Image-guided biopsy and percutaneous drainage are interventional radiology procedures in which a thin needle or tube is guided by CT or ultrasound to take a small tissue sample (biopsy) or to drain trapped bile, pus or fluid (drainage). Both are done through a single needle puncture, without open surgery. In 5,235 kidney biopsies from 176 hospitals in Germany, Austria and Switzerland, 94.92% gave tissue suitable for diagnosis and major complications occurred in only 0.74%.
This article summarises two large registry studies published in CardioVascular and Interventional Radiology (CVIR) in December 2025 and June 2026, a 2025 prospective study of biliary drainage from three Indian centres, procedure numbers from the IVR Center of Japan's National Cancer Center Hospital, and Mayo Clinic patient guidance, covering who is treated, the latest results, the procedure and recovery.
Treatment status · Image-guided biopsy and percutaneous drainage are standard procedures performed every day in Japan, Europe and the United States. The figures below come from registry and observational studies of real-world patients. This article is general information, not a treatment recommendation.
What are biopsy and drainage?
Cancer care begins with an accurate diagnosis. A scan can show a mass, but only tissue examined under the microscope tells whether it is cancer and what type. In an image-guided biopsy, the radiologist watches the needle tip on CT or ultrasound in real time and steers it precisely into the target. The tissue is now often used for genetic testing as well, which helps choose targeted medicines.
Drainage removes fluid that has built up inside the body. When a tumour blocks the bile ducts, jaundice develops; when pus collects after surgery, fever follows. A needle opens a path and a thin tube (catheter) is left in place so the fluid can flow out of the body or into the bowel.
| Item | Image-guided biopsy | Percutaneous drainage |
|---|---|---|
| Purpose | Obtain tissue for diagnosis (cancer, type, genes) | Remove bile, pus or fluid to relieve symptoms |
| Device | Thin needle (most often 18 gauge) | Needle access, then a thin catheter left in place |
| Imaging | CT, ultrasound | Ultrasound, fluoroscopy, CT |
| Anaesthesia | Local, with sedation if needed | Local anaesthesia and sedation |
| Tube left in | None (needle removed) | Days to months, depending on the cause |
Based on Mayo Clinic patient information and the studies below.
For an overview of needle- and catheter-based treatment, see our IVR (interventional radiology) guide.
Who needs them?
- Cancer diagnosis: a mass in the liver, lung, kidney, spleen, bone or lymph nodes that needs tissue confirmation.
- Treatment planning: checking whether a suspected recurrence or metastasis matches the original cancer, or obtaining more tissue for genetic tests.
- Bile duct blockage from cancer: jaundice from pancreatic cancer, bile duct cancer or liver metastases when an endoscopic route is difficult.
- Collections of pus or fluid: post-operative abscess, liver abscess, or pleural fluid and ascites causing fever or breathlessness.
Blood thinners or a low platelet count may need adjusting beforehand. See pre-procedure tests for liver cancer for the blood tests usually checked.
Results from 5,235 kidney biopsies
Radiologists at University Hospital Essen, Germany, analysed 5,235 image-guided kidney biopsies performed at 176 hospitals between 2018 and 2024, using the registry of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR). The study appeared in CVIR in December 2025. Median patient age was 70, and 75.30% of lesions were solid.
| Measure | Result | Note |
|---|---|---|
| Technical success | 98.38% | Needle reached the target and tissue was obtained |
| Diagnostic yield | 94.92% | Of 4,154 cases with a pathology report |
| Any complication (24 h) | 5.04% | Mostly minor bleeding |
| Major complication | 0.74% | Needed additional treatment |
| Deaths within 24 h | 0 | Three later deaths recorded among inpatients |
| Technical success, outpatients | 99.26% | Inpatients 98.33% |
Ocker-Serger R, et al. CVIR 2026;49(2):330-343 (online December 2025). Registry data from Germany, Austria and Switzerland.
The authors concluded that image-guided kidney biopsy is effective and safe, with a high diagnostic yield and low complication rate. The 18-gauge needle was used most often, with 98.72% technical success in 3,747 procedures. Ultrasound-guided biopsies had fewer complications, which the authors suggest may reflect easier lesions being chosen for ultrasound. For small kidney cancers that may be treated by freezing after biopsy, see long-term results of kidney cancer cryoablation.
Results from 400 spleen biopsies
The spleen has a rich blood supply, so biopsy there has long been considered high risk. The same Essen team analysed 400 spleen biopsies from 92 hospitals in the DeGIR registry and published the results in CVIR in June 2026. The findings were reassuring.
| Measure | Result | Note |
|---|---|---|
| Technical success | 99.00% | Of 400 procedures |
| Diagnostic yield | 90.83% | 307 of 338 with a pathology report |
| With three tissue cores | 98.67% | 74 of 75 diagnosed |
| Yield with sedation | 96.94% | 88.94% with local anaesthesia only |
| Any complication | 5.00% | Major 2.50% |
| Procedure-related deaths | 0 | All 400 procedures |
Ocker-Serger R, et al. CVIR 2026, doi:10.1007/s00270-026-04517-0. Registry data 2018 to 2024.
The authors described spleen biopsy as a safe and effective diagnostic procedure in routine practice. Sedation improved the diagnostic yield and lowered complications (0.5% vs 4.25%), and taking three cores gave the best yield. This is useful for diagnosing conditions such as lymphoma that involve the spleen.
