1
|
Okamoto D, Ushijima Y, Fujita N, Ishimatsu K, Murayama R, Itoyama M, Ishigami K. Safety and clinical contribution of computed tomography-guided biopsy for cervical spine lesion. MINIM INVASIV THER 2024; 33:171-175. [PMID: 38315057 DOI: 10.1080/13645706.2024.2311720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION The purpose is to clarify the safety and clinical contribution of computed tomography (CT)-guided percutaneous needle-biopsy for patients with cervical spine lesion. MATERIAL AND METHODS Between June 2015 and August 2022, CT-guided percutaneous needle biopsies were performed for 15 cervical spine lesions of 15 patients (8 male, 7 female; 2-81 years old). The technical success, clinical contribution, and safety were evaluated. Technical success was defined as the completion of the biopsy procedure. Clinical contribution was defined as any contribution to the therapeutic strategy. Safety was assessed by the Common Terminology Criteria for Adverse Events, version 5.0. RESULTS The technical success rate was 100%. In all 15 patients, nontarget organs (e.g., major vessels, spinal cord) could be avoided. The post-biopsy histological diagnoses were myeloma (n = 2), metastatic adenocarcinoma (n = 2), chordoma (n = 2), Langerhans cell histiocytosis (n = 3), and one case each of malignant lymphoma, schwannoma, pyogenic spondylitis, non-pyogenic spondylitis, degenerative change, and non-pathological fracture. All of these diagnoses contributed to the therapeutic strategy decisions. One case of grade 2 pain was observed, but no complications with grade 3 or more were observed during or after the biopsies. CONCLUSION CT-guided percutaneous needle biopsies for cervical spine lesions were safe and clinically beneficial.
Collapse
Affiliation(s)
- Daisuke Okamoto
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Ushijima
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuhiro Fujita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keisuke Ishimatsu
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryo Murayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Itoyama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
2
|
Husseini JS, Huang AJ. Discitis-osteomyelitis: optimizing results of percutaneous sampling. Skeletal Radiol 2023; 52:1815-1823. [PMID: 35976405 DOI: 10.1007/s00256-022-04151-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 02/02/2023]
Abstract
Vertebral discitis-osteomyelitis is an infection of the spine that involves the intervertebral disc and the adjacent vertebral body but may also extend into the paraspinal and epidural soft tissues. If blood cultures and other culture data fail to identify a causative microorganism, percutaneous sampling is indicated to help guide targeted antimicrobial therapy. Despite limited supporting evidence, withholding antimicrobial therapy for up to 2 weeks is recommended to maximize microbiological yield, although literature supporting this recommendation is limited. During the procedure, technical factors that may improve yield include targeting of paraspinal fluid collections or soft tissue abnormalities for sampling, acquiring multiple core samples if possible, and use of larger gauge needles when available. Repeat sampling may be indicated if initial percutaneous biopsy is negative but should be performed no sooner than 72 h after the initial percutaneous biopsy to ensure adequate time for culture results to return.
Collapse
Affiliation(s)
- Jad S Husseini
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
| | - Ambrose J Huang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
| |
Collapse
|
3
|
Laborda-Vidal P, Martín M, Orts-Porcar M, Vilalta L, Melendez-Lazo A, de Carellán AG, Ros C. Computed Tomography-Guided Fine Needle Biopsies of Vertebral and Paravertebral Lesions in Small Animals. Animals (Basel) 2022; 12:ani12131688. [PMID: 35804586 PMCID: PMC9265075 DOI: 10.3390/ani12131688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Fine needle biopsy (FNB) is an effective, minimally invasive and inexpensive diagnostic technique. Under computed tomography (CT)-guidance, lesions that have a difficult approach can be sampled to reach a diagnosis. The aim of this study is to describe the use of CT-guidance to obtain FNB from vertebral and paravertebral lesions in small animals. Ten dogs and one ferret that had undergone CT-guided FNB of vertebral and paravertebral lesions and had a cytological or a histological diagnosis were included in this retrospective study. The FNB samples were taken in four cases from the vertebra, in two cases from the intervertebral disc and in five cases from the intervertebral foramen. Two infectious and nine neoplastic lesions were diagnosed. The percentage of successful FNB was 91%. The percentage of samples with a cytological diagnosis was 80%. The percentage of complications was 9%. Limitations were the small number of animals in the study, the lacking complementary percutaneous biopsies for comparison, the lacking final histological diagnoses in some cases and the intervention of multiple operators. Computed tomography-guided FNB is a useful and safe technique for the diagnosis of vertebral and paravertebral lesions in small animals. However, a degree of expertise is important.
