First biopsy
Region: Retroperitoneum
Age: 64
Findings: Multiple enlarged nodes
Lesion Biopsied: Left para-aortic
Size of Lesion: 27.8 x 26.3 mm - conglomerate
Gun: 18G
No of cores: 8 only for HP
Sedation: No
Position & Approach: Prone, In-Plane angulation
Time Taken (marker to wash-out): 8 mins
Complication: None
Level of Difficulty: 2/5
Diagnosis: Metastatic adenocarcinoma from Ca colon. NGS not possible
Second biopsy 6 weeks later
Region: Retroperitoneum
Age: 64
Findings: Retroperitoneal nodes
Lesion Biopsied: Left para-aortic at bifurcation
Size of Lesion: 33.2 x 28.5 mm
Gun: 18 G, 20 mm throw
No of cores: 8 for histopath
Sedation: No
Position & Approach: Supine, In-plane angulation
Time Taken (marker to wash-out): 15 mins
Complication: None
Level of Difficulty: 4/5
Diagnosis: BRAF, KRAS, NRAS not detected
64-years old man treated for carcinoma sigmoid colon came with new liver and retroperitoneal nodal lesions. The first biopsy from one of the left para-aortic retroperitoneal nodes showed metastastic adenocarcinoma, but the lesions were necrotic and there wasn't enough viable tissue for NGS and mutation analysis, so six weeks later, another biopsy was requested, which I did from another retroperitoneal node, larger, but with lesser activity, using an anterior approach in the supine position.
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