Biliary drainage in 175 patients
Percutaneous transhepatic biliary drainage (PTBD) places a tube through the skin into the bile ducts inside the liver to drain blocked bile. Researchers at AIIMS Bhubaneswar, AIIMS New Delhi and a cancer institute in Lucknow followed 175 patients with malignant biliary obstruction treated with PTBD between March 2023 and August 2024. The results were published online in Abdominal Radiology in July 2025.
| Measure | Result | Note |
|---|---|---|
| Technical success | 100% | Catheter in place with bile flow |
| Clinical success | 81.6% | Bilirubin fell to the target level |
| Median bilirubin | 15.67 → 3.9 | mg/dL, before and at 4 weeks |
| Quality of life | Clearly improved | Eating, jaundice, tiredness, weight loss (1 month) |
| Most common issue | 34.2% | Leakage around the catheter, usually managed simply |
| Cholangitis or sepsis | 11.2% | Treated with antibiotics and catheter exchange |
Sahoo B, et al. Abdom Radiol 2026;51(2):939-953. Complication rates are based on 152 patients.
The authors concluded that PTBD is a safe and effective option for malignant biliary obstruction, with lasting quality-of-life gains, especially for jaundice and tiredness. Relieving jaundice often allows chemotherapy to restart, so drainage acts as a bridge to further treatment. For tumour ablation inside the bile duct see endobiliary RFA for bile duct cancer, and for pancreatic cancer see NanoKnife (IRE) survival results.
Procedure and recovery
According to Mayo Clinic, most biopsies need no special preparation, but sedation may require fasting and pausing certain medicines. The skin is cleaned and numbed, and the needle is guided in using imaging. You may be asked to hold your breath briefly, and several samples are usually taken. Drainage uses the same access, after which a catheter is left and secured to the skin.
| When | Biopsy | Drainage |
|---|---|---|
| Right after | Pressure for a few minutes, observation for a few hours | Catheter position checked, observation on the ward |
| Same and next day | Rest for the day; mild ache fades in 1–2 days | Pain around the catheter controlled with painkillers |
| Results or effect | Pathology in a few days to a week or more | Bilirubin falls markedly within 4 weeks |
| Call your team | Fever, worsening pain, bleeding that does not stop | Fever, chills, catheter slipping out or no bile flow |
Based on Mayo Clinic needle biopsy guidance and the Indian PTBD study.
Patients who go home with a drain are taught how to flush it and change the dressing. In some cases the tube can be converted so bile drains into the bowel, or replaced with a stent, so no external bag is needed.
Japan and other countries
| Region | Current practice | Basis |
|---|---|---|
| Japan | National Cancer Center Hospital IVR Center: 8,061 IVR procedures in 2024, including 1,342 percutaneous biopsies and 1,150 percutaneous drainages | Published centre data (Japanese) |
| Germany, Austria, Switzerland | 176 hospitals track biopsy outcomes through a society registry | DeGIR registry studies (2025, 2026) |
| United States | CT, MRI and ultrasound-guided needle biopsy offered as outpatient care at major centres | Mayo Clinic |
| India | PTBD for malignant jaundice with 100% technical success at cancer centres | Abdominal Radiology (2025) |
International patients are often not covered by the host country's public insurance, so confirm costs and schedules directly with the hospital.
At Japan's National Cancer Center Hospital, biopsies rose from 1,034 in 2019 to 1,342 in 2024, and drainages from 857 to 1,150, showing the growing role of image-guided procedures in cancer diagnosis and symptom care.
Questions for your care team
- Will my biopsy be guided by CT or ultrasound?
- How many cores will be taken, and is that enough for genetic testing?
- Can I have sedation? When should I stop eating and pause medicines?
- How long will the drain stay in, and how do I care for it at home?
- Can the drain be converted to internal drainage or replaced by a stent?
To prepare for a consultation, see five questions to ask before RFA.
Frequently asked questions
Is an image-guided biopsy painful?
Local anaesthesia is used, so most people feel only pressure as the needle goes in. Mayo Clinic notes that a mild ache usually fades within a day or two. In the spleen study, sedation was linked to fewer complications.
Can a biopsy spread cancer?
Spread of cancer cells along the needle track is very rare. An accurate diagnosis lets the right treatment start sooner, so doctors recommend biopsy when the benefit clearly outweighs the risk.
How long does a biliary drain stay in?
It depends on the cause and the next treatment. Some drains are removed after a stent is placed once jaundice settles; others stay in during chemotherapy. In the Indian study, median bilirubin fell from 15.67 to 3.9 mg/dL within 4 weeks.
When will biopsy results be ready?
Usually within a few days to about a week, longer if genetic tests are added. A pathologist writes the report, and you can request a copy to use for consultations at other hospitals.
This article summarises overseas official sources and studies as general information and is not medical advice. Discuss treatment choices with a doctor who has examined you.
Sources (checked October 26, 2026)
- Ocker-Serger R, Opitz M, Klüner L, et al. Effectiveness and Safety of Image-Guided Renal Biopsies: Insights from 5,235 Procedures in the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) Registry. Cardiovascular and Interventional Radiology. 2026;49(2):330-343.
- Ocker-Serger R, Opitz M, Klüner L, et al. Safety and Effectiveness in 400 Image-Guided Spleen Biopsies from the DeGIR Registry. Cardiovascular and Interventional Radiology. 2026.
- Sahoo B, Mane K, Panigrahi MK, et al. Clinical outcomes of percutaneous biliary drainage and quality of life assessment: a prospective observational study. Abdominal Radiology. 2026;51(2):939-953.
- National Cancer Center Hospital (Japan), IVR Center. IVR procedure statistics (Japanese source).
- Mayo Clinic. Needle biopsy.