Spleen biopsy, like lung and pancreatic biopsies, are technically simple but reluctant biopsies. This is because the spleen contains blood-filled cavities, has a relatively loose tissue, and therefore has a greater risk of bleeding. Because of this reservation, spleen biopsy is not performed in many centers, instead the spleen is surgically removed (splenectomy). Thus, many patients who can be diagnosed with a simple needle biopsy lose their spleen unnecessarily.
Spleen biopsy, just like liver biopsy, is performed under local anesthesia and under ultrasound guidance. Since the bleeding risk is slightly higher, the spleen capsule should be passed in one go with a guide needle and the suspicious mass in the spleen should be reached. At this time, large vessels in the spleen should be avoided. Then, a smaller cutting needle is inserted through this needle and multiple biopsies are taken from the mass. In some cases, the spleen does not have discrete masses, the entire spleen is widely involved (diffuse infiltration). In this case, it is sufficient to take a biopsy from any part of the middle part of the spleen. After the biopsies are finished, the inner needle is withdrawn and bleeding is controlled from the outer needle. If there is no bleeding, the external needle is also taken out. If there is obvious bleeding, the bleeding is stopped with the patient’s own clot (autologous clot) or plugs such as coil, glue, and the external needle is then withdrawn.
In the studies in the literature, it has been shown that the risk of spleen biopsy is not higher than liver biopsy when performed with an appropriate method in experienced centers. In our center, spleen biopsy has been routinely performed for years and no serious bleeding complication has been observed so far.