https://radiopaedia.org/articles/chiba-needle

Introduction

The Chiba biopsy needle first rose to fame as a puncture instrument for percutaneous transhepatic cholangiography, yet its clinical utility extends far beyond biliary interventions. Its core capability-accurately accessing deep internal targets with minimal trauma under image guidance-has established it as a universal bridging tool linking diagnostic assessment and interventional treatment. Within modern interventional medicine, its role has expanded from standalone diagnostic puncture to encompass drainage, therapeutic injection, and access tract creation across multiple modalities. This paper systematically outlines the wide-ranging clinical applications of Chiba biopsy needles across specialties, illustrating their extensive value as a foundational workhorse in interventional radiology.

1. Diagnostic Indications: Gold Standard for Cellular and Tissue Specimen Acquisition

This remains the Chiba needle's most classic and primary function.

1. Percutaneous Fine-Needle Cytological Biopsy

2. Suitable for solid and cystic-solid lesions throughout the whole body.
3. Thoracic and abdominal viscera: Pulmonary nodules/masses (especially for high-risk locations or patients with poor pulmonary function), hepatic lesions, pancreatic tumors (fine-needle puncture is the first-line choice given high procedural risks), renal and adrenal masses, retroperitoneal lymph nodes, etc. Cytological samples can be harvested precisely under ultrasound, CT or fluoroscopic guidance.
4. Superficial lesions: Thyroid nodules, salivary gland masses, superficial lymph nodes, soft tissue tumors and more. Ultrasound-guided manipulation is convenient and delivers high diagnostic accuracy.

Guiding Introducer for Coaxial Biopsy

As noted previously, a Chiba needle (most commonly 22G) acts as the primary introducer, creating a safe tunnel for subsequent larger cutting needles (e.g., 18G). This enables multi-site, repeated core tissue sampling from a single lesion, drastically boosting the success rate of histopathological diagnosis. It has become one of the dominant standard techniques for biopsies of solid visceral organs.

2. Drainage and Decompression Therapy: Minimally Invasive Relief and Infection Control

Its precise puncture capacity enables establishment of initial access tracts for subsequent drainage procedures.

Percutaneous Transhepatic Biliary Drainage (PTCD)

Its iconic landmark procedure. Deployed for pre-operative jaundice reduction or palliative care in patients with obstructive jaundice. The Chiba needle punctures dilated intrahepatic bile ducts; contrast medium is injected post-successful cannulation to localize the obstruction site, followed by guidewire placement and exchange for an indwelling drainage catheter. This forms the starting point for many biliary interventional therapies.

Abscess and Effusion Drainage

For hepatic abscesses, intra-abdominal abscesses, pancreatic pseudocysts, loculated pleural effusions and other collections, image-guided Chiba needle puncture accesses the abscess or cyst cavity. Fluid is aspirated for laboratory confirmation, and a drainage catheter is advanced along the needle tract for continuous drainage, eliminating the need for open surgical intervention.

Percutaneous Nephrostomy

Indicated for severe hydronephrosis or pyonephrosis secondary to upper urinary tract obstruction, delivering emergent decompression to preserve renal function.

3. Vascular and Luminal Intervention: Trailblazer for Complex Operations

In many technically demanding vascular interventional procedures, the Chiba needle creates the critical initial access pathway.

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

A landmark operation for managing complications of portal hypertension. Access is gained via the jugular vein, superior vena cava and right atrium to reach the hepatic vein. A specialized TIPS puncture kit-centered on a long, rigid Chiba-style trocar-punctures from the hepatic vein into a portal vein branch to form a shunt tract. This cannulation step represents the technical crux of TIPS; precise puncture with the Chiba-style needle dictates procedural success or failure.

Vascular Puncture for Challenging Anatomy

For patients with severe anasarca, morbid obesity, severely compromised vasculature, or requirements for specialized access (e.g., percutaneous transhepatic portal vein puncture), ultrasound-directed Chiba needle cannulation accurately targets the vessel, followed by guidewire advancement to establish a stable access route.

4. Therapeutic Injection and Ablation Assistance: A Precision Drug Delivery Vehicle

Nerve Block and Neuroablation

Under CT or ultrasound guidance, the Chiba needle is positioned adjacent to target nerve plexuses (celiac plexus, splanchnic nerves, posterior spinal nerve rami, etc.). Absolute ethanol or phenol glycerin is injected for chemical neurolysis, or local anesthetics plus steroids for therapeutic nerve blocks, treating advanced cancer pain and intractable chronic pain.

Cyst Sclerotherapy

For symptomatic simple hepatic or renal cysts, complete aspiration of cyst fluid is followed by injection of sclerosants (e.g., absolute ethanol) through the Chiba needle to ablate cyst lining endothelial cells and induce cyst obliteration.

Localization and Monitoring for Tumor Ablation

Prior to radiofrequency, microwave and other thermal ablation therapies, a Chiba needle may be placed at the tumor margin or adjacent vital structures as a localization marker to delineate planned ablation zones. During ablation, small volumes of gas or fluid can be injected through the needle tract to separate and shield adjacent healthy parenchymal tissue.

Conclusion

The clinical scope of the Chiba biopsy needle far surpasses the narrow definition implied by the term "biopsy". It has evolved from a standalone diagnostic instrument into a multi-functional interventional procedural platform. Its core value lies in offering a repeatable, low-risk, high-precision percutaneous access technique. Whether harvesting diagnostic specimens, constructing therapeutic access pathways, or delivering direct local treatment, the Chiba needle fulfills an irreplaceable pioneering and bridging role. Mastery of its diversified applications equips clinicians to address a broader spectrum of clinical conditions via less invasive approaches-an embodiment of interventional medicine's core philosophy: treating severe disease with minimal trauma. With continuous advancements in image navigation technology, the clinical indications and depth of utilization for the Chiba needle will undoubtedly expand further in the future.