The role of ultrasound-guided fine needle aspiration biopsy in musculoskeletal diseases

Diagnostic Value of Contrast-Enhanced Ultrasound for Differential Diagnosis of Malignant and Benign Soft Tissue Masses: A Meta-Analysis

This meta-analysis was aimed at investigating the value of using contrast-enhanced ultrasound (CEUS) in the differential diagnosis of benign and malignant soft tissue masses (STMs). Relevant studies published before March 24, 2020 were identified through a comprehensive search of PubMed, Ovid, Cochrane and Web of Science. According to the inclusion criteria, five studies were selected comprising 746 patients. In the differential diagnosis of benign and malignant STMs, the pooled sensitivity and specificity of CEUS were 76% (95% confidence interval [CI]: 71%-81%; heterogeneity [I²] = 74.5%) and 67% (95% CI: 62%-71%; I² = 36.5%), respectively. The diagnostic odds ratio was 7.37 (95% CI: 3.78%-14.35; I² = 66.6%). The overall area under the curve was 0.77 (standard error: 0.0392). Subgroup analysis revealed that different index tests of CEUS resulted in different diagnostic performance. Importantly, CEUS is an effective method for the differential diagnosis between benign and malignant STMs.

Inter- and Intra-Individual Differences in EMG and MMG during Maximal, Bilateral, Dynamic Leg Extensions

The purpose of this study was to compare the composite, inter-individual, and intra-individual differences in the patterns of responses for electromyographic (EMG) and mechanomyographic (MMG) amplitude (AMP) and mean power frequency (MPF) during fatiguing, maximal, bilateral, and isokinetic leg extension muscle actions. Thirteen recreationally active men (age = 21.7 ± 2.6 years; body mass = 79.8 ± 11.5 kg; height = 174.2 ± 12.7 cm) performed maximal, bilateral leg extensions at 180°·s⁻¹ until the torque values dropped to 50% of peak torque for two consecutive repetitions. The EMG and MMG signals from the vastus lateralis (VL) muscles of both limbs were recorded. Four 2(Leg) × 19(time) repeated measures ANOVAs were conducted to examine mean differences for EMG AMP, EMG MPF, MMG AMP, and MMG MPF between limbs, and polynomial regression analyses were performed to identify the patterns of neuromuscular responses. The results indicated no significant differences between limbs for EMG AMP (p = 0.44), EMG MPF (p = 0.33), MMG AMP (p = 0.89), or MMG MPF (p = 0.52). Polynomial regression analyses demonstrated substantial inter-individual variability. Inferences made regarding the patterns of neuromuscular responses to fatiguing and bilateral muscle actions should be considered on a subject-by-subject basis.

Concordance between fine-needle aspiration and core biopsies for osseous lesions by lesion imaging appearance and CT attenuation

OBJECTIVES

To compare the concordance between fine-needle aspiration and core biopsies for osseous lesions by lesion imaging appearance and CT attenuation.

MATERIALS AND METHODS

Retrospective review of 215 FNAs of osseous lesions performed in conjunction with core biopsy at our institution over a 6-year period (2011-2016). FNAs were interpreted independently of core biopsies. We assessed if FNA in conjunction with core biopsy increased diagnostic accuracy compared to core biopsy alone. We also calculated the concordance between FNA and core biopsy by lesion appearance, lesion CT attenuation, lesion histology, lesion location and FNA needle gauge size.

RESULTS

Core biopsy alone provided the diagnosis in 207/215 cases (96.3%), however, the FNA provided the diagnosis in the remaining 8/215 cases (3.7%) where the core biopsy was non-diagnostic. There were 154 (71.6%) lytic lesions, 21 (9.8%) blastic lesions, 25 (11.6%) mixed lytic and blastic lesions and 15 (7.0%) lesions that were neither lytic nor blastic. The concordance between FNA and core biopsy for lytic osseous lesions (136/154 cases, 88.3%) was statistically significantly higher than that for blastic osseous lesions (13/21 cases, 61.9%) [P = 4.2 × 10^-3; 95% CI (0.02, 0.50)]. The concordance between FNA and core biopsy was higher for low-attenuation- (110/126) than high-attenuation (58/77) lesions (P = 0.028). The concordance between FNA and core biopsy was also higher for metastases (102/119 cases, 85.7%) than non-metastases (78/96, 81.3%) [P = 0.487; 95% CI (- 0.15, 0.065)]. There was no difference in the rate of concordance between FNA and core biopsy by lesion location or FNA needle gauge size (P > 0.05).

CONCLUSION

FNA with core biopsy increases diagnostic rate compared to core biopsy alone or FNA alone. The concordance between FNA and core biopsy is higher for lytic lesions than for blastic lesions; and higher for low-attenuation lesions than for high-attenuation lesions.