Collapse
Affiliation(s)
- Patricia Laborda-Vidal
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, Calle Tirant lo Blanch 7, 46115 Alfara del Patriarca, Valencia, Spain
- Correspondence:
| | - Myriam Martín
- Department of Veterinary Clinical Sciences, Louisiana State University School of Veterinary Medicine, Skip Bertman Drive, Baton Rouge, LA 70803, USA;
| | | | - Laura Vilalta
- Servicio de Animales Exóticos, Hospital Veterinari Canis, 17006 Girona, Spain;
- Hospital Veterinario UCV, Universidad Católica de Valencia, Avenida Pérez Galdós 51, 46980 Valencia, Spain; (A.M.-L.); (A.G.d.C.); (C.R.)
| | - Antonio Melendez-Lazo
- Hospital Veterinario UCV, Universidad Católica de Valencia, Avenida Pérez Galdós 51, 46980 Valencia, Spain; (A.M.-L.); (A.G.d.C.); (C.R.)
- T-Cito, Avenida Pérez Galdós 51, 46980 Valencia, Spain
| | - Alejandra García de Carellán
- Hospital Veterinario UCV, Universidad Católica de Valencia, Avenida Pérez Galdós 51, 46980 Valencia, Spain; (A.M.-L.); (A.G.d.C.); (C.R.)
- Servicio de Anestesia y Unidad del Dolor, Memvet Centro de Referencia Veterinaria, 07003 Palma de Mallorca, Spain
| | - Carlos Ros
- Hospital Veterinario UCV, Universidad Católica de Valencia, Avenida Pérez Galdós 51, 46980 Valencia, Spain; (A.M.-L.); (A.G.d.C.); (C.R.)
- Servicio de Neurología, Memvet Centro de Referencia Veterinaria, 07003 Palma de Mallorca, Spain
| |
Collapse
|
4
|
Shao X, Li J, Yang Q, Li K, Yao Y, Sun F, Li Z. Transnasal Endoscopic and Transoral Approaches in the Biopsies of Ventral Atlas and Axis Vertebrae: A Comprehensive Retrospective Study for Preprocedural Scheme, Biopsy Procedure, Core Technique Analysis, Diagnostic Yield and Clinical Outcome. Orthop Surg 2022; 14:1593-1606. [PMID: 35706342 PMCID: PMC9363750 DOI: 10.1111/os.13366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 05/22/2022] [Accepted: 05/22/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study aims to describe and analyze the transoral and transnasal approaches for pathologies of the ventral atlas and axis vertebrae, which are considered technically challenging regions for diagnostic biopsy. METHODS A series of transnasal endoscopic approach (TNA) and transoral approach (TOA) biopsies for the pathologies of the first and second cervical vertebrae were conducted and retrospectively analyzed from July 2014 to May 2021. The depth of the biopsy trajectory was measured on computed tomography images for all nine patients (eight males and one female with an average age of 58.11 ± 11.60 years), as were the coronal, sagittal, and vertical biopsy safe ranges. The characteristics of each lesion, including radiographic features, blood supply, and destruction of anterior or posterior vertebral body edges, were evaluated to guide the biopsy. Four biopsy core techniques (BCTs), including "lesion perforating", "aspiration", "cutting-and-scraping" and "biopsy forceps utilization" were elaborated in this study. The biopsy procedures and periprocedural precautions were demonstrated. Patient demographics, clinical data, lesion characteristics, diagnostic yield, and complications were recorded for each case. RESULTS Eight TOA biopsies for the axis vertebral body and one TNA biopsy for the atlas anterior arch were successfully performed and yielded adequate pathologies. All biopsies were organized based on the preprocedural radiographic measurements, which showed that the average length of biopsy trajectory and coronal, sagittal, and vertical safe biopsy ranges were 85.00 ± 5.88, 20.63 ± 4.75, 16.25 ± 1.49, and 24.63 ± 2.26 mm, respectively, and these corresponding data were 95, 36, 9, and 26 mm in the TNA patient. Six osteolytic lesions (66.7%), one osteoblastic lesion (11.1%), and two mixed lesions (22.2%) were observed, among which seven lesions had a rich blood supply. Biopsy forceps and core needles were utilized to obtain samples in six and three patients, respectively. All the TNA and TOA biopsies were performed with cooperative application of multiple BCTs under