1
|
Cooke TM, Maybody M, Aly AK, Petre EN, Santos E, Noy A, Chan AY, Lis E, Gangai N, Cornelis FH, Moussa AM. Factors Affecting Diagnostic Yield of Lesional Bone Biopsy in Hematologic Malignancy Patients. Cardiovasc Intervent Radiol 2024; 47:80-86. [PMID: 37910259 PMCID: PMC11149476 DOI: 10.1007/s00270-023-03594-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE To evaluate factors affecting the diagnostic yield (percent of biopsy samples leading to a pathologic diagnosis) of lesional bone biopsies in patients with hematologic malignancies. MATERIALS AND METHODS This retrospective study included 206 lesional bone biopsies in 182 patients with a hematologic malignancy between January 2017 and December 2022. The parameters that were reviewed to evaluate diagnostic yield included biopsy device type (manual vs. electric-powered drill), number of biopsy cores acquired, core biopsy needle gauge, preliminary intra-procedural sample adequacy (touch preparation cytology determining if samples are adequate for final pathologic examination), lesion morphology on Computed Tomography (CT), and presence of crush artifact. RESULTS Review of 206 lesional biopsies showed overall diagnostic yield to be 89.8% (185/206). The two statistically significant factors affecting diagnostic yield were biopsy device type and in-room adequacy. 41/42 samples obtained with the electric-powered drill and 144/164 samples obtained using a variety of manual needles were diagnostic (97.6% vs 87.8%, p = 0.03). Of the 192 samples that were assessed for sample adequacy intra-procedurally, 97/102 of the samples that were deemed adequate were diagnostic, and 77/90 of the samples where intra-procedural adequacy was not confirmed were diagnostic (95.1% vs 85.6%, p = 0.018). The remaining factors did not affect diagnostic yield. CONCLUSION The use of an electric-powered drill bone biopsy device and intra-procedural confirmation of sample adequacy are associated with a higher diagnostic yield of lesional bone biopsies in patients with hematologic malignancies. The presence or absence of crush artifact did not significantly affect the diagnostic yield in these patients. LEVEL OF EVIDENCE IV
Collapse
Affiliation(s)
- Timothy M Cooke
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
- College of Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Majid Maybody
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Ahmed K Aly
- Department of Radiology, University of Nebraska Medical Center, 981045 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Ernesto Santos
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Ariela Noy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Alexander Y Chan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Eric Lis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Amgad M Moussa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA.
| |
Collapse
|
2
|
Abstract
Even in pandemic times cancer remains one of the leading causes of death worldwide. Spine and peripheral skeleton constitute a common location for metastatic disease whilst numerous sarcomatous and other primary cancers may be depicted in the musculoskeletal system. Tissue sampling is necessary for histopathological identification as well as for molecular profiling in order to personalize cancer prevention, diagnosis and treatment; in addition cultures of bone and soft tissue sampling contribute to identifying pathogens in order to provide the most appropriate systemic therapy. Performing an open surgical biopsy increases morbidity and mortality while at the same time runs the risk of destabilizing a pathologic segment. Imaging guidance ensures high safety and efficacy rates and contributes to the minimally invasive character of percutaneous biopsy by providing immediate confirmation of correct needle location in the area of interest. Selecting the imaging guidance method which will visualize the target lesion and the needle trajectory as well as the largest possible needle biopsy that can maximize the diagnostic yield is of outmost importance for high safety and efficacy rates. The purpose of the present review is to provide a comprehensive, current overview of percutaneous, imaging guided biopsy in the spine and peripheral skeleton, to become familiar with the most common indications, to learn about different technical considerations during performance and to provide the current evidence. Controversies concerning products will be addressed.
Collapse
|