Search

OBJECTIVE. The purpose of this article is to review the current guidelines and recommendations for percutaneous image-guided treatment of musculoskeletal tumors. CONCLUSION. With the ongoing technologic advances, it is essential that the musculoskeletal interventionalist is familiar with the current tools and techniques available for the treatment of soft-tissue and bone tumors. Fortunately, many of these tools are readily available in a standard interventional radiology department and can be easily applied to the musculoskeletal system.

ObjectiveThe purpose of this article is to investigate potential technical, imaging, and histopathologic contributors to the success of CT biopsy.Materials and methodsFour hundred forty-four consecutive CT biopsies of musculoskeletal lesions performed from 2005 to 2008 were retrospectively classified as diagnostic or nondiagnostic and as accurate or inaccurate. A biopsy was considered as diagnostic if it provided a definitive pathologic diagnosis or was clinically useful; as accurate if it was concordant with the ultimate diagnosis with respect to identification of malignancy, grade, and histopathologic features; and as successful if it was both diagnostic and accurate. Biopsy success rate, diagnostic yield, and accuracy were assessed according to lesion location, use of sedation, biopsy equipment type, bone lesion matrix type, and lesion histologic type (i.e., bone or soft-tissue origin, malignant or benign neoplasm, and low-or intermediate-to-high-grade neoplasm).ResultsOf 444 biopsies, 71% were diagnostic, 86% were accurate, and 70% were successful. Biopsy success and diagnostic yield were greater in bone lesions, malignant neoplasms, and intermediate-to-high-grade neoplasms compared with soft-tissue lesions (p < 0.01), benign neoplasms (p < 0.0001), and low-grade neoplasms (p < 0.0001). Success and diagnostic yield were not significantly associated with technical or imaging factors. Biopsy accuracy was not associated with any of the tested variables. Of the 128 nondiagnostic biopsy results, 53% were accurate with respect to subsequent surgical pathologic findings. Most of these biopsy results were of benign soft-tissue lesions.ConclusionCT biopsy of musculoskeletal lesions is accurate and effective. It may be limited in the evaluation of benign and low-grade soft-tissue neoplasms.

Objective The educational objectives for this self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of musculoskeletal tumor imaging, biopsy, and therapies. Conclusion The solutions in this activity review the imaging characteristics of musculoskeletal tumors, biopsy approaches, and therapies.

The purpose of this study was to design and use an algorithm for selection of the most appropriate biopsy technique.An algorithm was designed to maximize the tissue sampling and diagnostic accuracy of musculoskeletal tumor biopsy. We used fine-needle aspiration to sample small (3 cm) soft-tissue masses, an 18-gauge automated Biopty Gun to sample large (3 cm) soft-tissue masses, a bone-cutting core biopsy needle to sample sclerotic bone tumors, and a combination technique to sample lytic bone tumors with an intact bony shell. We reviewed the results of 46 consecutive biopsies obtained with this algorithm.The overall diagnostic accuracy was 96%, with one inadequate biopsy and one inaccurate biopsy. The diagnostic accuracies within subgroups of tumor types were: primary malignant tumors (n = 15), 93%; primary benign tumors (n = 9), 100%; secondary malignant tumors (n = 11), 100%; secondary benign tumors (n = 8), 88%; and infections (n = 3), 100%.This algorithm allows selection of the biopsy procedure most likely to safely provide adequate and accurate biopsy samples.