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Semin Musculoskelet Radiol 2020; 24(06): 667-675
DOI: 10.1055/s-0040-1717113
Review Article

Percutaneous Imaging-Guided versus Open Musculoskeletal Biopsy: Concepts and Controversies

Violeta Vasilevska Nikodinovska
1   Department of Radiology, Faculty of Medicine, University Surgical Clinic, St. Naum Ohridski Skopje, Ss. Cyril and Methodius University of Skopje, Skopje, North Macedonia
,
Slavcho Ivanoski 
2   Department of Radiology, Special Hospital for Orthopedic Surgery and Traumatology, St. Erazmo – Ohrid, Macedonia, Ss. Cyril and Methodius University of Skopje, Skopje, North Macedonia
,
Milan Samardziski
3   University Clinic for Orthopedic Surgery, Ss. Cyril and Methodius University of Skopje, Skopje, North Macedonia
,
Vesna Janevska
4   Institute of Pathology, Faculty of Medicine, Ss. Cyril and Methodius University of Skopje, Skopje, North Macedonia
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Abstract

Bone and soft tissue tumors are a largely heterogeneous group of tumors. Biopsy of musculoskeletal (MSK) tumors is sometimes a challenging procedure. Although the open biopsy is still considered the gold standard for the biopsy of MSK lesions, core needle biopsy can replace it in most cases, with similar accuracy and a low complication rate. The biopsy should be performed in a tertiary sarcoma center where the multidisciplinary team consists of at minimum a tumor surgeon, an MSK pathologist, and an MSK radiologist who can assess all steps of the procedure. Several factors can influence the success of the biopsy including the lesion characteristics, the equipment, and the method used for the procedure. This review highlights some of the important aspects regarding the biopsy of the MSK tumors, with special attention to imaging a guided core needle biopsy and highlighting some of the recent advancements and controversies in the field.

