Computed-tomography guided percutaneous biopsy of musculoskeletal lesions

Eugenio Rimondi, Alessandra Longhi, Marco Alberghini, Stefano Duranta, Franco Bertoni

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

The correct diagnosis of the nature of a bone lesion is mandatory in order to provide an adequate treatment of the lesion and of the underlying disease (infections, inflammation, benign and malignant tumors). Even if recent more sophisticated radiological imaging techniques have a good predictive value in differential diagnosis a histologic or/and cultural examination is often necessary to plan further treatment. Bone biopsies can be performed as open biopsy or percutaneous biopsy (PB). The use of percutaneous biopsy (PB) has increased importance because it is quicker, less expensive, with fewer complications compared to surgical open biopsy. Percutaneous biopsy can be done through Fine Needle Biopsy (FNB 0.6-1.2 mm gauge, used for soft tissue biopsy), Core Needle Biopsies (CNB,1.7-2.1 mm) and Trephine Needle Biposy (TNB 3-5 mm). From July 1990 to December 2003 in the Departement of Radiology of the Rizzoli Orthopaedic Institute, we carried out 912 percutaneous CTguided bone biopsies. Four Core Neeedle Biopsins were conducted in 4 children (3 spine lesions + 1 femur) and 908 Trephine Needle Biopsy; median age 46 years. 502 were biopsied of lesions of appendicular bones, 410 were biopsied on axial skeleton (9 cervical spine, 120 thoracic spine, 172 lumbar, 109 sacral). Only in 32 cases the biopsy material (or specimen) was not sufficient, in 179 cases the bone material was normal, 210 were primary malignant neoplasms (bone tumor + other malignant tumor), 143 were metastases of extraosseous solid tumor, 182 benign tumors, 84 were acute and chronic infections, 82 other different lesions, 31 cultural exams were done in suspected infectious lesions. Side effects were 28 (3,1%): 19 pain in the site of biopsy, 5 transient paresis of lower limbs, 3 psoas muscle hematomas, 1 retroperitoneal hematoma due to accidental puncture of a vertebral vein, no infections, no pneumothorax was registered. This study on a large casistic showed that CT-guided percuteneous biopsy (CNB +TNB) can be considered a simple, reliable method for either histopathologic diagnosis or cultural diagnosis with high accuracy. In our experience the total average accuracy rate, which changes according to the involved segment, to the kind of lesion biopsed and to the experience and ability of the operator is about 95% only in 5% of the cases the excised tissue proved insufficient for histologic diagnosis.

Original languageEnglish
Title of host publicationBiopsies: Procedures, Types and Complications
PublisherNova Science Publishers, Inc.
Pages99-139
Number of pages41
ISBN (Print)9781619427235
Publication statusPublished - 2012

Keywords

  • CT
  • Incisional biopsy
  • Musculo-skeletal disease
  • Percutaneous biopsy
  • Surgical approach

ASJC Scopus subject areas

  • Medicine(all)

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