Tru-cut biopsy as the initial method of tissue diagnosis in bone tumors with soft tissue extension

An Image-Guided Percutaneous Core Needle Biopsy for Accurate Assessment of Musculoskeletal Tumors: A Targeted Diagnosis

Background Accurate diagnosis of musculoskeletal tumors is essential for guiding appropriate treatment strategies. Percutaneous core needle biopsy (PCNB) is increasingly recognized as a valuable method for obtaining tissue samples for histopathological examination. This study aims to evaluate the diagnostic accuracy and clinical utility of PCNB in diagnosing musculoskeletal tumors. Methodology A total of 152 cases suspected of musculoskeletal tumors underwent PCNB at our tertiary care center between 2020 and 2023. Pre-biopsy evaluation included comprehensive clinical assessment and imaging studies. Core biopsies were performed under image guidance, with specimens sent for histopathological examination and culture sensitivity analysis. Diagnostic yield, accuracy, and performance metrics of PCNB were assessed. Results PCNB demonstrated a diagnostic yield of 93.4%. However, in cases where initial biopsies were inconclusive, repeat core biopsy or open biopsy provided the necessary diagnostic clarity. PCNB demonstrated a remarkable diagnostic accuracy of 97.9%, with a specificity and positive predictive value of 100%. There were no post-biopsy complications and no instances of local recurrence from the biopsy tract. Conclusions PCNB can be a reliable method for diagnosing musculoskeletal tumors, offering high diagnostic accuracy and minimal complications. The utilization of image guidance enhances precision and reduces the risk of complications. PCNB proves effective in diagnosing both primary tumors and bone infections, facilitating timely and appropriate treatment strategies in orthopedic oncology.

Radiologists with assistance of deep learning can achieve overall accuracy of benign-malignant differentiation of musculoskeletal tumors comparable with that of pre-surgical biopsies in the literature

PURPOSE

The purpose of this study was to assess if radiologists assisted by deep learning (DL) algorithms can achieve diagnostic accuracy comparable to that of pre-surgical biopsies in benign-malignant differentiation of musculoskeletal tumors (MST).

METHODS

We first conducted a systematic review of literature to get the respective overall diagnostic accuracies of fine-needle aspiration biopsy (FNAB) and core needle biopsy (CNB) in differentiating between benign and malignant MST, by synthesizing data from the articles meeting our inclusion criteria. To compared against the accuracies reported in literature, we then invited 4 radiologists, respectively with 2 (A), 6 (B), 7 (C), and 33 (D) years of experience in interpreting musculoskeletal MRI to perform diagnostic tests on our own dataset (n = 62), with and without assistance of a previously developed DL algorithm. The gold standard for benign-malignant differentiation was histopathologic confirmation or clinical/radiographic follow-up.

RESULTS

For FNAB, a meta-analysis containing 4604 samples met the inclusion criteria, with the overall diagnostic accuracy reported to be 0.77. For CNB, an overall accuracy of 0.86 was derived by synthesizing results from 7 original research articles containing a total of 587 samples. On our internal MST dataset, the invited radiologists, respectively, achieved diagnostic accuracies of 0.84 (A), 0.89 (B), 0.87 (C), and 0.90 (D), with the assistance of DL.

CONCLUSION

Use of DL algorithms on musculoskeletal dynamic contrast-enhanced MRI improved the benign-malignant differentiation accuracy of radiologists to a level comparable to that of pre-surgical biopsies. The developed DL algorithms have a potential to lower the risk of miss-diagnosing malignancy in radiological practice.

Malignant primary intraosseus synovial sarcoma – a rare case report

Primary intraosseous synovial sarcoma is an extremely rare malignancy that occurs primarily in young adults. We present a case of a primary intraosseous synovial sarcoma of the right distal ulna in a 19-year-old female. It has a propensity to mimic other radiologic and pathologic diagnosis. Histopathology after a surgical excisional biopsy with a wide margin plus adjunct radio and chemotherapy are necessary to improve prognosis.

Percutaneous CT Guided Vertebral Biopsy: Anatomy and Technical Considerations

In this review article, the authors discuss the anatomy and technical aspects of CT-guided biopsy of vertebral lesions. CT guidance is highly useful for vertebral biopsies, as the anatomy of the spine is complex and varies widely across the levels. Prebiopsy imaging should be reviewed and later correlated with the final histopathological diagnosis. The majority of the spine biopsies are performed under local anesthesia, except those in critical locations and pediatric age groups. The biopsy sample is sent for histopathological analysis and/or microbiological analysis depending on the indications. It is preferable to use a coaxial system for biopsies, so multiple cores can be obtained with a single needle puncture, thus minimizing the negative yield and complications. Complications after image-guided percutaneous biopsy are rare and can be managed easily.

