Percutaneous Splenic Biopsy

Background and indications

Image-guided percutaneous splenic biopsy is a rare but valuable procedure, indicated when the spleen presents a focal lesion or unexplained splenomegaly requiring histological diagnosis. Indications include: suspected splenic lymphoma, indeterminate focal splenic lesions, unexplained isolated splenomegaly, and staging of certain hematologic malignancies.

Pre-procedure assessment

Assessment includes recent imaging (contrast-enhanced CT or MRI), rigorous coagulation panel (PT, platelets > 60,000/mm³), blood typing with antibody screening, and multidisciplinary discussion. Hemorrhagic risk is higher than for other organ biopsies due to the spleen's rich vasculature.

Procedure

Under local anesthesia and sedation, a biopsy needle (18G) is inserted under CT or ultrasound guidance via a left intercostal approach. The trajectory is carefully planned to avoid hilar vessels. 2-3 cores are obtained. The procedure takes 20 to 30 minutes.

Results and scientific evidence

Percutaneous splenic biopsy offers 80-90% diagnostic yield and changes therapeutic management in 50-70% of cases. It avoids diagnostic splenectomy in most situations.

Risks and complications

Local pain (10-20%), bleeding (subcapsular or intraperitoneal hematoma: 2-5%, rarely requiring intervention), left pneumothorax (< 2%). Risk of major bleeding requiring splenectomy or embolization is 1-2%.

Recovery

Close monitoring for 4-6 hours with ultrasound check. 24-hour hospitalization recommended. Results within 5-10 days.

Practical information

The procedure is performed as a short inpatient stay. It is performed by an experienced interventional radiologist, in coordination with the hematologist.