Michael Gregory Rodriguez MD, Presenter: Nothing to Disclose

Joshua Poppell Smith MD, Abstract Co-Author: Nothing to Disclose

Shi Wei MD,PHD, Abstract Co-Author: Nothing to Disclose

Robert R. Lopez-Ben MD, Abstract Co-Author: Nothing to Disclose

Philip Howard Lander MD, Abstract Co-Author: Nothing to Disclose

Review the devices commonly used for imaged guided musculoskeletal biopsy. Evaluate the diagnostic accuracy of core bone and soft tissue biopsy, fine-needle aspiration, and flow cytometry. Discuss the clinical and surgical follow-up and pathologic correlation with biopsy results.

All CT and US-guided musculoskeletal biopsies performed in 2008 and 2009 at the UAB Medical Center were retrospectively analyzed. Biopsies were classified into 2 major groups: bone and soft tissue.  The bone biopsies were subdivided based on location, axial and appendicular skeleton.  The biopsies were organized by core only, FNA only, and combined core/FNA. Information was obtained regarding which devices were used and if the specimen was sent for culture and flow cytometry. Biopsy results were classified into definitive and non-definitive diagnosis.  Non-definitive diagnosis included non-diagnostic, clinical/imaging follow-up, repeat biopsy, and discordant surgical excisional biopsy. Specimens were subdivided into benign and malignant tumor, atypical cells, active inflammation, and reactive changes. Benefit of flow cytometry was assessed on specimens positive for lymphoma and myeloma.

207 patients were analyzed (102 M, 105 F). 115 bone (46 axial, 69 appendicular) and 112 soft tissue (79 CT, 33 US) biopsies were performed. 41 bone biopsies underwent core only, 50 soft tissue biopsies underwent core only, 8 underwent FNA only, and 113 underwent combined core/FNA. 127 patients had a definitive diagnosis, 77 were non-definitive, and 3 had unavailable pathology. In the definitive group, 83 underwent combined core/FNA. The diagnosis was concordant in 65, 14 on core only, 3 on FNA only, and 1 on flow only. In the non-definitive group, 9 nondiagnostic, 41 clinical/imaging follow-up, 2 rebiopsies, and 25 underwent surgical excision.

The majority of image guided musculoskeletal biopsies are performed with core or combined core/FNA. Core biopsy tends to have the highest yield for a definitive diagnosis. On rare instances, FNA and/or flow provided a diagnosis when cores did not. FNA and flow cytometry is complimentary in cases of lymphoma and myeloma.

Image guided biopsy in bone and soft tissue may require both core and FNA/flow cytometry to improve diagnostic accuracy.

Rodriguez, M, Smith, J, Wei, S, Lopez-Ben, R, Lander, P, Image-guided Musculoskeletal Biopsy: Educational Review with Clinical and Pathologic Correlation.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034383.html