compound anatomic and stereotactic navigations. Intraprocedural or postprocedural complications occurred in no patients who underwent the biopsy in the follow-up period (1-39 months). No significant differences were found between the preprocedural and postprocedural blood indexes and visual analogue scale scores. CONCLUSION With a sophisticated preprocedural arrangement, cooperative application of BCTs, and careful periprocedural precautions, transnasal endoscopic and transoral biopsies are two feasible, efficient, and well-tolerated procedures that achieve satisfactory diagnostic yield, complication rate, and clinical outcome.
Collapse
Affiliation(s)
- Xianhao Shao
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jianmin Li
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qiang Yang
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ka Li
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuan Yao
- Department of Radiography, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Feifei Sun
- Department of Pathology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhenfeng Li
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| |
Collapse
|
5
|
Best Practices: CT-Guided Percutaneous Sampling of Vertebral Discitis-Osteomyelitis and Technical Factors Maximizing Biopsy Yield. AJR Am J Roentgenol 2021; 217:1057-1068. [PMID: 33336581 DOI: 10.2214/ajr.20.24313] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Vertebral discitis-osteomyelitis is an infection of the intervertebral disk and vertebral bodies that may extend to adjacent paraspinal and epidural soft tissues. Its incidence is increasing, likely because of improved treatments and increased life expectancy for patients with predisposing chronic disease and increased rates of IV drug use and intravascular intervention. Because blood cultures are frequently negative in patients with vertebral discitis-osteomyelitis, biopsy is often indicated to identify a causative microorganism for targeted antimicrobial therapy. The reported yield of CT-guided percutaneous sampling is 31-91%, which is lower than the reported yield of open biopsy of 76-91%. However, the less invasive approach may be favored given its relative safety and low cost. If paravertebral fluid collections are present, CT-guided aspiration should be performed. If aspiration is unsuccessful or no paravertebral fluid collections are present, CT-guided percutaneous biopsy should be performed, considering technical factors (e.g., anatomic approach, needle selection, and needle angulation) that may improve microbiologic yield. Although antimicrobial therapy should be withheld for 1-2 weeks before biopsy if clinically feasible, biopsy may still be performed without stopping antimicrobial therapy if needed. Because of the importance of targeted antimicrobial therapy, repeat biopsy should be considered after 72 hours if initial biopsy does not identify a pathogen.
Collapse
|
6
|
Review article: the current status of CT-guided needle biopsy of the spine. Skeletal Radiol 2021; 50:281-299. [PMID: 32815040 DOI: 10.1007/s00256-020-03584-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 02/02/2023]
Abstract
CT-guided percutaneous needle biopsy of the spine is a well-described technique for determining the nature of indeterminate vertebral lesions or establishing a diagnosis of spinal infection, the high diagnostic accuracy and the safety of the procedure having been extensively documented. The purpose of the current article is to review the literature to date on CT-guided spinal biopsy. Specifically, indications for spinal biopsy, techniques for optimising yield, detail of the approaches for various spinal levels which is dependent upon both the region within the spinal column and lesion location within the vertebra (body vs. neural arch), determinants of biopsy outcome and complications are covered. It is hoped that the review will be of particular benefit to junior radiologists who are required to perform this procedure.
