Percutaneous endovascular biopsy for the diagnosis of intravascular masses: a single-center retrospective study

Background/objectives: Intravascular masses remain difficult to characterize with imaging alone, and histopathological confirmation is often required to guide individualized treatment. This study aimed to evaluate the technical success, diagnostic yield, and procedural safety of percutaneous endovascular biopsy (PEB) for the pathological diagnosis of intravascular masses. Methods: We retrospectively reviewed 30 patients (18 men and 12 women; mean age, 55 ± 10 years) who underwent PEB for pathological diagnosis between January 2016 and December 2023 at a single center. Tissue samples were obtained using 7-F biopsy forceps under digital subtraction angiography (DSA) guidance. Technical success, diagnostic yield, and procedure-related complications were analyzed. Results: Technical success was achieved in all patients (100%; 95% CI 88.6%-100%), with a median of three samples (range 3-4) obtained per lesion. No procedure-related complications were observed in this cohort. Histopathological analysis provided a definitive diagnosis in all cases (100%; 95% CI 88.6%-100%). Malignant lesions were identified in 11 patients (36.7%; 95% CI 21.9-54.5%), with hepatocellular carcinoma with vascular invasion being the most common malignant diagnosis. Benign lesions accounted for 19 cases (63.3%; 95% CI 45.5-78.1%) and consisted mainly of fibrous tissue and thrombi. Conclusions: PEB achieved high technical success and diagnostic yield, with no observed procedure-related complications in this selected single-center cohort. These findings suggest that PEB may be a useful diagnostic tool when imaging findings are inconclusive. Larger prospective multicenter studies are required to establish its diagnostic accuracy and clinical utility.