Musculoskeletal Biopsies Research Articles

MRI-guided biopsy and fine needle aspiration biopsy (FNAB) in the diagnosis of musculoskeletal lesions

ObjectivesThe purpose of this study was to evaluate the diagnostic performance of magnetic resonance imaging (MRI) guided musculoskeletal biopsy and the value of fine needle aspiration biopsy (FNAB) when combined with histologic biopsy. Materials and methodsA total of 172 biopsies were performed under MRI guidance, 170 were histologic biopsies. In 112 cases, a fine needle aspiration biopsy was also performed. In two cases, a stand-alone FNAB was performed. The diagnostic performance was evaluated retrospectively by comparing the histopathologic and cytologic diagnosis with the current or final diagnosis after at least one year of clinical and imaging follow-up. A 0.23T open MRI scanner with an interventional stereotactic guidance system was used. ResultsThe overall diagnostic accuracy of MRI guided biopsy was 0.95, sensitivity 0.91, specificity 0.98, positive predictive value (ppv) 0.97 and negative predictive value (npv) 0.93. The diagnostic accuracy of trephine biopsy alone was 0.93, sensitivity 0.89, specificity 0.98, ppv 0.97 and npv 0.91 and accuracy for FNAB alone was 0.85, sensitivity 0.80, specificity 0.90, ppv 0.89 and npv 0.82. ConclusionsMRI guidance is a feasible and accurate tool in percutaneous musculoskeletal biopsies. Fine needle biopsy is a useful low-cost supplement to histologic biopsy.

Using the CUSUM test to control the proportion of inadequate open biopsies of musculoskeletal tumors.

Biopsies of musculoskeletal tumors lead to alterations in treatment in almost 20% of cases. Control charts are useful to ensure that a process is operating at a predetermined level of performance, although their use has not been demonstrated in assessing the adequacy of musculoskeletal biopsies. We therefore (1) assessed the incidence of and the reasons for inadequate musculoskeletal biopsies when following guidelines for performing the procedure; and (2) implemented a process control chart, the CUSUM test, to monitor the proportion of inadequate biopsies. We prospectively studied 116 incisional biopsies. The biopsy was performed according to 10 rules to (1) minimize contamination in the tissues surrounding the tumor; and (2) improve accuracy. A frozen section was systematically performed to confirm that a representative specimen was obtained. Procedures were considered inadequate if: (1) another biopsy was necessary; (2) the biopsy tract was not appropriately placed; and (3) the treatment provided based on the diagnosis from the biopsy was not appropriate. Five (4.3%) of the 116 incisional biopsy procedures were considered failures. Three patients required a second repeat open biopsy and two were considered to receive inappropriate treatment. No alarm was raised by the control chart and the performance was deemed adequate over the monitoring period. The proportion of inadequate musculoskeletal open biopsies performed at a referral center was low. Using a statistical process control method to monitor the failures provided a continuous measure of the performance.

