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Tomasian A, Jennings JW. Bone marrow aspiration and biopsy: techniques and practice implications. Skeletal Radiol 2022; 51:81-88. [PMID: 34398308 DOI: 10.1007/s00256-021-03882-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 02/02/2023]
Abstract
Bone marrow aspiration and biopsy (BMAB) is a valuable diagnostic procedure commonly performed for evaluation of a wide spectrum of diseases including hematologic abnormalities, nonhematologic malignancies, metabolic abnormalities, and tumor treatment response such as chemotherapy and bone marrow transplantation, hematologic tumor staging, and suspected infection in patients with fever of unknown origin. This minimally invasive intervention offers excellent safety profile and a high diagnostic yield. Radiologists should be familiar with clinical implications of BMAB for patient care and be able to implement various technical armamentarium available to achieve a safe intervention while maximizing procedure yield.
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Affiliation(s)
- Anderanik Tomasian
- Department of Radiology, University of Southern California, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, 510 South Kingshighway Blvd, St. Louis, MO, 63110, USA
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Hasegawa T, Chatani S, Sato Y, Murata S, Yamaura H, Tsukii R, Yoshihara T, Machida M, Nagasawa K, Inaba Y. Percutaneous Image-guided Needle Biopsy of Musculoskeletal Tumors: Technical Tips. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2021; 6:75-82. [PMID: 35912278 PMCID: PMC9327433 DOI: 10.22575/interventionalradiology.2020-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/17/2020] [Indexed: 11/03/2022]
Abstract
With recent advances in imaging technology, the frequency of detecting musculoskeletal lesions has also increased. Percutaneous image-guided needle biopsy is occasionally required for the diagnosis of such lesions. Moreover, in the era of personalized cancer care, chances in histopathological diagnosis and the importance of histopathological diagnosis by percutaneous needle biopsy are increasing. However, as percutaneous needle biopsy is not a common procedure for musculoskeletal lesions, careful planning and the application of adequate techniques such as hydrodissection and the trans-osseous approach are occasionally required. In this review, we have summarized the indications and techniques for percutaneous image-guided needle biopsy for musculoskeletal lesions, including lymphatic lesions.
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Affiliation(s)
- Takaaki Hasegawa
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Japan
| | - Shohei Chatani
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Japan
| | - Yozo Sato
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Japan
| | - Shinichi Murata
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Japan
| | - Hidekazu Yamaura
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Japan
| | - Ryota Tsukii
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Japan
| | - Terutaka Yoshihara
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Japan
| | - Masanori Machida
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Japan
| | - Kyohei Nagasawa
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Japan
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Japan
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Long JR, Stensby JD, Wiesner EL, Bryson WN, Hillen TJ, Jennings JW. Efficacy and safety of bone marrow aspiration and biopsy using fluoroscopic guidance and a drill-powered needle: clinical experience from 775 cases. Eur Radiol 2020; 30:5964-5970. [PMID: 32518988 DOI: 10.1007/s00330-020-06987-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/17/2020] [Accepted: 05/27/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of performing a fluoroscopically guided bone marrow aspiration and biopsy (BMAB) using a drill-powered needle in a large patient population. METHODS This retrospective study received institutional review board approval with a waiver of patient informed consent. We identified all BMAB procedures from August 2012 through December 2016 performed at our institution using fluoroscopic guidance and a drill-powered needle. Clinical diagnosis, patient age, patient gender, biopsy site, biopsy needle gauge, bone marrow aspirate volume, bone marrow core biopsy length, patient platelet count, conscious sedation details, complications, and diagnostic adequacy were investigated for each case and summarized. RESULTS A total of 775 BMAB procedures were performed and analyzed. These were performed in 436 female patients and 339 male patients ranging in age between 16 and 91 years (average age of 53 years). Samples obtained from the procedures in our series were diagnostic in 95.0% of cases. The complication rate for our series was 0.3%. CONCLUSIONS The use of fluoroscopic guidance and a drill-powered needle for bone marrow aspiration and biopsy is a safe and efficacious procedure. KEY POINTS • Fluoroscopy can be utilized for imaging guidance during bone marrow aspiration and biopsy. • The use of fluoroscopic guidance and a drill-powered needle for bone marrow aspiration and biopsy has a high diagnostic yield. • The procedure has an excellent patient safety profile.
