CT arthrography prior to CT guided bone lesion biopsy, a case report
Background: Suspicious bone lesions are very common and often need a pathohistological verification. Surgical (open) and percutaneous image guided biopsies can be used to get a sample for pathology analysis. As the barriers of lesion compartment shouldn’t be crossed due to risk of dissemination, transarticular approach is not advised.
Case study: We present a case of 57-year-old female patient with lung cancer history and left knee pain. Lytic lesion in lateral femoral epycondile with fluorodeoxyglucose (FDG) uptake was confirmed by positron emission tomography with computed tomography (PET/CT). Surgical biopsy was performed and pathohistological analysis showed no tumor cells. A month later a computed tomography (CT)-guided percutaneous bone biopsy with CT arthrography was performed and pathohistological analysis confirmed metastatic lesion.
Conclusion: CT-guided percutaneous bone biopsy is a safe, effective and minimally invasive procedure. CT arthrography can add some additional information for anatomical positioning in order to avoid transarticular approach in reaching the targeted lesion.
Irani F, Gangi A. Bone biopsy. In: Gervais AD, Sabharwal T et al. Interventional Radiology Procedures in Biopsy and Drainage. Springer-Verlag London; 2011. pp 49-51.
Altuntas AO, Slavin J, Smith PJ et al. Accuracy of computed tomography guided core needle biopsy of musculoskeletal tumours. ANZ J Surg 2005;75:187–91.
Jelinek JS, Murphey MD, Welker JA et al. Diagnosis of primary bone tumors with image-guided percutaneous biopsy: experience with 110 tumors. Radiology 2002;223:731–7.
Leffler SG, Chew FS. CT-guided percutaneous biopsy of sclerotic bone lesions: diagnostic yield and accuracy. AJR 1999;172:1389–92.
Ashford RU, McCarthy SW, Scolyer RA et al. Surgical biopsy with intraoperative frozen section. An accurate and cost-effective method for diagnosis of musculoskeletal sarcomas. J Bone Joint Surg Br 2006;88:1207–11.
Fraser-Hill MA, Renfrew DL, Hilsenrath PE. Percutaneous needle biopsy of musculoskeletal lesions 2. Cost-effectiveness. AJR 1992;158:813–8.
Kiatisevi P, Nielsen T, Hayes M et al. Core needle biopsy is highly accurate in diagnosing bone and soft-tissue tumours. Orthopaedic Proceedings 2011;93-B SUPP_III:265(107).
Welker JA, Henshaw RM, Jelinek J et al. The percutaneous needle biopsy is safe and recommended in the diagnosis of musculoskeletal masses. Cancer 2000;89:2677–86.
Hau A, Kim I, Kattapuram S et al. Accuracy of CT-guided biopsies in 359 patients with musculoskeletal lesions. Skeletal Radiol 2002;31:349–53.
Datir A, Pechon P, Saifuddin A. Imaging-guided percutaneous biopsy of pathologic fractures: a retrospective analysis of 129 cases. AJR 2009;193:504–8.
Harish S, Hughes RJ, Saifuddin A et al. Image-guided percutaneous biopsy of intramedullary lytic bone lesions: utility of aspirated blood clots. Eur Radiol 2006;16:2120–5.
Ng CS, Salisbury JR, Darby AJ et al. Radiologically guided bone biopsy: results of 502 biopsies. Cardiovasc Intervent Radiol 1998;21:122–8.
Puri A, Shingade VU, Agarwal MG et al. CT-guided percutaneous core needle biopsy in deep seated musculoskeletal lesions: a prospective study of 128 cases. Skeletal Radiol 2006;35:138–43.
Wu JS, Goldsmith JD, Horwich PJ et al. Bone and soft-tissue lesions: what factors affect diagnostic yield of image-guided coreneedle biopsy? Radiology 2008;248:962–70.
Dupuy D, Rosenberg A, Punyaratabandhu T et al. Accuracy of CTguided needle biopsy of musculoskeletal neoplasms American Journal of Roentgenology 1998;171:759-62.
Marker DR, Carrino JA. Musculoskeletal biopsies: Extremities. In: Kamran A, Sanjay G., editors. Percutaneous Image-Guided Biopsy. New York, Heidelberg, Dordrecht, London: Springer; 2014. pp. 349-61.
Newberg AH, Munn CS, Robbins AH. Complications of arthrography. Radiology 1985;155: 605-6.
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