Magnetic resonance imaging guided biopsy of musculoskeletal lesions

BackgroundMinimally invasive interventional biopsy procedures have the advantages of accurate localization, small incisions, and rapid recovery. The purpose of this study was to clinically test and evaluate the efficacy of the magnetic resonance imaging (MRI)-guidance techniques for obtaining musculoskeletal biopsies using the appropriate imaging modalities and instruments. MethodsWe used MRI-compatible biopsy needles from the Invivo Bone Biopsy Set (Daum, Germany), and a 1.5-T closed-magnet MRI scanner was used to perform the MRI-guided biopsy. The pulse sequences included fast spin echo T1- and T2-weighted imaging and gradient echo imaging. The inclusion criteria included the presence of bone or soft tissue masses, infectious disease, and other nonspecific lesions that required tissue confirmation. Lesions that could not be visualized by computed tomography (CT) or other imaging modalities were preferred. ResultsFrom January 2005 through December 2009, 23 patients (12 males and 11 females, aged 11–82 years) underwent musculoskeletal MRI-guided biopsy. The biopsy locations were as follow: spine (n = 12), tibia (n = 3), pelvis (n = 1), femur (n = 2), scapula (n = 1), humerus (n = 1), ulna (n = 1), scapula (n = 1), and soft tissue mass of the shoulder (n = 1). The final diagnoses included bone metastasis (n = 7), spinal osteomyelitis and discitis (n = 5), osteonecrosis after chemotherapy (n = 4), bone marrow change or benign lesion without malignancy (n = 3), insufficiency fracture (n = 1), long bone osteomyelitis (n = 1), soft tissue metastasis (n = 1), and perineural ganglion cyst (n = 1). In 10 of the 23 cases, the lesions were barely visualized or invisible on CT guidance. Pathologic analysis and laboratory culturing revealed that the lesions were successfully accessed by MRI-guided biopsy in 100% (23/23) of cases. No obvious complications developed during or after the procedures. ConclusionBiopsy under MRI guidance is especially valuable for the localization of bone marrow lesions, viable tumors (after chemotherapy or radiation), and lesions that cannot be visualized using CT. It is both accurate and safe, is a good alternative biopsy method, and may be a good adjunctive technique for the localization of bone lesions for radiofrequency ablation or other interventional procedures.

Reply

Downloaded from www.ajronline.org by UCLA Digital Coll SVCS on 05/06/15 from IP address 149.142.243.67. Copyright ARRS. For personal use only; all rights reserved Letters Reply Although Loizides et al. [1] read our ar- ticle [2] with “great interest and surprise,” we read their letter with shock. It appears that the writers have completely missed the objective of our article. Rather than create a laundry list of responses to the comments, we will address the two salient points that were obviously lost or overlooked. The objective of our article [2] was to “better elucidate factors that may contrib- ute to the success of CT-guided core needle biopsy.” The Results section addresses this very clearly. The purpose was not to com- pare different guidance techniques to deter- mine a “modality of choice.” This article was not designed to evaluate different imaging techniques for the diagno- sis of bone and soft-tissue tumors. It addresses CT as a tool for guiding biopsy. Our patients generally present with multiple outside studies, including radiography, MRI, ultrasound, radio- nuclide, and even PET examinations. Such fea- tures as necrosis, aggressive-appearing bone destruction, and vascularity are noted on these outside studies, and localization is transferred to unenhanced CT to target the area for tissue sampling. Admittedly, the legend for Figure 1 is somewhat misleading in alluding that CT was the only imaging tool available. We regret that our article [2] caused so much confusion for Loizides et al. [1]. Leanne L. Seeger Kambiz Motamedi David Geffen School of Medicine at UCLA, Los Angeles, CA; Scott D. Nelson Santa Monica–UCLA Medical Center, Santa Monica, CA DOI:10.2214/AJR.11.7865 WEB—This is a Web exclusive article.

Image-Guided Musculoskeletal Biopsies

Image-guided musculoskeletal (MSK) biopsies are safe and effective procedures that yield diagnostic accuracies up to 97%. When performed in conjunction with a multidisciplinary team, they provide crucial information that will affect patient care and outcome. Computed tomography and ultrasound are the main modalities used to carry out MSK biopsies, and various needles and techniques are available to help the radiologist perform these procedures safely.

Musculoskeletal Biopsies Using Computed Tomography Fluoroscopy

To determine the diagnostic yield, accuracy, and safety of computed tomography (CT) fluoroscopy guidance for musculoskeletal biopsies. A retrospective analysis of musculoskeletal biopsies performed with CT fluoroscopy guidance over a 2-year period was made. Data collected were biopsy sites, CT fluoroscopic times, and biopsy results. Results were categorized as the following: positive, negative (but diagnostic), or nondiagnostic. Reference standard consisted of 5 years of follow-up to verify results. Ninety-five CT fluoroscopy-guided musculoskeletal biopsies were performed. Bone biopsies comprised 83% (79/95), and soft tissue biopsies comprised 17% (16/95). The mean age was 54 years (range, 16-90 years); 40.0% (38/95) were male subjects, and 60.0% (57/95) were female subjects. For all subjects, CT fluoroscopic times ranged from 2 to 310 seconds, with a mean time of 63 seconds and a median time of 34 seconds. The diagnostic yield was 96% (91/95), with a nondiagnostic result in 4% (4/95) of subjects. Diagnostic biopsy specimens showed a positive result in 63% (60/95) of subjects and a negative but diagnostic result in 33% (31/95) of subjects. There were no major complications. Computed tomography fluoroscopic-guided musculoskeletal biopsies show a high diagnostic yield and are accurate and safe. The biopsy results are similar or superior to other published reports using conventional CT guidance with only a small overall fraction being nondiagnostic. The benefits of real-time imaging are at the cost of operator exposure to ionizing radiation and the risk of potentially high exposures to both patient and operator. The impact on indications for which lesions are most amenable to percutaneous biopsy using CT fluoroscopy and procedure time has yet to be determined.

