Abstract
Approximately 70% of cancer patients will eventually develop bone metastases. Spine, due to the abundance of red marrow in the vertebral bodies and the communication of deep thoracic-pelvic veins with valve-less vertebral venous plexuses, is the most common site of osseous metastatic disease. Open biopsies run the risk of destabilizing an already diseased spinal or peripheral skeleton segment. Percutaneous biopsies obviate such issues and provide immediate confirmation of correct needle location in the area of interest. Indications for percutaneous bone biopsy include lesion characterization, optimal treatment and tumor recurrence identification, as well as tumor response and recurrence rate prediction. Predicting recurrence in curative cases could help in treatment stratification, identification, and validation of new targets. The overall accuracy of percutaneous biopsy is 90–95%; higher positive recovery rates govern biopsy of osteolytic lesions. The rate of complications for percutaneous biopsy approaches is <5%. The purpose of this review is to provide information about performing bone biopsy and what to expect from it as well as choosing the appropriate imaging guidance. Additionally, factors governing the appropriate needle trajectory that would likely give the greatest diagnostic yield and choice of the most appropriate biopsy system and type of anesthesia will be addressed.
Highlights
Bone metastasis is the end result of a cascade of events including tumor cell seeding and dormancy as well as metastatic growth; the bone marrow microenvironment can act as a reservoir for malignant cells [1]
Metastatic bone disease is most commonly seen with cancer arising from the breast, prostate, lung, and kidney, as well as multiple myeloma; the most common sites of bone metastases are throughout the axial skeleton [1,2]
Percutaneous postero-lateral blind biopsy approaches have been performed since the mid-1930s by Robertson and Ball; fluoroscopically- and computed tomography-guided biopsies were introduced in everyday clinical practice since 1949 and 1981, respectively [3]
Summary
Bone metastasis is the end result of a cascade of events including tumor cell seeding and dormancy as well as metastatic growth; the bone marrow microenvironment can act as a reservoir for malignant cells [1]. Metastatic bone disease is most commonly seen with cancer arising from the breast, prostate, lung, and kidney, as well as multiple myeloma; the most common sites of bone metastases are throughout the axial skeleton [1,2]. Percutaneous, imaging-guided biopsy of bone metastasis is a minimally invasive diagnostic technique that can be proposed, among others, for characterization and identification of a suspicious lesion. Open biopsies run the risk of destabilizing an already diseased spinal or peripheral skeleton segment. Percutaneous biopsies obviate such issues and provide immediate confirmation of correct needle location in the area of interest. The purpose of this review is to provide information about performing bone biopsies and what is to be expected from them as well as choosing the appropriate imaging guidance. Factors governing the appropriate needle trajectory that would likely give the greatest diagnostic yield and choice of the most appropriate biopsy system and type of anesthesia will be addressed
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