Keywords

bone - soft tissue - biopsy - core needle - accuracy


Publication History

Article published online:
11 December 2020

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  • References

  • 1 Trieu J, Sinnathamby M, Di Bella C. et al. Biopsy and the diagnostic evaluation of musculoskeletal tumours: critical but often missed in the 21st century. ANZ J Surg 2016; 86 (03) 133-138
    CrossrefPubMedGoogle Scholar
  • 2 Kubo T, Furuta T, Johan MP, Sakuda T, Ochi M, Adachi N. A meta-analysis supports core needle biopsy by radiologists for better histological diagnosis in soft tissue and bone sarcomas. Medicine (Baltimore) 2018; 97 (29) e11567
    CrossrefPubMedGoogle Scholar
  • 3 Traina F, Errani C, Toscano A. et al. Current concepts in the biopsy of musculoskeletal tumors: AAOS exhibit selection. J Bone Joint Surg Am 2015; 97 (02) e7
    CrossrefPubMedGoogle Scholar
  • 4 Omura MC, Motamedi K, UyBico S, Nelson SD, Seeger LL. Revisiting CT-guided percutaneous core needle biopsy of musculoskeletal lesions: contributors to biopsy success. AJR Am J Roentgenol 2011; 197 (02) 457-461
    CrossrefPubMedGoogle Scholar
  • 5 Trieu J, Schlicht SM, Choong PF. Diagnosing musculoskeletal tumours: how accurate is CT-guided core needle biopsy?. Eur J Surg Oncol 2016; 42 (07) 1049-1056
    CrossrefPubMedGoogle Scholar
  • 6 Mavrogenis AF, Angelini A, Errani C, Rimondi E. How should musculoskeletal biopsies be performed?. Orthopedics 2014; 37 (09) 585-588
    CrossrefPubMedGoogle Scholar
  • 7 Pohlig F, Kirchhoff C, Lenze U. et al. Percutaneous core needle biopsy versus open biopsy in diagnostics of bone and soft tissue sarcoma: a retrospective study. Eur J Med Res 2012; 17 (01) 29
    CrossrefPubMedGoogle Scholar
  • 8 Kiatisevi P, Thanakit V, Sukunthanak B, Boonthatip M, Bumrungchart S, Witoonchart K. Computed tomography-guided core needle biopsy versus incisional biopsy in diagnosing musculoskeletal lesions. J Orthop Surg (Hong Kong) 2013; 21 (02) 204-208
    CrossrefPubMedGoogle Scholar
  • 9 Welker JA, Henshaw RM, Jelinek J, Shmookler BM, Malawer MM. The percutaneous needle biopsy is safe and recommended in the diagnosis of musculoskeletal masses. Cancer 2000; 89 (12) 2677-2686
    CrossrefPubMedGoogle Scholar
  • 10 Barrientos-Ruiz I, Ortiz-Cruz EJ, Serrano-Montilla J, Bernabeu-Taboada D, Pozo-Kreilinger JJ. Are biopsy tracts a concern for seeding and local recurrence in sarcomas?. Clin Orthop Relat Res 2017; 475 (02) 511-518
    CrossrefPubMedGoogle Scholar
  • 11 Filippiadis DK, Charalampopoulos G, Mazioti A, Keramida K, Kelekis A. Bone and soft-tissue biopsies: what you need to know. Semin Intervent Radiol 2018; 35 (04) 215-220
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Gogna A, Peh WC, Munk PL. Image-guided musculoskeletal biopsy. Radiol Clin North Am 2008; 46 (03) 455-473 , v
    CrossrefPubMedGoogle Scholar
  • 13 Adams SC, Potter BK, Pitcher DJ, Temple HT. Office-based core needle biopsy of bone and soft tissue malignancies: an accurate alternative to open biopsy with infrequent complications. Clin Orthop Relat Res 2010; 468 (10) 2774-2780
    CrossrefPubMedGoogle Scholar
  • 14 Qi D, Zhao M, Hu T, Zhang G. Diagnostic yield of percutaneous core needle biopsy in suspected soft tissue lesions of extremities. J Int Med Res 2019; 47 (06) 2598-2606
    CrossrefPubMedGoogle Scholar
  • 15 Mitton B, Seeger LL, Eckardt MA. et al. Image-guided percutaneous core needle biopsy of musculoskeletal tumors in children. J Pediatr Hematol Oncol 2014; 36 (05) 337-341
    CrossrefPubMedGoogle Scholar
  • 16 Ceraulo A, Ouziel A, Lavergne E. et al. Percutaneous guided biopsy for diagnosing suspected primary malignant bone tumors in pediatric patients: a safe, accurate, and cost-saving procedure. Pediatr Radiol 2017; 47 (02) 235-244
    CrossrefPubMedGoogle Scholar
  • 17 Kasraeian S, Allison DC, Ahlmann ER, Fedenko AN, Menendez LR. A comparison of fine-needle aspiration, core biopsy, and surgical biopsy in the diagnosis of extremity soft tissue masses. Clin Orthop Relat Res 2010; 468 (11) 2992-3002
    CrossrefPubMedGoogle Scholar
  • 18 Oliveira MP, Lima PM, da Silva HJ, de Mello RJ. Neoplasm seeding in biopsy tract of the musculoskeletal system. A systematic review. Acta Ortop Bras 2014; 22 (02) 106-110
    CrossrefPubMedGoogle Scholar
  • 19 Jelinek JS, Murphey MD, Welker JA. et al. Diagnosis of primary bone tumors with image-guided percutaneous biopsy: experience with 110 tumors. Radiology 2002; 223 (03) 731-737
