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CT-guided percutaneous biopsy of sclerotic bone lesions: diagnostic outcomes

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Abstract

Objective

To determine the diagnostic yield of CT-guided percutaneous biopsy of densely sclerotic bone lesions.

Materials and methods

We retrospectively analyzed CT-guided percutaneous bone biopsies performed at our institution from September 2008 through August 2011 (329 cases) and from September 2012 through August 2015 (324 cases) after adoption of a battery-powered drill system (OnControl). Bone lesions were included in the analysis if they were >70% sclerotic by visual inspection, had a density > 2 times that of adjacent trabecular bone, and had an attenuation of ≥250 HU. Pathological fractures, diskitis–osteomyelitis, and osteoid osteomas were excluded. Eligible cases were characterized by lesion location, maximum lesion diameter, mean density, biopsy needle type and gauge, reported complications, and histological diagnosis. Clinical and imaging follow-up was used to confirm histological diagnosis. Cases in which a benign histological diagnosis could not be confirmed by imaging over a minimum period of 1 year were excluded.

Results

A total of 37 biopsies of sclerotic bone lesions met the inclusion criteria, 17 of which were performed with a power drill needle and 20 of which were performed with a manually driven needle. The mean lesion density was 604.1 HU. The overall diagnostic yield was 78.4%; overall diagnostic accuracy was 94.6%, and the false-negative rate was 5.4%. Diagnostic yield and accuracy were 82.4% and 100% respectively, with a power drill and 75% and 90% respectively, with a manual device. Diagnostic yield for lesions ≥700 HU was 90% (9 out of 10).

Conclusion

Densely sclerotic bone lesions are amenable to percutaneous needle biopsy.

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Acknowledgements

We would like to thank Megan Griffiths for her help with editing the manuscript and Jennifer Bullen for her help with the statistical analysis.

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Authors and Affiliations

  1. Department of Radiology, Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX, 75219, USA

    I-Yuan Joseph Chang

  2. Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Hakan Ilaslan, Murali Sundaram, Jean Schils & Naveen Subhas

Authors
  1. I-Yuan Joseph Chang
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  2. Hakan Ilaslan
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  3. Murali Sundaram
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  4. Jean Schils
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  5. Naveen Subhas
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Correspondence to I-Yuan Joseph Chang.

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The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards for the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Chang, IY.J., Ilaslan, H., Sundaram, M. et al. CT-guided percutaneous biopsy of sclerotic bone lesions: diagnostic outcomes. Skeletal Radiol 47, 661–669 (2018). https://doi.org/10.1007/s00256-017-2828-x

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  • DOI: https://doi.org/10.1007/s00256-017-2828-x

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