Percutaneous bone biopsy in the patient with known or suspected osseous metastases

One hundred fifty-three percutaneous bone biopsies were performed on 70 patients with and 83 patients without a known extraosseous primary tumor who had either scintigraphic evidence or plain radiographic evidence suggesting bony metastases. Biopsy results were shown to be true-negative, true-positive, or false-negative based on results of the needle biopsy, open biopsy, or radiographic follow-up. The overall accuracy of biopsy was 95.4%. In the group with positive scans only, the accuracy was 85.7%. Twenty-nine percent of the patients with known cancer and 33.7% of patients without cancer proved to have benign causes for their radiographic abnormality. The rate of significant complications was 0.7%. Biopsy of suspect osseous lesions can be performed safely and may significantly alter treatment. Biopsy of scan-positive, radiograph-negative lesions is a highly accurate procedure.     

Image-guided percutaneous biopsy of intramedullary lytic bone lesions: utility of aspirated blood clots

The diagnostic value of aspirating blood clots while performing percutaneous biopsy of intramedullary lytic bone lesions was assessed. This was a retrospective analysis of 400 patients with intramedullary lytic bone lesions who underwent image-guided needle biopsy. The nature of the specimens obtained was noted from the histopathology records. In 83 (20.8%) of the 400 patients, the specimen obtained was either blood clot only or essentially blood clot with only tiny fragments of bone or soft tissue. Lesional tissue was present on needle biopsy specimens in 65 (78.3%) of the 83 cases, while in 18 (21.7%) cases no lesional tissue was obtained. In 24 of the 83 cases, there was no surgical histological diagnosis available. Inthe 59 cases where surgical histological diagnosis was available for comparison, the diagnostic accuracy for needle biopsy was 73%. Percutaneous biopsy provided the diagnosis allowing appropriate further management in 62 cases, for an overall diagnostic yield of 75%. The results of our study show a sufficiently good diagnostic value in obtaining blood clots as to necessitate routine attempts at obtaining such material while performing percutaneous biopsy of intramedullary lytic bone lesions.     

Percutaneous bone biopsy, techniques and indications

In the first part of this article we discuss some special technical aspects of percutaneous bone biopsy (PBB). But our main intention is to illuminate the critical indication of PBB against the background of the diagnostic and clinical utility. Reliable indications for PBB are: lytic metastases, solitary lytic lesions in a patient with known primary tumour and infection. Sclerotic metascases and vertebral compressions, on the other hand, have a lower diagnostic utility. Negative biopsies must be interpreted carefully and repeated if considered to be nonreprcsentative. The indication for percutaneous biopsy of primary bone tumours remains doubtful. Most of them require open biopsy.     

Percutaneous biopsy following positive bone scans.

When a bone scan reveals an abnormal radionuclide accumulation and the cause is uncertain, bone biopsy is sometimes necessary. One hundred thirty biopsies have been performed in our institution with a percutaneous needle guided by fluoroscopy. This procedure is safe and effective.     

Percutaneous needle biopsy of bone in the cancer patient.

Needle biopsy of skeletal lesions is easily accomplished by the percutaneous technique. Although this approach has been utilized for many years, the frequency has definitely increased of the 91 cases performed at M. D. Anderson Hospital and Tumor Institute from September 1976 to September 1977, adequate material was obtained in 92.3% of the patients, and the diagnosis was established accurately in 83.5% of the cases. No complications were encountered. The technique, indications, and contraindications are discussed and illustrated with representative cases. The contribution of this technique to the management of patients with malignant disease is significant. The benefits include rapid and accurate establishment of a tissue diagnosis, avoidance of a surgical procedure with its associated risks and cost, and simplicity and safety of the procedure facilitating its repetition if needed.     

Percutaneous CT-guided biopsy of osseous lesion of the spine in patients with known or suspected malignancy

BACKGROUND AND PURPOSE: CT-guided spinal biopsy (CTGSB) is considered a safe and accurate procedure. Our goal was to determine the accuracy of a CTGSB of osseous spinal lesions in patients with known or suspected underlying malignancy in reference to major variables such as the radiographic appearance of the biopsied lesion and its location within the spinal column. METHODS: We retrospectively reviewed results of 410 consecutive percutaneous CTGSB procedures of osseous spinal lesions. Biopsy was determined to be adequate if diagnostic tissue was obtained (n = 401) or unsatisfactory (n = 9) if only blood without cellular elements was present on final pathologic-cytologic examination. RESULTS: The level of spinal biopsy was cervical in nine patients (2%), thoracic in 123 (31%), lumbar in 164 (42%), and sacral in 96 (25%). The overall diagnostic accuracy of CTGSB was 89%, with a false-negative rate of 11%. Biopsy of lytic lesions yielded an accurate diagnosis in 93% (220 of 236). Despite technical challenges inherent to biopsy of sclerotic lesions, diagnostic accuracy was 76% (63 of 83), although more importantly, 24% (20 of 83) of the results in sclerotic lesions were falsely negative. CONCLUSION: CTGSB of osseous spinal lesions is an important tool in the workup of patients with known or suspected underlying neoplastic disease. However, a negative result must be confirmed with either close follow-up or, preferably, open biopsy, especially in cases of sclerotic lesions for which diagnostic accuracy is decreased and the false-negative rate is high.     