Musculoskeletal Biopsy: Utilization and Provider Distribution in the United States Medicare Population

Physicians from many specialties perform musculoskeletal biopsy. Using the Medicare database, we sought to determine which specialties represent the physicians who are performing the majority. Using the CMS physician supplier procedure summary master file for 1996-2003, we extracted all claims for biopsy procedure codes (including marrow aspiration, muscle biopsy, percutaneous bone biopsy, and open surgical biopsy) categorized by provider specialty, and we analyzed procedure volumes. Since 1996, the rate of utilization of percutaneous bone biopsy has remained stable. In 2003, marrow aspiration was most commonly performed by hematology/oncology (80,038, 57%), followed by medical oncology (23,428, 17%); radiologists performed 755 (0.5%). Muscle biopsies were predominantly performed by radiologists (4,761, 40%), followed by neurosurgery (591, 5%). Percutaneous bone biopsy was mostly performed by radiologists (14,830, 53%), but orthopedic surgeons, neurosurgeons, and hematology/oncology specialists performed a large minority (6,879, 2,296, and 1,048 respectively; in aggregate, 37%). From 1996 to 2003, radiologists performed 71% more muscle biopsies (2,788 to 4,761) and 60% more percutaneous bone biopsies (9,259 to 14,830). Although most specialties are performing fewer percutaneous bone biopsies (e.g., oncologists: 7,217 to 1,048, -85%), orthopedic surgeons are performing 247% more (1,983 to 6,879) and neurosurgeons are performing 2,343% more (94 to 2,296). Excluding marrow aspiration, radiologists perform the majority of percutaneous bone biopsies, and the volume is increasing in the U.S. Medicare population. The overall volume has remained relatively stable from 1996 to 2003; although medical specialties are performing fewer, the volume performed by surgeons is increasing rapidly.

