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General Surgery · Additional Topics

Ultrasound-guided puncture

Punctio sub echographia

Ultrasound-guided puncture is a minimally invasive surgical and diagnostic procedure in which a needle is inserted into a pathological lesion or cavity under continuous visual monitoring using an ultrasound transducer. This approach ensures high precision in collecting biological material for morphological verification of the diagnosis and reduces the risk of damaging adjacent anatomical structures.

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General codeA04.30.009 — ultrasound navigation for minimally invasive procedures.
Mediastinal tumorsTransthoracic puncture under ultrasound or CT guidance is indicated for all patients for verification.
Lymph nodesIf sentinel node biopsy is not feasible, FNA of suspicious nodes under ultrasound guidance is indicated.
RoutingFor benign breast lesions, the patient is followed up by an obstetrician-gynecologist.
3 min readFor medical studentsUpdated 10.10.2026
Material prepared by WhiteCoat Pro editorial team based on platform study guidesPending instructor review

Main types of ultrasound-guided interventions

Ultrasound navigation is a key component of many diagnostic and therapeutic procedures in general surgery. It allows for real-time tracking of instrument advancement. According to the medical services nomenclature, the following basic procedures are performed under ultrasound (as well as fluoroscopic, CT, or MRI in some cases) guidance:

  • Lymph node biopsy (code A11.06.002.001).
  • Soft tissue puncture (code A11.30.024.001).
  • Thoracentesis or pleural puncture (code A11.09.003.002).
  • Liver biopsy (code A11.14.001.001).
  • Pancreatic needle biopsy (code A11.15.001.001).

In addition, navigation technologies are actively used in thyroid and renal interventions.

Refinements in diagnostic methods for neoplasms

To obtain an adequate volume of tissue and an accurate diagnosis, a wide range of biopsy techniques is used. Taking the diagnosis of breast neoplasms as an example, the following methods are distinguished:

  1. Fine-needle aspiration biopsy (FNAB). Targeted puncture of a neoplasm performed strictly under ultrasound guidance to obtain cellular material.
  2. Core needle biopsy (core biopsy). A percutaneous procedure that yields a tissue core for comprehensive histological examination.
  3. Vacuum-assisted biopsy (VAB). A high-tech method that can be performed under various types of navigation: ultrasound, X-ray (mammography), or magnetic resonance imaging (MRI).
  4. Excisional biopsy and ductography. Additional diagnostic methods used according to indications.

Management strategy: If morphological verification rules out a malignant neoplasm (MN), patients with benign conditions are referred for follow-up care by an obstetrician-gynecologist.

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Morphological verification of mediastinal tumors and lymph nodes

When mediastinal tumors are detected, clinical protocols require mandatory morphological verification of the diagnosis. Recommendation: all patients with this condition must undergo a transthoracic puncture. A prerequisite for the safe and effective performance of this procedure is strict guidance using ultrasound or computed tomography (CT navigation). Transbronchial, transesophageal punctures, or endobronchial biopsy are used in other clinical situations.

Assessment of regional lymph nodes: In oncology practice, sentinel lymph node biopsy is often the gold standard. However, if it is technically unfeasible, an alternative algorithm with a high level of evidence is used (level of evidence A, grade of recommendation 2):

  • A thorough examination of regional lymphatic basins is performed.
  • Ultrasound navigation is used to locate the suspicious node.
  • Fine-needle aspiration of the identified node is performed, followed by cytological examination of the obtained material.
How to memorize

To memorize breast biopsy methods: "F-C-V-E-D" — Fine-needle, Core, Vacuum-assisted, Excisional, Ductography.

Class and exam questions

What navigation methods are used in vacuum-assisted biopsy (VAB)?

VAB can be performed under ultrasound guidance, as well as under X-ray or MRI guidance.

What to do if sentinel lymph node biopsy is impossible?

In such cases, a thorough ultrasound of the regional nodes is recommended. If a suspicious node is identified, a targeted fine-needle aspiration with cytological examination is performed.

What type of puncture is indicated for patients with a mediastinal tumor?

All patients with a mediastinal tumor are indicated for transthoracic puncture under ultrasound or CT guidance for morphological verification of the diagnosis.

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What else to study on this topic

  • Technique of thoracentesis (pleural puncture).
  • Specifics of performing pancreatic and liver needle biopsies.
  • Comparative analysis of FNAB, core biopsy, and VAB in oncology.
  • Fluoroscopic, CT, and MRI navigation: indications for use.

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Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.