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Najm A, Orr C, Heymann MF, Bart G, Veale DJ, Le Goff B. Success Rate and Utility of Ultrasound-guided Synovial Biopsies in Clinical Practice. J Rheumatol 2016; 43:2113-2119. [PMID: 27744399 DOI: 10.3899/jrheum.151441] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The utility of synovial biopsy in increasing our understanding of the pathogenesis of inflammatory arthropathies, as well as in evaluating treatments, is well established. Ultrasound (US) allows synovial assessment and therefore assists in biopsying synovial tissue in a safe and well-tolerated manner. This study's objectives were to (1) determine the rate of success in retrieving synovial tissue using US guidance, (2) describe the indications for US-guided synovial biopsies in the clinical setting, (3) determine how frequently the synovial biopsy can lead to a clear diagnosis, and (4) assess the quality of the synovial tissue obtained using this technique. METHODS Synovial biopsies of small and large joints were performed under US guidance between February 2007 and December 2014 using a semiautomatic core biopsy needle. The biopsy procedure was considered successful if synovial tissue was found at histological examination. RESULTS Seventy-four patients with undifferentiated arthritis underwent 76 synovial biopsies. The success rate in retrieving synovial tissue was 81.6% (62/76). One patient taking acetyl salicylic acid at 75 mg at the time of the biopsy presented with hemarthrosis 48 h after the procedure, which resolved following simple arthrocentesis. A definitive diagnosis was achieved in 16% of the patients where synovial tissue was sampled successfully. CONCLUSION US-guided synovial biopsies in clinical practice can be performed safely on patients with undifferentiated arthritis and with heterogeneous presentations. The rate of success in acquiring synovial tissue is high. The procedure usually retrieves quality tissue and leads to a definite diagnosis in a significant minority of patients.
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Affiliation(s)
- Aurélie Najm
- From the Department of Rheumatology, and Department of Pathology, Hôtel-Dieu Hospital, Nantes, France; University College Dublin Department of Rheumatology, St. Vincent's Hospital, Dublin, Ireland.,A. Najm, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; C. Orr, MD, University College Dublin Department of Rheumatology, St. Vincent's Hospital; M.F. Heymann, MD, Department of Pathology, Hôtel-Dieu Hospital; G. Bart, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; D.J. Veale, MD, PhD, Professor, University College Dublin Department of Rheumatology, St. Vincent's Hospital; B. Le Goff, PhD, Assistant Professor, Department of Rheumatology, Hôtel-Dieu Hospital
| | - Carl Orr
- From the Department of Rheumatology, and Department of Pathology, Hôtel-Dieu Hospital, Nantes, France; University College Dublin Department of Rheumatology, St. Vincent's Hospital, Dublin, Ireland.,A. Najm, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; C. Orr, MD, University College Dublin Department of Rheumatology, St. Vincent's Hospital; M.F. Heymann, MD, Department of Pathology, Hôtel-Dieu Hospital; G. Bart, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; D.J. Veale, MD, PhD, Professor, University College Dublin Department of Rheumatology, St. Vincent's Hospital; B. Le Goff, PhD, Assistant Professor, Department of Rheumatology, Hôtel-Dieu Hospital
| | - Marie-Françoise Heymann
- From the Department of Rheumatology, and Department of Pathology, Hôtel-Dieu Hospital, Nantes, France; University College Dublin Department of Rheumatology, St. Vincent's Hospital, Dublin, Ireland.,A. Najm, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; C. Orr, MD, University College Dublin Department of Rheumatology, St. Vincent's Hospital; M.F. Heymann, MD, Department of Pathology, Hôtel-Dieu Hospital; G. Bart, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; D.J. Veale, MD, PhD, Professor, University College Dublin Department of Rheumatology, St. Vincent's Hospital; B. Le Goff, PhD, Assistant Professor, Department of Rheumatology, Hôtel-Dieu Hospital
| | - Géraldine Bart
- From the Department of Rheumatology, and Department of Pathology, Hôtel-Dieu Hospital, Nantes, France; University College Dublin Department of Rheumatology, St. Vincent's Hospital, Dublin, Ireland.,A. Najm, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; C. Orr, MD, University College Dublin Department of Rheumatology, St. Vincent's Hospital; M.F. Heymann, MD, Department of Pathology, Hôtel-Dieu Hospital; G. Bart, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; D.J. Veale, MD, PhD, Professor, University College Dublin Department of Rheumatology, St. Vincent's Hospital; B. Le Goff, PhD, Assistant Professor, Department of Rheumatology, Hôtel-Dieu Hospital
| | - Douglas J Veale
- From the Department of Rheumatology, and Department of Pathology, Hôtel-Dieu Hospital, Nantes, France; University College Dublin Department of Rheumatology, St. Vincent's Hospital, Dublin, Ireland.,A. Najm, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; C. Orr, MD, University College Dublin Department of Rheumatology, St. Vincent's Hospital; M.F. Heymann, MD, Department of Pathology, Hôtel-Dieu Hospital; G. Bart, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; D.J. Veale, MD, PhD, Professor, University College Dublin Department of Rheumatology, St. Vincent's Hospital; B. Le Goff, PhD, Assistant Professor, Department of Rheumatology, Hôtel-Dieu Hospital
| | - Benoît Le Goff
- From the Department of Rheumatology, and Department of Pathology, Hôtel-Dieu Hospital, Nantes, France; University College Dublin Department of Rheumatology, St. Vincent's Hospital, Dublin, Ireland. .,A. Najm, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; C. Orr, MD, University College Dublin Department of Rheumatology, St. Vincent's Hospital; M.F. Heymann, MD, Department of Pathology, Hôtel-Dieu Hospital; G. Bart, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; D.J. Veale, MD, PhD, Professor, University College Dublin Department of Rheumatology, St. Vincent's Hospital; B. Le Goff, PhD, Assistant Professor, Department of Rheumatology, Hôtel-Dieu Hospital.
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