagnosis.

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