Comparison of Tru-Cut Biopsy and Incisional Biopsy in Achieving Prompt Diagnosis of Maxillofacial Pathology

Tru-cut (core needle) biopsy has many advantages over open biopsy. It is quick and easy to perform, may be carried out in the outpatient department, avoids incision through previously irradiated skin and has few complications. The purpose of this study is to compare the two available biopsy techniques that are Tru-cut biopsy and incisional biopsy in achieving prompt diagnosis of maxillofacial pathology. A prospective study was conducted in 25 patients reported to our department. The Tru-cut biopsy was performed by using 14 gauge disposable Tru-cut biopsy needles (Baxter, made in the USA) by means of two successive insertions with different angulations of the needle into the core of the lesion followed by incisional biopsy. The diagnostic criteria which were evaluated include: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Tru-cut biopsy had sensitivity of 68.42%; specificity of 83.33%; PPV of 92.86%; NPV of 45.45% with accuracy rate of 72%. The Tru-cut biopsy method was evaluated as a very helpful method for prompt diagnosis of maxillofacial pathology since it is practical to perform, causes minimum trauma to the tissue, decreases the metastatic risk of malignant lesions during the procedure and relatively free from complications.

A meta-analysis supports core needle biopsy by radiologists for better histological diagnosis in soft tissue and bone sarcomas

BACKGROUND

Although surgical biopsy has historically been considered to be the standard diagnostic biopsy for soft tissue and bone sarcomas, recent literature suggests that percutaneous core needle biopsy yields similar results. Therefore, an evaluation of the exact diagnostic accuracy and associated influential variables of core needle biopsy that is based on a large data set would be useful.

METHODS

We searched MEDLINE, Web of Science, and EMBASE to identify core needle biopsy studies for predicting final histological subtypes of musculoskeletal lesions. The diagnostic accuracies of core needle biopsy and of surgical biopsy were assessed and compared by using random-effect meta-analyses. The factors relevant to diagnostic accuracy were evaluated by meta-regression and subgroup analyses.

RESULTS

We selected 32 studies comprising 7209 musculoskeletal lesions. The pooled proportion estimate for the diagnostic accuracy of core needle biopsy was 0.84 (95% confidential interval, CI: 0.81-0.87), which indicated an approximate 84% concordance between core needle biopsy results and final histological diagnoses. The findings of meta-regression and subgroup analyses suggested that radiologists were better core needle biopsy operators than surgeons. An additional meta-analysis for direct comparison between core needle biopsy and surgical biopsy demonstrated that diagnostic accuracy was significantly lower for core needle biopsy than for surgical (pooled odds ratio: 0.39, 95% CI: 0.20-0.76).

CONCLUSION

Our results suggested that core needle biopsy should be performed by expert radiologists and that surgical biopsy should be performed if diagnosis following core needle biopsy does not match the clinical presentation and radiographic findings.

Use of minimally invasive spine surgical instruments for the treatment of bone tumors

INTRODUCTION

Orthopedic oncologists often encounter patients with minor bony lesions that are difficult to access surgically and therefore require large exposures out of proportion to the severity of disease that confer significant patient morbidity. Minimally invasive surgical techniques offer the advantage of smaller incisions, shorter operative times, decreased tissue damage, and decreased costs. A variety of surgical procedures have emerged using minimally invasive technologies, particularly in the field of spine surgery. Areas covered: In this article, we describe the Minimal Exposure Tubular Retractor (METRx^TM) System which is a minimally invasive surgical device that utilizes a series of dilators to permit access to a surgical site of interest. This system was developed for use in treatment of disc herniation, spinal stenosis, posterior lumbar interbody fusion, transforaminal lumbar interbody fusion and spinal cord stimulation implantation. We also describe novel uses of this system for minimally invasive biopsy and treatment of benign and metastatic bone lesions at our institution. Expert commentary: Minimally invasive surgical techniques will continue to expand into the field of orthopedic oncology. With a greater number of studies proving the safety and effectiveness of this technique, the demand for minimally invasive treatments will grow.