Collapse
|
7
|
Yao G, Zhou Y, Gu Y, Wang Z, Yang M, Sun J, Luo Q, Zhao H. Value of combining PET/CT and clinicopathological features in predicting EGFR mutation in Lung Adenocarcinoma with Bone Metastasis. J Cancer 2020; 11:5511-5517. [PMID: 32742498 PMCID: PMC7391209 DOI: 10.7150/jca.46414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/29/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose: Epidermal growth factor receptor (EGFR) mutation is the most common target for precision treatment in metastatic lung adenocarcinoma. We investigated the predictive role of 18F-FDG PET/CT and clinicopathological features for EGFR mutations in lung adenocarcinoma with bone metastasis. Methods: Seventy-five lung adenocarcinoma patients with histologically confirmed bone metastasis were included. They all received EGFR status test and PET/CT before systemic treatment. The differences of maximum standardized uptake value (SUVmax) in primary tumor (pSUVmax), regional lymph node (nSUVmax) and bone metastasis (bmSUVmax) between different EGFR status groups were compared, alongside with common clinicopathological features. Multivariate logistic regression analysis was performed to evaluate predictors of EGFR mutations. Results: EGFR mutations were found in 37 patients (49.3%). EGFR mutations were more common in females, non-smokers, expression of Thyroid Transcription Factor-1 (TTF-1) and NaspinA. Low bmSUVmax was significantly associated with EGFR mutations, while no significant difference was observed in pSUVmax and nSUVmax. Multivariate analysis showed that bmSUVmax ≤7, non-smoking, expression of TTF-1 were predictors of EGFR mutations. The area under the curve (AUC) of receiver operating characteristic (ROC) curve was 0.84 for the combination of the three factors. Conclusion: Low bmSUVmax is more frequently in EGFR mutations, and bmSUVmax is an independent predictor of EGFR mutations. Combining bmSUVmax with other clinicopathological features could forecast the EGFR status in lung adenocarcinoma with unavailable EGFR gene testing.
Collapse
Affiliation(s)
- Guangyu Yao
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200030, China
| | - Yiyi Zhou
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200030, China
| | - Yifeng Gu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200030, China
| | - Zhiyu Wang
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200030, China
| | - Mengdi Yang
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200030, China
| | - Jing Sun
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200030, China
| | - Quanyong Luo
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200030, China
| | - Hui Zhao
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200030, China
| |
Collapse
|
8
|
Toffart AC, Asfari S, Mc Leer A, Reymond E, Jankowski A, Moro-Sibilot D, Stephanov O, Ghelfi J, Lantuejoul S, Ferretti GR. Percutaneous CT-guided biopsy of lytic bone lesions in patients clinically suspected of lung cancer: Diagnostic performances for pathological diagnosis and molecular testing. Lung Cancer 2020; 140:93-98. [PMID: 31901769 DOI: 10.1016/j.lungcan.2019.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Bone is a common location for lung cancer metastasis. Clinicians are often reluctant to biopsy bone metastases, as they are known to require a decalcification process that damages nucleic acids, which makes it incompatible with molecular testing. We performed this study to assess the diagnostic performance of histopathology and molecular testing of computed tomography (CT)-guided percutaneous bone biopsies of lytic bone lesions during the initial assessment or during the progression of lung cancer. MATERIALS AND METHODS This retrospective study included all patients suspected of having or known to have primary lung cancer and CT-guided percutaneous bone biopsies of lytic bone from January 2010 to June 2017. The main judgment criterion was the diagnostic performance of the pathological analysis. Secondary endpoints were the diagnostic performance of molecular testing and incidence of complications. RESULTS Fifty patients were included. The yield of CT-guided percutaneous bone biopsies for pathological analysis was 100 %, allowing for a diagnosis of certainty in all cases. The percentage of tumor cells in samples was higher than the 20 % threshold in 83.9 % of cases. The yield of molecular analysis was 94.6 %. A mutation was found in 60 % of cases; most frequently in KRAS (Kirsten rat sarcoma viral oncogene homolog) (28.6 %) and EGFR (epidermal growth factor receptor) (14.3 %). The complication rate was 2 %, i.e. a minor undrained pneumothorax. CONCLUSION CT-guided percutaneous biopsies of lytic bone is associated with a very low complication rate and high diagnostic performance for histopathology and mutation testing.