Invited Commentary

HomeRadioGraphicsVol. 27, No. 1 PreviousNext RSNA Education ExhibitsInvited CommentaryMark J. KransdorfMark J. KransdorfAuthor AffiliationsDepartment of Radiology, Mayo Clinic Jacksonville, FloridaMark J. KransdorfPublished Online:Jan 1 2007https://doi.org/10.1148/radiographics.27.1.0270206MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References1 Hippocrates. Epidemics, Book I, Section XI. Quoted in: Smith CM. Origin and uses of primum non nocere—above all, do no harm! J Clin Pharmacol 2005; 45: 371–377. Crossref, Medline, Google Scholar2 MankinHJ, Lange TA, Spanier SS. The hazards of biopsy in patients with malignant primary bone and soft-tissue tumors. J Bone Joint Surg Am1982; 64: 1121–1127. Crossref, Medline, Google Scholar3 MankinHJ, Mankin CJ, Simon MA. The hazards of the biopsy, revisited. Members of the Musculoskeletal Tumor Society. J Bone Joint Surg Am1996; 78: 656–663. Crossref, Medline, Google Scholar4 LiuPT, Valadez SD, Chivers FS, Roberts CC, Beauchamp CP. Anatomically based guidelines for core needle biopsy of bone tumors with respect to limb-sparing surgery. RadioGraphics2007; 27: 189–206. Link, Google ScholarArticle HistoryPublished in print: Jan 2007 FiguresReferencesRelatedDetailsCited ByMRI of the Retroperitoneum9 June 2016Recommended Articles Pearls and Pitfalls for Soft-Tissue and Bone Biopsies: A Cross-Institutional ReviewRadioGraphics2020Volume: 40Issue: 1pp. 266-290Common Skeletal Neoplasms and Nonneoplastic Lesions at 18F-FDG PET/CTRadioGraphics2021Volume: 42Issue: 1pp. 250-267Multitask Deep Learning for Segmentation and Classification of Primary Bone Tumors on RadiographsRadiology2021Volume: 301Issue: 2pp. 398-406Comprehensive Palliative Musculoskeletal Interventional Radiology Care for Patients with CancerRadioGraphics2022Volume: 42Issue: 6pp. 1654-1669Pediatric Osteosarcoma: Correlation of Imaging Findings with Histopathologic Features, Treatment, and OutcomeRadioGraphics2022Volume: 42Issue: 4pp. 1196-1213See More RSNA Education Exhibits Musculoskeletal Biopsy 101: From Pre-Procedural Planning to Post Procedure CareDigital Posters2018Primary Leiomyosarcoma of Bone: Imaging Findings with Pathologic CorrelationDigital Posters2020You Sow What You Reap: Tumoral Needle Tract Seeding After Percutaneous Breast Biopsy  Digital Posters2018 RSNA Case Collection Mazabraud syndromeRSNA Case Collection2020Primary angiosarcoma of boneRSNA Case Collection2020Bone infarct complicated by osteomyelitisRSNA Case Collection2020 Vol. 27, No. 1 Metrics Altmetric Score PDF download

Percutaneous CT-guided interventional procedures in musculoskeletal system (our experience)

Percutaneous interventional procedures include a broad spectrum of minimal invasive techniques, which are a useful diagnostic and therapeutic tool. In this study we present our experience in CT-guided percutaneous musculoskeletal biopsies, drainages of musculoskeletal abscesses, facet and sacroiliac joint injection and radiofrequency thermal ablation of painful metastases or osteoid osteomas.

Percutaneous musculoskeletal biopsy

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-

MRI-guided musculoskeletal biopsy

MRI-guided musculoskeletal biopsy has been mentioned to be a minimally invasive method to obtain specimens for diagnostic purposes in bone tumors. To evaluate the viability, to assess the accuracy, and to record possible complications of this method, clinical data of 19 MRI-guided biopsies were analyzed. Interventions were performed on 18 patients (1-78 years) as an outpatient procedure: 15 skeletal and 4 soft tissue biopsies were taken from the pelvis, upper limb,or lower limb. We used T1-weighted gradient echoes (GE) for locating the puncture site and T2-weighted turbo spin echoes (TSE) for visualization of needle position. In 14 of 18 MRI-guided biopsies, a definite histological diagnosis was obtained. According to the pathologist, the inadequate size of the specimen was the main reason for missing the diagnoses in four cases.Long intervention time and inappropriate biopsy tools proved to be the main disadvantages of MRI-guided biopsy, but technical improvement might solve these technical problems in future.A postbiopsy hematoma was the only complication observed. Once technically improved, MRI-guided biopsy could be a precise alternative routine method for musculoskeletal biopsies in future.

Interventional Musculoskeletal Procedures

Percutaneous interventional procedures for the musculoskeletal system are demonstrated and explained by means of a hypertext-based teaching file. The authors provide an overview of different procedures including musculoskeletal biopsy, percutaneous periradicular infiltration, diskography, percutaneous cementoplasty, percutaneous treatment of disk herniation, and percutaneous treatment of osteoid osteoma. The procedures are demonstrated with detailed illustration of materials used and computed tomographic and fluoroscopic images. The authors guide the user through each step of the procedures, with case studies that include indications, techniques, complications, and results.