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Affiliation(s)
- Jeremiah R Long
- Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA.
| | - J Derek Stensby
- University of Missouri, One Hospital Drive, Columbia, MO, 65212, USA
| | - Elizabeth L Wiesner
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Boulevard, St. Louis, MO, 63110, USA
| | - Wesley N Bryson
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Boulevard, St. Louis, MO, 63110, USA
| | - Travis J Hillen
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Boulevard, St. Louis, MO, 63110, USA
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Boulevard, St. Louis, MO, 63110, USA
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Guenette JP, Cho CH, Huang RY, Miskin N, Ghazikhanian V, Lee TC. CT-Guided Percutaneous Spine Biopsy Specimen Adequacy, Pathology Concordance, and Negative Predictive Value with Battery-Powered Drill and Manual Approaches. Curr Probl Diagn Radiol 2019; 48:558-562. [DOI: 10.1067/j.cpradiol.2018.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/30/2018] [Accepted: 08/30/2018] [Indexed: 11/22/2022]
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Wallace AN, McWilliams SR, Wallace A, Chang RO, Vaswani D, Stone RE, Berlin AN, Liu KX, Gilcrease-Garcia B, Madaelil TP, Shoela RA, Hillen TJ, Long J, Jennings JW. Drill-Assisted Biopsy of the Axial and Appendicular Skeleton: Safety, Technical Success, and Diagnostic Efficacy. J Vasc Interv Radiol 2017; 27:1618-22. [PMID: 27670996 DOI: 10.1016/j.jvir.2016.05.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to evaluate the safety, technical success rate, and diagnostic efficacy of drill-assisted axial and appendicular bone biopsies. During a 3-y period, 703 drill-assisted biopsies were performed. The cohort included 54.2% men, with a mean age of 57.6 y ± 17.1. Median lesion volume was 10.9 mL (interquartile range, 3.4-30.2 mL). Lesions were lytic (31.7%), sclerotic (21.2%), mixed lytic and sclerotic (27.7%), or normal radiographic bone quality (19.3%). No complications were reported. The technical biopsy success rate was 99.9%. Crush artifact was present in 5.8% of specimens submitted for surgical pathologic examination, and 2.1% of specimens were inadequate for histologic evaluation.
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Affiliation(s)
- Adam N Wallace
- Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd., St. Louis, MO 63110.
| | | | - Andrew Wallace
- Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd., St. Louis, MO 63110
| | - Randy O Chang
- Washington University School of Medicine, 510 S. Kingshighway Blvd., St. Louis, MO 63110
| | - Devin Vaswani
- Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd., St. Louis, MO 63110
| | - Robert E Stone
- Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd., St. Louis, MO 63110
| | - Ari N Berlin
- Washington University School of Medicine, 510 S. Kingshighway Blvd., St. Louis, MO 63110
| | - Kevin X Liu
- Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd., St. Louis, MO 63110
| | | | - Thomas P Madaelil
- Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd., St. Louis, MO 63110
| | - Ramy A Shoela
- Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd., St. Louis, MO 63110
| | - Travis J Hillen
- Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd., St. Louis, MO 63110
| | - Jeremiah Long
- Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd., St. Louis, MO 63110
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd., St. Louis, MO 63110
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Comparison of Battery-Powered and Manual Bone Biopsy Systems for Core Needle Biopsy of Sclerotic Bone Lesions. AJR Am J Roentgenol 2016; 206:W83-6. [PMID: 26959290 DOI: 10.2214/ajr.15.15067] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare manual and battery-powered bone biopsy systems for diagnostic yield and procedural factors during core needle biopsy of sclerotic bone lesions. MATERIALS AND METHODS A total of 155 consecutive CT-guided core needle biopsies of sclerotic bone lesions were performed at one institution from January 2006 to November 2014. Before March 2012, lesions were biopsied with manual bone drill systems. After March 2012, most biopsies were performed with a battery-powered system and either noncoaxial or coaxial biopsy needles. Diagnostic yield, crush artifact, CT procedure time, procedure radiation dose, conscious sedation dose, and complications were compared between the manual and battery-powered core needle biopsy systems by Fisher exact test