    CrossrefPubMedGoogle Scholar
  • 20 Rimondi E, Rossi G, Bartalena T. et al. Percutaneous CT-guided biopsy of the musculoskeletal system: results of 2027 cases. Eur J Radiol 2011; 77 (01) 34-42
    CrossrefPubMedGoogle Scholar
  • 21 Le HB, Lee ST, Munk PL. Image-guided musculoskeletal biopsies. Semin Intervent Radiol 2010; 27 (02) 191-198
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Fonseca EKUN, Castro ADAE, Kubo RS. et al. Musculoskeletal “don't touch” lesions: pictorial essay. Radiol Bras 2019; 52 (01) 48-53
    CrossrefPubMedGoogle Scholar
  • 23 Liu B, Limback J, Kendall M. et al. Safety of CT-guided bone marrow biopsy in thrombocytopenic patients: a retrospective review. J Vasc Interv Radiol 2017; 28 (12) 1727-1731
    CrossrefPubMedGoogle Scholar
  • 24 Shif Y, Kung JW, McMahon CJ. et al. Safety of omitting routine bleeding tests prior to image-guided musculoskeletal core needle biopsy. Skeletal Radiol 2018; 47 (02) 215-221
    CrossrefPubMedGoogle Scholar
  • 25 Patel IJ, Davidson JC, Nikolic B. Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement. et al; Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol 2012; 23 (06) 727-736
    CrossrefPubMedGoogle Scholar
  • 26 Sinha R, Mohamed AM, Karsandas A. The impact of ultrasound in an integrated one-stop sarcoma clinic. Clin Radiol 2020; 75 (04) 321.e21-321.e28
    CrossrefPubMedGoogle Scholar
  • 27 Bhangu AA, Beard JA, Grimer RJ. Should soft tissue sarcomas be treated at a specialist centre?. Sarcoma 2004; 8 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 28 Dyrop HB, Vedsted P, Rædkjær M, Safwat A, Keller J. Imaging investigations before referral to a sarcoma center delay the final diagnosis of musculoskeletal sarcoma. Acta Orthop 2017; 88 (02) 211-216
    CrossrefPubMedGoogle Scholar
  • 29 Clark MA, Thomas JM. Delay in referral to a specialist soft-tissue sarcoma unit. Eur J Surg Oncol 2005; 31 (04) 443-448
    CrossrefPubMedGoogle Scholar
  • 30 McCarthy EF. CT-guided needle biopsies of bone and soft tissue tumors: a pathologist's perspective. Skeletal Radiol 2007; 36 (03) 181-182
    CrossrefPubMedGoogle Scholar
  • 31 Noebauer-Huhmann IM, Weber MA, Lalam RK. et al. Soft tissue tumors in adults: ESSR-approved guidelines for diagnostic imaging. Semin Musculoskelet Radiol 2015; 19 (05) 475-482
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Lalam R, Bloem JL, Noebauer-Huhmann IM. et al. ESSR consensus document for detection, characterization, and referral pathway for tumors and tumorlike lesions of bone. Semin Musculoskelet Radiol 2017; 21 (05) 630-647
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Exner GU, Kurrer MO, Mamisch-Saupe N, Cannon SR. The tactics and technique of musculoskeletal biopsy. EFORT Open Rev 2017; 2 (02) 51-57
    CrossrefPubMedGoogle Scholar
  • 34 Noebauer-Huhmann I-M, Amann G, Krssak M. et al. Use of diagnostic dynamic contrast-enhanced (DCE)-MRI for targeting of soft tissue tumour biopsies at 3T: preliminary results. Eur Radiol 2015; 25 (07) 2041-2048
    CrossrefPubMedGoogle Scholar
  • 35 Rozenberg A, Kenneally BE, Abraham JA. et al. Clinical impact of second-opinion musculoskeletal subspecialty interpretations during a multidisciplinary orthopedic oncology conference. J Am Coll Radiol 2017; 14 (07) 931-936
    CrossrefPubMedGoogle Scholar
  • 36 Veltri A, Bargellini I, Giorgi L, Almeida PAMS, Akhan O. CIRSE guidelines on percutaneous needle biopsy (PNB). Cardiovasc Intervent Radiol 2017; 40 (10) 1501-1513
    CrossrefPubMedGoogle Scholar
  • 37 Welch BT, Welch TJ. Percutaneous image-guided biopsy of the musculoskeletal system. Tech Vasc Interv Radiol 2011; 14 (03) 110-117
    CrossrefPubMedGoogle Scholar
  • 38 Kim SY, Chung HW, Oh TS, Lee JS. Practical guidelines for ultrasound-guided core needle biopsy of soft-tissue lesions: transformation from beginner to specialist. Korean J Radiol 2017; 18 (02) 361-369
    CrossrefPubMedGoogle Scholar
  • 39 Bancroft LW, Peterson JJ, Kransdorf MJ, Berquist TH, O'Connor MI. Compartmental anatomy relevant to biopsy planning. Semin Musculoskelet Radiol 2007; 11 (01) 16-27
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Liu PT, Valadez SD, Chivers FS, Roberts CC, Beauchamp CP. Anatomically based guidelines for core needle biopsy of bone tumors: implications for limb-sparing surgery. Radiographics 2007; 27 (01) 189-205 ; discussion 206
