OWL: OCOSH Classification/Orthopaedic Procedures/Biopsy/Needle Biopsy

2002 Use of Real-Time Magnetic Resonance Guidance to Assist Bone Biopsy in Pediatric Malignancy

Ueno et al — 2009-10-30 07:01:20 GMT

Magnetic resonance (MR) imaging (MRI) has the advantage of demonstrating lesions not visualized by other radiologic modalities. We present a case involving pediatric malignancy where MR-guided bone biopsy confirmed correct histologic diagnosis and was used to plan additional treatment. A 2-year, 9-month-old boy had a history of spontaneous regression of stage 4S neuroblastoma. 123I-metaiodobenzylguanidine scintigraphy showed a hot spot at his right lower leg; however, neither plain radiograph 99mTc diphosphonate bone scan was positive. Only MRI depicted a lesion at the distal third of his right tibia, and a subsequent MR-guided bone biopsy was diagnostic of bone marrow metastasis. After 6 courses of intensive chemotherapy, he has been in complete remission. MR-guided biopsy technique is likely to be particularly useful for the resection of invisible metastatic lesions, especially those that are only visible using MRI.
PEDIATRICS Vol. 109 No. 1 January 2002, pp. e18 full text Use of Real-Time Magnetic Resonance Guidance to Assist Bone Biopsy in Pediatric Malignancy Shigeru Ueno, MD, Seishichi Yokoyama, MD, Hitoshi Hirakawa, MD*, Hiromasa Yabe, MD, Yutaka Suzuki, MD, Hideki Atsumi, MD and Mitsunori Matsumae, MD

Closed vertebral biopsy

Fyfe et al — 2009-10-30 07:01:20 GMT

A study of cadaveric vertebral biopsy and a review of 100 clinical biopsies has shown that needles and trephines producing tissue specimens of two millimetres or more in diameter can be expected to give a high degree of diagnostic accuracy. The erythrocyte sedimentation rate was a more useful screening investigation than were estimations of serum alkaline phosphatase. The complications are described. It is suggested that patients with painful thoracic metastases and evidence of progressive cord compression should have early decompression after open biopsy if further neurological compromise is to be prevented.
Closed vertebral biopsy. Fyfe IS, Henry AP, Mulholland RC. J Bone Joint Surg Br. 1983 Mar;65(2):140-3.

Cytological diagnosis of bone tumours

Kreicbergs et al — 2009-10-30 07:01:20 GMT

Our study suggests that fine-needle aspiration biopsy is a valid option for the diagnosis of bone tumours. It is a simple outpatient procedure which gives sufficient cytological material for the correct diagnosis in 80% of cases. As with histological analysis of material from open biopsy, the cytological assessment must agree with the clinical and radiological findings.
Cytological diagnosis of bone tumors. Kreicbergs A, Bauer HC, Brosjö O, Lindholm J, Skoog L, Söderlund V. J Bone Joint Surg Br. 1996 Mar;78(2):258-63. full text

Cytological diagnosis of skeletal lesions

Wedin et al — 2009-10-30 07:01:20 GMT

ine-needle aspiration biopsy (FNAB) is a safe and efficient method for the discrimination between benign, primary malignant and metastatic bony lesions. We have now studied metastatic lesions to assess the diagnostic accuracy and to ascertain whether FNAB allows identification of the primary lesion. Between 1990 and 1997, 447 patients were referred for diagnosis of skeletal lesions of unknown type. Of these 119 proved to have metastatic disease, either myeloma or lymphoma. Nine were excluded leaving 110 consecutive patients with metastatic carcinoma (80), myeloma (16) or lymphoma (14). FNAB gave a correct diagnosis in 102 of the 110 patients (93%). In eight it was inconclusive.
Cytological diagnosis of skeletal lesions. Fine-needle aspiration biopsy in 110 tumours. Wedin R, Bauer HC, Skoog L, Söderlund V, Tani E. J Bone Joint Surg Br. 2000 Jul;82(5):673-8 Full text

Diagnosis of Primary Bone Tumors with Image-guided Percutaneous Biopsy

Jelinek et al — 2009-10-30 07:01:20 GMT

One hundred ten consecutive patients with primary bone tumors underwent biopsy with computed tomography (CT) or fluoroscopy.
CONCLUSION: Percutaneous biopsy of primary bone tumors is safe and accurate for diagnosis and grade of specific tumor. In cases with nondiagnostic biopsy, open-procedure biopsy is likely to be associated with similar diagnostic difficulties.
Diagnosis of Primary Bone Tumors with Image-guided Percutaneous Biopsy: Experience with 110 Tumors James S. Jelinek, MD, Mark D. Murphey, MD, James A. Welker, DO, Robert M. Henshaw, MD, Mark J. Kransdorf, MD, Barry M. Shmookler, MD and Martin M. Malawer, MD June 2002 Radiology, 223, 731-737. Full text

