Percutaneous musculoskeletal biopsy

Abstract

c a F m s p c t i ( f m f HE RADIOLOGIST’S involvement in percutaneous musculoskeletal biopsies is ever inreasing, and biopsy techniques using fluoroscopy, omputed tomography (CT), ultrasound, and magetic resonance imaging (MRI) have obviated the eed for many open surgical biopsies.1-8 Almost ny part of the musculoskeletal system can be ccessed by a percutaneous route, and the majority f these biopsies can be easily and safely perormed by an experienced physician. There are ultiple benefits associated with percutaneous bipsies: a 3to 5-fold increase in cost-effectiveness ver open biopsy,9-11 minimal activity limitation fter the procedure, a rapid recovery time, quicker nitiation of patient treatment, and assistance with perative planning.4,6,12-14 Contrary to open bipsy, percutaneous biopsy does not likely result in he weakening of bone structures, particularly in eight-bearing areas, thus avoiding the need for mmobilization.14-16 A percutaneous biopsy is relatively easy to erform and with proper technique has a low omplication rate. However, Mankin et al13 reorted on the hazards of percutaneous biopsy in a tudy of 597 patients revealing 13.5% major errors n diagnosis, 15.9% complication rate, and 3% nnecessary amputation. They reported higher ates in nonspecialized oncology centers and recmmended that an institution that is not equipped o perform accurate diagnostic studies or definitive urgery and adjunctive treatment should refer the atient to specialized centers. Thus, performing a ercutaneous musculoskeletal biopsy requires an nderstanding of various concepts including: leion imaging appearance, imaging guidance, bipsy tools, potential complications, and patient reatment plans. Maintaining procedure safety and ccuracy requires close interaction between the adiologist and the referring services, such as the rthopedic oncology surgeon, oncologist and or-