Interventional Musculoskeletal Procedures

HomeRadioGraphicsVol. 21, No. 2 PreviousNext Online: Abstracted Contents of March-April 2001Free AccessInterventional Musculoskeletal ProceduresAfshin Gangi, Stephane Guth, Jean-Louis Dietemann, Catherine RoyAfshin Gangi, Stephane Guth, Jean-Louis Dietemann, Catherine RoyAfshin GangiStephane GuthJean-Louis DietemannCatherine RoyPublished Online:Mar 1 2001https://doi.org/10.1148/radiographics.21.2.g01mr98520MoreSections ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked InEmail Percutaneous interventional procedures for the musculoskeletal system are demonstrated and explained by means of a hypertext-based teaching file. The authors provide an overview of different procedures, including musculoskeletal biopsy, percutaneous periradicular infiltration, diskography, percutaneous cementoplasty, percutaneous treatment of disk herniation, and percutaneous treatment of osteoid osteoma. The procedures are demonstrated with detailed illustration of materials used and computed tomographic and fluoroscopic images. The authors guide the user through each step of the procedures, with case studies that include indications, techniques, complications, and results.—Received September 10, 2000; accepted November 9. Available at http://radiographics.rsnajnls.org/cgi/content/full/21/2/e1.Article HistoryPublished in print: Mar 2001 FiguresReferencesRelatedDetailsCited ByMedical Journal of Australia, Vol. 175, No. 1Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 21, No. 2 Metrics Downloaded 358 times Altmetric Score

Percutaneous Biopsy of Musculoskeletal Lesions

Percutaneous biopsy is a minimally invasive technique that yields a high diagnostic accuracy at a relatively low cost in musculoskeletal lesions, especially tumors and infection. In this article, technical refinements improving the results of percutaneous biopsy of musculoskeletal lesions are reviewed, especially the type of radiological guidance, the different biopsy needles available, and the technique of approach depending on the lesion site. Reported complications, results, and indications of musculoskeletal percutaneous biopsy are also discussed.

Alcoholic Skeletal Myopathy, A Clinical and Pathological Study

One hundred and fifty-one inpatients with a history of chronic heavy alcohol intake were examined for evidence of muscle disease. Ninety-two patients (60 per cent) had histologically abnormal biopsies of the quadriceps muscle. The most common abnormality, which was often severe, was type II muscle fibre atrophy. Seven patients (5 per cent) had histological evidence of acute myopathy, one of whom presented with the full clinical picture of acute rhabdomyolysis. Twenty-three patients had cirrhosis, 36 were significantly malnourished and 98 had evidence of a peripheral neuropathy. None of these features, however, were sufficient to account for the muscle abnormalities. There was no clear relationship between musculo-skeletal symptoms and muscle biopsy histology. Serum creatine kinase activity was elevated in only 23 subjects and was an insensitive indicator of subclinical acute myopathy and of chronic alcoholic myopathy. Follow-up studies after abstinence from alcohol invariably showed both objective and subjective improvement of muscle function - often in the absence of any clinical recovery from the peripheral neuropathy. Continued alcohol consumption was accompanied by persistence and often deterioration of muscle fibre atrophy. It is concluded that chronic skeletal myopathy is a frequent consequence of alcohol abuse and may result from a direct toxic effect of ethanol on muscle fibres.

Radiologically Guided Percutaneous Musculoskeletal Biopsy

Radiologically guided percutaneous musculoskeletal biopsy can be done rapidly and precisely with highly accurate results and is nearly painless with only local anesthesia. Orthopedic surgeons should consider including a radiologist in the team with the patient and pathologist when such biopsies are necessary.

Percutaneous skeletal biopsy 1981: a procedure for radiologists--results, review, and recommendations.

A retrospective study of 169 percutaneous skeletal biopsies performed by radiologists at the Mallinckrodt Institute of Radiology and Barnes Hospital between October 1974 and July 1980 showed an overall accuracy of 94%; a negative result had a predictive value of 92%. A review of the English-language literature revealed that nearly 10,000 aspiration or trephine musculoskeletal biopsies have been reported during the past 50 years; historical accuracy is approximately 80%, but this figure is probably an underestimate because true-negative cases may not have been well documented or tabulated. The authors believe that percutaneous skeletal biopsy should be considered a radiological procedure, and that radiologists could and should perform this procedure as part of a team effort.