Revisiting CT-Guided Percutaneous Core Needle Biopsy of Musculoskeletal Lesions: Contributors to Biopsy Success

ObjectiveThe purpose of this article is to investigate potential technical, imaging, and histopathologic contributors to the success of CT biopsy.Materials and methodsFour hundred forty-four consecutive CT biopsies of musculoskeletal lesions performed from 2005 to 2008 were retrospectively classified as diagnostic or nondiagnostic and as accurate or inaccurate. A biopsy was considered as diagnostic if it provided a definitive pathologic diagnosis or was clinically useful; as accurate if it was concordant with the ultimate diagnosis with respect to identification of malignancy, grade, and histopathologic features; and as successful if it was both diagnostic and accurate. Biopsy success rate, diagnostic yield, and accuracy were assessed according to lesion location, use of sedation, biopsy equipment type, bone lesion matrix type, and lesion histologic type (i.e., bone or soft-tissue origin, malignant or benign neoplasm, and low-or intermediate-to-high-grade neoplasm).ResultsOf 444 biopsies, 71% were diagnostic, 86% were accurate, and 70% were successful. Biopsy success and diagnostic yield were greater in bone lesions, malignant neoplasms, and intermediate-to-high-grade neoplasms compared with soft-tissue lesions (p < 0.01), benign neoplasms (p < 0.0001), and low-grade neoplasms (p < 0.0001). Success and diagnostic yield were not significantly associated with technical or imaging factors. Biopsy accuracy was not associated with any of the tested variables. Of the 128 nondiagnostic biopsy results, 53% were accurate with respect to subsequent surgical pathologic findings. Most of these biopsy results were of benign soft-tissue lesions.ConclusionCT biopsy of musculoskeletal lesions is accurate and effective. It may be limited in the evaluation of benign and low-grade soft-tissue neoplasms

Percutaneous CT-guided biopsy of the spine: results of 430 biopsies

Biopsies of lesions in the spine are often challenging procedures with significant risk of complications. CT-guided needle biopsies could lower these risks but uncertainties still exist about the diagnostic accuracy. Aim of this retrospective study was to evaluate the diagnostic accuracy of CT-guided needle biopsies for bone lesions of the spine. We retrieved the results of 430 core needle biopsies carried out over the past fifteen years at the authors’ institute and examined the results obtained. Of the 430 biopsies performed, in 401 cases the right diagnosis was made with the first CT-guided needle biopsy (93.3% accuracy rate). Highest accuracy rates were obtained in primary and secondary malignant lesions. Most false negative results were found in cervical lesions and in benign, pseudotumoral, inflammatory, and systemic pathologies. There were only 9 complications (5 transient paresis, 4 haematomas that resolved spontaneously) that had no influence on the treatment strategy, nor on the patient’s outcome. In conclusion we can assert that this technique is reliable and safe and should be considered the gold standard in biopsies of the spine

The diagnostic value of needle biopsy for musculoskeletal lesions

The purpose of this study was to assess the diagnostic value of imaging-guided core needle biopsy for the diagnosis of musculoskeletal lesions. Between 2004 and 2007, 309 biopsies (ultrasound 151, computed tomography 89, and fluoroscopy 69) were included. There were 142 soft tissue and 167 bony lesions. Diagnostic yields and accuracies were assessed using the chi-square test or Fisher’s exact test with Bonferroni’s correction when necessary. Overall diagnostic yield was 90.6% for all 309 lesions (bone 91.6% vs. soft tissue 89.3%, p = 0.5125). The diagnostic accuracy of the 185 core needle biopsies, which were confirmed by definitive surgical biopsies, was 84.3% (bone 88.9% vs. soft tissue 79.1%, p = 0.0669). The yields of homogenous bone tumours (96.8%) were not significantly higher than those of bone tumours with a heterogenic architecture (86.4%, p = 0.0794). The difference between accuracies for homogenous bone tumours (89.1%) and heterogenous bone tumours (85.0%) was not significant (p = 0.6930). However, for soft tissue tumours, homogenous tumours had a significantly higher diagnostic yield than heterogenous tumours (97.5% vs. 81.4%, p = 0.0036). Diagnostic accuracy for homogenous tumours was also significantly higher than that for heterogenous soft tissue tumours (94.4% vs. 60.6%, p < 0.0001). The image-guided percutaneous needle biopsy of musculoskeletal lesions is a safe and effective procedure if it is performed selectively in soft tissue tumours with homogenous architectures