Aspiration of lymph nodes or tumors under computed tomography guidance

The article is professionally consulted by Master, Doctor Ton Nu Tra My - Department of Diagnostic Imaging - Vinmec Central Park International General Hospital.

The technique of aspiration of lymph nodes or tumors under the guidance of computed tomography is being widely applied today in the definitive diagnosis of intra-abdominal or retroperitoneal lesions. From the results obtained, the doctor will recommend the most appropriate treatment for the patient.

Aspiration (or fine-needle aspiration) is a procedure in which a small, hollow needle is inserted through the skin into the lesion, to obtain a sample of cells or fluid from a tumor or lymph node. The collected cell samples will be sent to a laboratory for examination under a microscope. This is a very useful technique for detecting cancer.
Computed tomography (CT scan) is also known as computed tomography. This is a method of using a CT machine that runs around the patient's body, emitting X-ray waves and measuring the absorption of X-ray energy of body structures. Then, this information is combined together, creating an image of the body in 2D or 3D space.
Aspiration of lymph nodes or tumors under the guidance of computed tomography helps the doctor to clearly locate the lesion during the procedure, thereby determining the direction of the needle accurately to the lesion to be cut. (or aspirate) specimens. This technique is often applied in cases where ultrasound cannot be performed when the lesion is deep, the patient is overweight or after surgery,...

2.1 Indications and contraindications Indications
Perform technique to identify mass lesions in the abdominal cavity or retroperitoneal space but of unknown nature.
Contraindications
Cases with blood clotting disorders ; Uncooperative patients: The elderly or children,...; There is no safe entrance for suction.

2.2 Preparation of techniques The team will perform: Including specialists, assistant doctors, nurses, doctors (or anesthesiologists if the patient does not cooperate) and radiology technicians; Technical facilities: Computed tomography machine, film, film printer and image storage system; Medical supplies: Syringe of different sizes, distilled water or physiological saline, gloves, shirt, hat, mask, cotton, gauze, adhesive tape, specialized aspiration needle and specialized biopsy needle; Medicines: Local anesthetics, general anesthetics if there are indications for anesthesia and water-soluble iodine contrast agents; Patient: The doctor explains clearly about the procedure and procedure; the patient is overstimulated and unable to lie still can be sedated; in the intervention room, the patient lies on his stomach, is fitted with a machine to monitor pulse, blood pressure, breathing rate, electrocardiogram, SpO2 ; disinfect the skin, cover with a sterile towel with holes; Test sheet: Medical record, order form for procedure, X-ray film, CT scan, MRI if available. 2.3 Technical implementation General principles: Place an intravenous line for the patient before the intervention. ; perform the procedure under local anesthesia; some cases need contrast injection; Patient position: Lying supine or prone, left - right side depending on the doctor's request; perform local anesthesia; Approaching the lesion: The doctor inserts a needle under the direction of the computed tomography into the lesion. Important note:
Principle of entrance: Need to choose the shortest possible tumor or lymph node aspiration route. However, structures of the gastrointestinal tract, pleura, and blood vessels must be avoided. For some types of needles can be inserted through the digestive tract. In cases where a gastrointestinal puncture is required, a transcolon should be avoided to reduce the risk of peritonitis; Some techniques can be applied: Change the patient's position to choose the safest place to puncture the lymph node (or tumor); can bend or redirect the puncture needle; take a deep breath or exhale while pushing the needle; Pumping air or water into the peritoneal cavity to push out unwanted organs, compressing the patient's abdomen,... In some cases with a high risk of bleeding, it is possible to plug the biopsy line while the needle is removed from the body. patient. 2.4 Risk of complications The technique of aspiration lymph nodes or tumors under the guidance of computed tomography can cause some unwanted complications such as:
Intestinal perforation, peritonitis; Hemorrhage in the abdomen or retroperitoneal space; Pleural effusion ; Paroxysmal hypertension in cases of biopsy of adrenal medulla or paraganglioma; Can cause cancer cells to spread through the puncture.

Regarding the treatment, depending on the severity of the accident and the cause, the doctor will have an appropriate treatment plan according to the standard protocol.
Aspiration of lymph nodes or tumors under CT guidance should be performed rigorously to minimize the risk of complications. Therefore, the patient must absolutely follow all instructions of the doctor during the procedure.
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