Fine-needle bone biopsy to diagnose osteomyelitis

Howard et al — 2009-10-30 07:01:20 GMT

In 30 patients in whom osteomyelitis was suspected fine-needle bone biopsies (FNBB) were taken at the same time as bone was aspirated for bacteriological examination. The diagnosis of osteomyelitis was eventually confirmed in 15 patients; the other 15 had myositis (3), arthritis (3), trauma (2), microgeodic phalangeal syndrome (2), haematoma in a non-ossifying fibroma (1), and Ewing's sarcoma (1). In three patients no pathology was found. The temperature, WBC and ESR at presentation did not help to distinguish osteomyelitis from other conditions. FNBB, however, proved to be a useful additional investigation with a sensitivity for osteomyelitis of 87% and a specificity of 93%.
Fine-needle bone biopsy to diagnose osteomyelitis CB Howard, M Einhorn, R Dagan, P Yagupski, and S Porat Journal of Bone and Joint Surgery - British Volume, Vol 76-B, Issue 2, 311-314 Copyright © 1994

Needle biopsy of musculoskeletal lesions

Stoker et al — 2009-10-30 07:01:20 GMT

Needle biopsies, performed on 208 consecutive patients and interpreted at the London Bone Tumour Service over a two-year period, were reviewed. A correct diagnosis was reached in 97% (133 out of 137) using this technique alone. Needle biopsy is safe and accurate when undertaken in consultation within a bone tumour service; it offers considerable advantages to both patient and surgeon over conventional open biopsy.
Needle biopsy of musculoskeletal lesions. A review of 208 procedures. Stoker DJ, Cobb JP, Pringle JA. J Bone Joint Surg Br. 1991 May;73(3):498-500

Percutaneous CT-guided biopsy of the spine

Rimondi et al — 2009-10-30 07:01:20 GMT

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).
Percutaneous CT-guided biopsy of the spine: results of 430 biopsies. Rimondi E, Staals EL, Errani C, Bianchi G, Casadei R, Alberghini M, Malaguti MC, Rossi G, Durante S, Mercuri M. Eur Spine J. 2008 Jul;17(7):975-81.

Recurrence of an osteosarcoma in a needle biopsy track

Davies et al — 2009-10-30 07:01:20 GMT

Percutaneous needle biopsy was introduced 60 years ago but only more recently has it been used for the diagnosis of primary bone tumours. It is accurate, rapid, and is associated with fewer complications than open biopsy. Care is required because of the theoretical risk of recurrence in the track of a fine-needle biopsy. We report such a case.
Recurrence of an osteosarcoma in a needle biopsy track. Davies NM, Livesley PJ, Cannon SR. J Bone Joint Surg Br. 1993 Nov;75(6):977-8

Technique for percutaneous needle biopsy of bone and marrow

L F Fajardo and H Sarasti — 2009-10-30 07:01:20 GMT

Technique description with emphasis on how to avoid errors
Calif Med. 1972 August; 117(2): 21–24. Full text available Technique for percutaneous needle biopsy of bone and marrow. L F Fajardo and H Sarasti

Ultrasound-guided needle biopsy of primary bone tumors

Saifuddin et al — 2009-10-30 07:01:20 GMT

Needle biopsy is an established technique for the histological diagnosis of bone tumours, usually guided by fluoroscopy or CT. Surface lesions and aggressive tumours which have extended through the cortex are also amenable to imaging with ultrasound (US). We have assessed the diagnostic accuracy of US-guided Trucut needle biopsy in a consecutive series of patients referred to a Bone Tumour Unit with suspected primary bone tumours. Of 144 patients (83 men, 61 women; mean age 34.7 years) referred over a period of two years, 63 were considered suitable for US-guided biopsy. This was based on the presence of a relatively large extraosseous component, seen typically in osteosarcoma and malignant round-cell tumours. The results of needle biopsy were compared with those of surgical biopsy. The diagnostic accuracy was 98.4%, with only a single failed biopsy. Thus, in a selected group of patients, US is a very reliable technique of guidance for percutaneous needle biopsy of bone tumours.
Ultrasound-guided needle biopsy of primary bone tumours. Saifuddin A, Mitchell R, Burnett SJ, Sandison A, Pringle JA. J Bone Joint Surg Br. 2000 Jan;82(1):50-4.