    CrossrefPubMedGoogle Scholar
  • 41 Seeger LL. Revisiting tract seeding and compartmental anatomy for percutaneous image-guided musculoskeletal biopsies. Skeletal Radiol 2019; 48 (04) 499-501
    CrossrefPubMedGoogle Scholar
  • 42 UyBico SJ, Motamedi K, Omura MC. et al. Relevance of compartmental anatomic guidelines for biopsy of musculoskeletal tumors: retrospective review of 363 biopsies over a 6-year period. J Vasc Interv Radiol 2012; 23 (04) 511-518 , 518.e1–518.e2
    CrossrefPubMedGoogle Scholar
  • 43 Siddiqi MA, Kim HS, Jede F, Han I. Association of core needle biopsy tract resection with local recurrence in extremity soft tissue sarcoma. Skeletal Radiol 2017; 46 (04) 507-512
    CrossrefPubMedGoogle Scholar
  • 44 Saghieh S, Masrouha KZ, Musallam KM. et al. The risk of local recurrence along the core-needle biopsy tract in patients with bone sarcomas. Iowa Orthop J 2010; 30: 80-83
    PubMedGoogle Scholar
  • 45 Khalbuss WE, Teot LA, Monaco SE. Diagnostic accuracy and limitations of fine-needle aspiration cytology of bone and soft tissue lesions: a review of 1114 cases with cytological-histological correlation. Cancer Cytopathol 2010; 118 (01) 24-32
    CrossrefPubMedGoogle Scholar
  • 46 Yu GH, Maisel J, Frank R, Pukenas BA, Sebro R, Weber K. Diagnostic utility of fine-needle aspiration cytology of lesions involving bone. Diagn Cytopathol 2017; 45 (07) 608-613
    CrossrefPubMedGoogle Scholar
  • 47 Rekhi B. Core needle biopsy versus fine needle aspiration cytology in bone and soft tissue tumors. J Cytol 2019; 36 (02) 118-123
    CrossrefPubMedGoogle Scholar
  • 48 Li Y, Du Y, Luo TY. et al. Factors influencing diagnostic yield of CT-guided percutaneous core needle biopsy for bone lesions. Clin Radiol 2014; 69 (01) e43-e47
    CrossrefPubMedGoogle Scholar
  • 49 Mangham DC, Athanasou NA. Guidelines for histopathological specimen examination and diagnostic reporting of primary bone tumours. Clin Sarcoma Res 2011; 1 (01) 6
    CrossrefPubMedGoogle Scholar
  • 50 Wu JS, Goldsmith JD, Horwich PJ, Shetty SK, Hochman MG. Bone and soft-tissue lesions: what factors affect diagnostic yield of image-guided core-needle biopsy?. Radiology 2008; 248 (03) 962-970
    CrossrefPubMedGoogle Scholar
  • 51 Chira RI, Chira A, Calauz A. et al. Ultrasound-guided biopsy of osteolytic metastasis—could be less than three cores enough?. Med Ultrason 2018; 1 (01) 50-56
    CrossrefPubMedGoogle Scholar
  • 52 Kim SY, Chung HW. Small musculoskeletal soft-tissue lesions: US-guided core needle biopsy—comparative study of diagnostic yields according to lesion size. Radiology 2016; 278 (01) 156-163
    CrossrefPubMedGoogle Scholar
  • 53 Rougraff BT, Aboulafia A, Biermann JS, Healey J. Biopsy of soft tissue masses: evidence-based medicine for the musculoskeletal tumor society. Clin Orthop Relat Res 2009; 467 (11) 2783-2791
    CrossrefPubMedGoogle Scholar
  • 54 Chang CY, Huang AJ, Bredella MA. et al. Percutaneous CT-guided needle biopsies of musculoskeletal tumors: a 5-year analysis of non-diagnostic biopsies. Skeletal Radiol 2015; 44 (12) 1795-1803
    CrossrefPubMedGoogle Scholar
  • 55 Yang J, Frassica FJ, Fayad L, Clark DP, Weber KL. Analysis of nondiagnostic results after image-guided needle biopsies of musculoskeletal lesions. Clin Orthop Relat Res 2010; 468 (11) 3103-3111
    CrossrefPubMedGoogle Scholar
  • 56 Ferguson KB, McGlynn J, Jane M, Ritchie D, Mahendra A. Outcome of image-guided biopsies: retrospective review of the West of Scotland musculoskeletal oncology service. Surgeon 2016; 14 (02) 87-90
    CrossrefPubMedGoogle Scholar
  • 57 Chang IJ, Ilaslan H, Sundaram M, Schils J, Subhas N. CT-guided percutaneous biopsy of sclerotic bone lesions: diagnostic outcomes. Skeletal Radiol 2018; 47 (05) 661-669
    CrossrefPubMedGoogle Scholar
  • 58 Suh CH, Yun SJ. Diagnostic outcome of image-guided percutaneous core needle biopsy of sclerotic bone lesions: a meta-analysis. AJR Am J Roentgenol 2019; 212 (03) 625-631
    CrossrefPubMedGoogle Scholar
  • 59 Tsukushi S, Nishida Y, Yamada Y, Yoshida M, Ishiguro N. CT-guided needle biopsy for musculoskeletal lesions. Arch Orthop Trauma Surg 2010; 130 (05) 699-703
    CrossrefPubMedGoogle Scholar
  • 60 Didolkar MM, Anderson ME, Hochman MG. et al. Image guided core needle biopsy of musculoskeletal lesions: are nondiagnostic results clinically useful?. Clin Orthop Relat Res 2013; 471 (11) 3601-3609
    CrossrefPubMedGoogle Scholar