ICE ICE baby: Using Intracardiac Echocardiography (ICE) to Aid in Transvenous Biopsy as an Alternative to Excisional Biopsies

Monday, March 31, 2025

5:00 PM – 5:05 PM CT

Location: Music City Center, 202 A

Abstract Presenter(s)

Wasih Kamran, MD

Diagnostic Radiology Resident
Henry Ford Hospital, United States

Author/Co-author(s)

AM

Alexandra Morris, MD

Chief Resident, Division of Vascular and Interventional Radiology
Henry Ford Hospital, United States
GM

Giordano Mitchell, MD

Interventional Radiology Faculty
Henry Ford Health, United States

Learning Objectives:

Review appropriate patient selection for transvenous biopsies including patient characteristics and lesion location.

Describe general technical considerations including approaches and equipment.

Identify and discuss the management and prevention of complications of transvenous biopsies.

Background: “Tissue is the issue” is an age-old cliche in oncology for a reason. Tissue biopsy remains the gold standard for most malignancies. While percutaneous image-guided biopsies remain the mainstay for obtaining tissue samples, there are cases where the lesion of concern is in a location that is not accessible due to overlying critical structures. Previously, these lesions would need to be sampled via surgical excisional biopsies. However, intracardiac echocardiography (ICE) catheters now allow for precise, real-time guidance of transvenous biopsies of otherwise hard-to-reach lesions obviating the need for surgical biopsies in specific cases.

Clinical Findings/Procedure Details: Imaging findings and differential diagnoses of retroperitoneal and porta hepatis lesions are reviewed as it pertains to appropriate selection of transvenous biopsy cases. Contraindications and patient selection criteria are also reviewed. Technical aspects of transvenous biopsy including typical materials list and stepwise procedural process are delineated. Complications of transvenous biopsy and their management are discussed, including bleeding, poor visualization of target lesion, and inadequate tissue for diagnosis.

Conclusion and/or Teaching Points: Transvenous biopsy of otherwise hard-to-reach lesions is an important skill for interventional radiologists to use to help patients avoid unnecessary surgical biopsy of lesions not amenable to percutaneous biopsy. As the oncological population continues to skew older and ICE becomes more prevalent in the world of IR, these procedures have the potential to become more commonplace in the average interventional radiologists repetoire.