Collapse
Affiliation(s)
- Anne-Claire Toffart
- Unité d'oncologie thoracique, Service de pneumologie, CS 10217, 38043 Grenoble, France; INSERM U 1209 IAB, la Tronche, 38700, France
| | - Stéphane Asfari
- Service de radiologie diagnostique et interventionnelle, CS 10217, 38043 Grenoble, France
| | - Anne Mc Leer
- INSERM U 1209 IAB, la Tronche, 38700, France; pathologie moléculaire, Institut de Biologie et de Pathologie, CS 10217, 38043 Grenoble, France
| | - Emilie Reymond
- Service de radiologie diagnostique et interventionnelle, CS 10217, 38043 Grenoble, France
| | - Adrien Jankowski
- Service de radiologie diagnostique et interventionnelle, CS 10217, 38043 Grenoble, France
| | - Denis Moro-Sibilot
- Unité d'oncologie thoracique, Service de pneumologie, CS 10217, 38043 Grenoble, France; INSERM U 1209 IAB, la Tronche, 38700, France
| | - Olivier Stephanov
- anatomopathologie, Institut de Biologie et de Pathologie, CS 10217, 38043 Grenoble, France
| | - Julien Ghelfi
- Service de radiologie diagnostique et interventionnelle, CS 10217, 38043 Grenoble, France
| | - Sylvie Lantuejoul
- Plateforme Anapath Recherche Synergie Lyon Cancer-Est, Département de Recherche Translationnelle et d'Innovations Centre de Lutte Contre le Cancer UNICANCER Léon Bérard, 28 rue Laënnec, 69008 Lyon, France
| | - Gilbert R Ferretti
- INSERM U 1209 IAB, la Tronche, 38700, France; Service de radiologie diagnostique et interventionnelle, CS 10217, 38043 Grenoble, France.
| |
Collapse
|
9
|
Burke MC, Garg A, Youngner JM, Deshmukh SD, Omar IM. Initial experience with dual-energy computed tomography-guided bone biopsies of bone lesions that are occult on monoenergetic CT. Skeletal Radiol 2019; 48:605-613. [PMID: 30343440 DOI: 10.1007/s00256-018-3087-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/24/2018] [Accepted: 10/01/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Our purpose was to determine whether dual-energy CT (DECT), specifically the bone marrow setting of the virtual noncalcium (VNCa) algorithm, could be used to identify and accurately biopsy suspected bone malignancies that were visible on magnetic resonance imaging (MRI), nuclear bone scintigraphy, or positron-emission tomography/computed tomography (PET/CT), but occult on monoenergetic computed tomography (CT) by virtue of being either isodense or nearly isodense to surrounding normal bone. MATERIALS AND METHODS We present 4 cases in which DECT was used to detect various malignant bone lesions and was successfully used to direct percutaneous DECT-guided bone biopsies. RESULTS Two of the lesions were solid tumor metastases (breast and prostate carcinoma), whereas two others were hematological malignancies (leukemia and lymphoma). This technique enabled us to confidently and accurately direct the biopsy needle into the target lesion. CONCLUSION The authors demonstrate that the DECT VNCa bone marrow algorithm may be helpful in identifying isodense bone lesions of various histologies and may be used to guide percutaneous bone biopsies. This technique may help to maximize diagnostic yield, minimize the number of passes into the region of concern, and prevent patients from undergoing repeat biopsy.