Percutaneous pediatric renal biopsy: use of the biopsy gun

A recently developed biopsy gun was used in the ultrasound (US)-guided biopsy of native kidneys in seven children. The biopsy gun employs a needle (18 gauge) smaller than that usually used for renal biopsies. In all seven cases it provided a core biopsy specimen that contained enough glomeruli to make a definitive histologic diagnosis of renal parenchymal disease. Use of the biopsy gun eliminated the more complicated movements needed to obtain samples with the conventional manual biopsy techniques. No major complications occurred, and in only one case a minor complication, trace hematuria determined by means of dipstick analysis, was found. The time required to obtain the tissue samples was decreased with use of this technique. Because of the advantages of the biopsy gun, the authors now use it exclusively in percutaneous US-guided biopsy of native pediatric kidneys and recommended that this method be considered by other institutions performing similar biopsies.     

Percutaneous vertebral biopsy through intact bone: a coaxial bone transgressing technique with 18 gauge needle

Advancement of radiologic technologies allows the detection of vertebral lesions at an earlier stage, thereby increasing the proportion of vertebral lesions that are surrounded by intact bone when they are detected. While biopsy guns are effective in obtaining good-quality tissue samples of osteolytic bone lesions, lesions that are covered by intact bone are not accessible with a biopsy gun. For percutaneous biopsy of osteolytic vertebral lesions, an intact-bone transgressing technique is described in which a simple, inexpensive and small-calibre (18-gauge) instrument is used to allow multiple passage of 20-gauge biopsy guns for effective tissue sampling. In this series consisting of metastatic and myeloproliferative lesions, the effectiveness and safety of this well-tolerated technique are demonstrated in thoracic and lumbar vertebrae.     

Percutaneous bone puncture biopsy with trocar. Apropos of 60 cases

Deep bone biopsies were performed in 58 patients over the last 2 years, in a radiology department in Tours, France, under television screen control. Data obtained included pathologic, cytologic and bacteriologic features in the 60 biopsies conducted, localization being the spine in 52 cases (12 dorsal, 36 lumbar, 4 sacroiliac) and the pelvis 8 times. Etiology was a tumoral process in 15 cases (14 metastases and 1 reticulosarcoma), 7 infectious processes including 2 cases of tuberculosis, 26 cases of decalcifying degenerative osteopathies, 1 Paget's disease, 1 ankylosing spondylitis and 1 bone infarct. Biopsy was unsuccessful in 9 cases, the success rate being an overall 85%. Complications were not observed. Conducted under local anesthesia, deep bone biopsy provides a rapid diagnosis and allows a shortened hospital stay. Surgery is generally avoided and appropriate treatment instituted more rapidly.     

Percutaneous biopsy of the liver

Retrospective evaluation of 510 percutaneous CT-guided biopsies of the liver mainly fineneedle aspiration biopsies for cytology (89% of cases), yielded an overall accuracy rate of 92% and a sensitivity of 94%. The relatively high percentage of false-positive diagnoses (7% of all benign tumors) may be reduced by more consistent consideration of possible errors in cytology and a more consistent use of large bore biopsies.     

Percutaneous needle biopsy of the spine

The purpose of this review article is to provide a brief overview of the recent literature on the two main types of percutaneous biopsy methods done in the spinal column: fine needle aspiration biopsy (FNAB) and core needle biopsy (CNB). FNAB is the process of obtaining a sample of cells and bits of tissue for examination by applying suction through a fine needle attached to a syringe. Core needle biopsy involves extracting a cylindrical sample of tissue using a large, hollow needle. The decision for needle biopsy is a joint effort between the clinician, pathologist, radiologist, surgeon, and patient. Specific techniques and approaches with varying needle systems are described for each spinal region. Percutaneous image-guided spine biopsy is a safe and effective procedure. It is the procedure of choice in definitive diagnosis of pathologic lesions of the spine.     

Percutaneous needle biopsy of the pleura

Percutaneous needle biopsy of the pleura and thoracic wall is a relatively simple, minimally invasive, and safe technique that may be performed in an outpatient setting under local anesthesia. Image guidance, combined with the use of core biopsy needles and immunohistochemical techniques, have lead to increased diagnostic yield and overall accuracy. Open and thoracoscopic biopsies are reserved for a minority of patients in whom pleural fluid cytology and percutaneous needle biopsy are nondiagnostic.     

经皮骨成形术治疗跟骨血管瘤1例

经皮椎体成形术治疗脊柱侵袭性血管瘤已取得良好的疗效,然而,其在非脊柱骨血管瘤治疗方便应用较少.发生于跟骨的血管瘤非常少见,同时接受经皮骨成形术治疗的跟骨血管瘤病例更是罕见,现将我科1例随访3年的跟骨血管瘤患者报道如下.