Analysis of nondiagnostic results after image-guided needle biopsies of musculoskeletal lesions

Abstract

Background/rationale: Image-guided needle biopsies are commonly used to diagnose musculoskeletal tumors, but nondiagnostic (ND) results can delay diagnosis and treatment. It is important to understand which factors or diagnoses predispose to a ND result so that appropriate patient education or a possible change in the clinical plan can be made. Currently it is unclear which factors or specific lesions are more likely to lead to a ND result after image-guided needle biopsy.

Questions/purposes: We therefore identified specific factors and diagnoses most likely to yield ND results. We also asked whether an image-guided needle biopsy of bone and soft tissue lesions is an accurate and clinically useful tool.

Methods: We retrospectively reviewed data from a prospectively collected database for a case-control study of 508 image-guided needle biopsies of patients with suspected musculoskeletal tumors between 2003 and 2008.

Results: The interpretations of 453 of the 508 (89%) needle biopsies were accurate and clinically useful. Forty-five biopsies (9%) were ND and 10 (2%) were incorrect (IC). Bone lesions had a higher ND rate than soft tissue lesions (13% vs. 4%). The specific diagnosis with the highest ND rate was histiocytosis. Elbow and forearm locations had higher ND rates than average. Malignant tumors had a higher IC rate than benign tumors (5% vs. 0%); fibromyxoid sarcoma and rare subtypes of osteosarcoma had higher IC rates than other diagnoses. Repeat needle or open biopsies were performed in 71 (14%) patients. Bone lesions were more likely than soft tissue lesions to require repeat biopsies (18% vs. 9%).

Conclusions: A high rate of accuracy and clinical usefulness is possible with image-guided needle biopsies of musculoskeletal lesions. We believe these biopsies appropriate in selected circumstances but a key factor for appropriate use is an experienced musculoskeletal tumor team with frequent communication to correlate clinical, radiographic, and histologic information for each patient.

Fig. 1A–C

(A) AP and (B) lateral radiographs are shown of the right hip of a 52-year-old woman with progressive, localized right thigh pain occurring at rest and at night . She has no history of cancer but is a long-time cigarette smoker, and a CT scan of the chest revealed a lung nodule and a thyroid mass. Although the plain radiographic appearance is suggestive of fibrous dysplasia, an alternative cause for her pain was not identified, therefore, a CT-guided needle biopsy was performed. (C) The biopsy revealed “bone and fibrous tissue with reactive changes” per the formal pathology report. There was “no malignancy in the specimen”. In this case a definitive diagnosis of fibrous dysplasia was not provided by the pathologist, but the surgeon chose to counsel the patient and continue to follow her with serial radiographs. In the biopsy database, this lesion was categorized as fibrous dysplasia.