Collapse
Affiliation(s)
- Michael C Burke
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA.
| | - Ankur Garg
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA
| | - Jonathan M Youngner
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA
| | - Swati D Deshmukh
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA
| | - Imran M Omar
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA
| |
Collapse
|
10
|
Liu JF, Jiao DC, Ren JZ, Zhang WG, Han XW. Percutaneous bone biopsy using a flat-panel cone beam computed tomography virtual navigation system. Saudi Med J 2018; 39:519-523. [PMID: 29738014 PMCID: PMC6118190 DOI: 10.15537/smj.2018.5.21872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objectives To assess the clinical role of flat-panel cone beam CT (CBCT) in performing percutaneous needle biopsy (PNB) of bone lesions. Flat-panel cone beam CT systems have been used as a guidance tool for performing percutaneous biopsy. Real-time fluoroscopy and virtual navigation systems help simplify needle path planning and shorten procedure times. Methods From March 2012 to March 2016, 80 patients with 80 bone lesions were retrospectively enrolled in the study in Zhengzhou city of China. Technical success, diagnostic accuracy, puncture performance, procedure time, complications, and effective radiation exposure were calculated. Results All biopsies were technically successful (100%). Sufficient tissue for histopathological analysis was obtained in 75 of 80 cases. The sensitivity of PNB of bone lesions was 95.5%, the specificity was 83.3%, and accuracy was 93.7%. The mean scoring of puncture performance was 3.9 ± 1.3. The mean total procedure time was 13.20 ± 4.4 min, resulting in a mean exposure dose of 11.3 ± 5.1 mSv. The complication rate was 8.7%. Conclusion Percutaneous bone biopsy using CBCT is a safe and effective method that simplifies needle path planning and shortens procedure times.
Collapse
Affiliation(s)
- Juan-Fang Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China. E-mail.
| | | | | | | | | |
Collapse
|
11
|
Wiesner EL, Hillen TJ, Long J, Jennings JW. Percutaneous CT-Guided Biopsies of the Cervical Spine: Technique, Histopathologic and Microbiologic Yield, and Safety at a Single Academic Institution. AJNR Am J Neuroradiol 2018; 39:981-985. [PMID: 29650783 DOI: 10.3174/ajnr.a5603] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 01/24/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Cervical spine biopsies can be challenging due to the anatomy and the adjacent critical structures. Percutaneous image-guided biopsies can obviate the need for an open biopsy, however there have been few studies looking at the approaches, safety, and efficacy of percutaneous cervical spine biopsies. This retrospective study evaluated technical considerations, histopathologic and microbiologic yield, and safety in CT-guided cervical bone biopsies. MATERIALS AND METHODS A retrospective review of cervical bone and/or bone/disc biopsies performed from January 2010 to January 2017 was included in this study. Clinical diagnosis and indication, patient demographics, biopsy location, biopsy needle type, technical approach, lesion size, dose-length product, conscious sedation details, complications, and diagnostic histopathologic and/or microbiologic yield were recorded for each case and summarized. RESULTS A total of 73 patients underwent CT-guided cervical bone biopsies. Fifty-three percent (39/73) were for clinical/imaging concern for infection and 47% (34/73) were for primary tumors or metastatic disease. Thirty-four percent (25/73) were of the inferior cervical spine (ie, C6 and C7). A sufficient sample was obtained for histopathologic and microbiologic analyses in 96% (70/73) of the biopsies. Forty-six percent (18/39) of those samples taken for infection had positive cultures. Two intraprocedural complications occurred in which the patients became hypotensive during the procedure without long-term complications. CONCLUSIONS Percutaneous CT-guided biopsy of the cervical spine is an effective and safe procedure with high diagnostic yield and can obviate open procedures for histopathologic and microbiologic analyses of patients with clinical and imaging findings concerning for infection or primary and metastatic osseous lesions.
Collapse
Affiliation(s)
- E L Wiesner
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
| | - T J Hillen
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - J Long
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - J W Jennings
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|