and t test. One-way ANOVA was used for subgroup analysis of the two battery-powered systems for procedure time and radiation dose. RESULTS The diagnostic yield for all sclerotic lesions was 60.0% (93/155) and was significantly higher with the battery-powered system (73.0% [27/37]) than with the manual systems (55.9% [66/118]) (p = 0.047). There was no significant difference between the two systems in terms of crush artifact, procedure time, radiation dose, conscious sedation administered, or complications. In subgroup analysis, the coaxial battery-powered biopsies had shorter procedure times (p = 0.01) and lower radiation doses (p = 0.002) than the coaxial manual systems, but the noncoaxial battery-powered biopsies had longer average procedure times and higher radiation doses than the coaxial manual systems. CONCLUSION In biopsy of sclerotic bone lesions, use of a battery-powered bone drill system improves diagnostic yield over use of a manual system.
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Wallace AN, Pacheco RA, Vyhmeister R, Tomasian A, Chang RO, Jennings JW. Fluoroscopy-guided intervertebral disc biopsy with a coaxial drill system. Skeletal Radiol 2016; 45:273-8. [PMID: 26572628 DOI: 10.1007/s00256-015-2273-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/12/2015] [Accepted: 10/14/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Percutaneous biopsy of discitis-osteomyelitis is performed to isolate the causative microorganism and exclude alternative diagnoses. We compared drill-assisted and manual fluoroscopy-guided intervertebral disc biopsies with respect to conscious sedation requirements and histologic quality of obtained specimens. MATERIALS AND METHODS Medical records of all single-level, fluoroscopy-guided intervertebral disc biopsies supervised by one of two musculoskeletal radiologists between January 2010 and March 2015 were reviewed. Duration and cumulative medication doses required for each biopsy were recorded. Pathology reports were reviewed to determine whether the obtained specimens were adequate for histopathologic evaluation. Microbiology reports were reviewed to determine whether the causative organism was isolated from the biopsy specimen. RESULTS During the study period, 21 drill-assisted and 20 manual biopsies were performed. The median duration of conscious sedation for drill-assisted biopsies was 30 min (range, 17-40 min) compared with 39 min (range, 20-90 min) for manual biopsies (p < 0.01). Drill-assisted biopsies also required lower median cumulative doses of intravenous midazolam [2 mg (range, 0-5 mg) vs. 3 mg (range, 0-9 mg); p = 0.02]. All drill-assisted biopsy specimens were adequate for histopathologic evaluation. One manual biopsy specimen (5 %; 1/20) was inadequate for histopathologic evaluation owing to crush artifact. The microbiology yields of drill-assisted and manual biopsies were comparable [14 % (3/21) vs. 20 % (4/20); p = 0.62]. CONCLUSIONS Fluoroscopically-guided intervertebral disc biopsies performed with drill assistance require less conscious sedation compared with manual biopsies and yield specimens that are adequate for histopathologic evaluation.
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Affiliation(s)
- Adam N Wallace
- Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, Saint Louis, MO, 63110, USA.
| | - Rafael A Pacheco
- Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, Saint Louis, MO, 63110, USA
| | - Ross Vyhmeister
- Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA
| | - Anderanik Tomasian
- Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, Saint Louis, MO, 63110, USA
| | - Randy O Chang
- Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, Saint Louis, MO, 63110, USA
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Battery-powered bone drill: caution needed in densely blastic lesions. Skeletal Radiol 2015; 44:1845-8. [PMID: 26315889 DOI: 10.1007/s00256-015-2241-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/13/2015] [Accepted: 08/17/2015] [Indexed: 02/02/2023]
Abstract
Image-guided biopsies play an important role for pathologic diagnosis of bone tumors. Recently, motorized, battery powered bone marrow biopsy devices have been used to biopsy focal bone lesions with high accuracy. We present here two cases of densely blastic metastases where the biopsy sample could not be removed from the needle. These two cases suggest that if the lesion is densely blastic, then the sample should be small (<5 mm) to ensure that the biopsy specimen will not be stuck within the biopsy needle.
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Fluoroscopy-Guided Percutaneous Vertebral Body Biopsy Using a Novel Drill-Powered Device: Technical Case Series. Cardiovasc Intervent Radiol 2015; 39:290-5. [DOI: 10.1007/s00270-015-1216-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 09/17/2015] [Indexed: 10/22/2022]
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CT-guided radiofrequency ablation of osteoid osteoma using a novel battery-powered drill. Skeletal Radiol 2015; 44:695-701. [PMID: 25371086 DOI: 10.1007/s00256-014-2029-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 09/22/2014] [Accepted: 10/01/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the use of a novel battery-powered drill, enabling specimen requirement while drilling, in radiofrequency ablation of osteoid osteoma as an alternative to conventional orthopedic drills. MATERIALS AND METHODS Between 2009 and 2013, altogether 33 patients underwent CT-guided radiofrequency ablation of an osteoid osteoma at our institution. To access the nidus of the clinically and radiologically suspected osteoid osteoma, a channel was drilled using the OnControl Bone Marrow Biopsy System (OBM, Arrow OnControl, Teleflex, Shavano Park, TX, USA) and a biopsy was taken. Procedure time (i.e., drilling including local anesthesia), amount of scans (i.e., single-shot fluoroscopy), radiation exposure, and the results of biopsy were investigated and compared retrospectively to a classical approach using either a manual bone biopsy system or a conventional orthopedic drill (n = 10) after ethical review board approval. RESULTS Drilling the tract into the nidus was performed without problems in 22 of the 23 OBM cases. Median procedure time was 7 min compared to 13 min using the classical approach (p < 0.001). Median amount CT scans, performed to control correct positioning of the drill was comparable with 26 compared to 24.5 (p = NS) scans. Histologically, the diagnosis of osteoid osteomas could be determined in all 17 cases where a biopsy was taken. Radiofrequency ablation could be performed without problems in any case. CONCLUSIONS The use of the battery-powered drill was feasible and facilitated the access to the osteoid osteoma's nidus offering the possibility to extract a specimen in the same step.
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Lynch DW, Stauffer SL, Rosenthal NS. Adequacy of powered vs manual bone marrow biopsy specimens: a retrospective review of sequential marrow aspirates and biopsies in 68 patients. Am J Clin Pathol 2015; 143:535-9. [PMID: 25780005 DOI: 10.1309/ajcp67witvpvvtnf] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES To evaluate the quality and quantity of the bone marrow aspirates and biopsy specimens obtained with a powered system in comparison with the standard manual method. METHODS The Pathology Laboratory Information System was reviewed for patients who had previously undergone bone marrow biopsies performed by both the OnControl Bone Marrow System and the manual method. A total of 136 cases (68 patients) were reviewed for adequacy and compared using an unpaired t test. RESULTS The core biopsy specimens obtained by the OnControl system were significantly longer compared with those obtained by the manual system (16.9 vs 14.4 mm, P = .0036). However, the core biopsy specimens obtained by the manual method had on average more evaluable marrow elements (66% vs 40%, P < .0001), and the manual method was superior in 46 of the 68 cases when the length of evaluable marrow was calculated (9.7 vs 7 mm, P = .0049). CONCLUSIONS Our findings show that longer core biopsy specimens are obtained by the OnControl Bone Marrow system but that the manual method is still superior when the percentage and length of evaluable bone marrow are analyzed.
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Affiliation(s)
- Douglas W. Lynch
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City
| | | | - Nancy S. Rosenthal
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City
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