CT-guided percutaneous biopsy of sclerotic bone lesions: diagnostic yield and accuracy.
OBJECTIVE
We assessed the positive predictive value of percutaneous biopsy of sclerotic lesions to determine whether the reported success rate of the percutaneous technique could be generalized to sclerotic lesions or whether our diagnostic yield was too low to justify this added step before open surgical confirmation.


METHODS
We retrospectively studied all sclerotic bone lesions biopsied by the percutaneous CT-guided technique at the Massachusetts General Hospital between 1988 and 1997. The 43 lesions were categorized by location, maximum diameter, density (graded 1-4, relative to cortex), and pattern of density (geographic, vague, or geographic with sclerotic margins). Pathologic and clinical follow-up were used to determine the positive and negative predictive values.


RESULTS
Of the 43 patients biopsied, neither the maximum diameter of the lesion nor its density was predictive of benignancy or malignancy. Fine-needle aspiration (FNA) complemented core biopsy results; for example, in one case, FNA showed findings indicating disease when the core biopsy showed none, and in another case the reverse occurred. No complications were reported in these 43 patients.


CONCLUSIONS
Percutaneous CT-guided biopsy of sclerotic bone lesions is a viable alternative to open surgical biopsy. In this study, the positive predictive value of the combined FNA and bone biopsy results was 82% and the negative predictive value was 100%. No complications were reported.
Leffler
S G
SG
Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
Chew
F S
FS
D001707:Biopsy, Needle / Q000379:methods; D001847:Bone Diseases / Q000453:epidemiology / Q000473:pathology*; D001859:Bone Neoplasms / Q000453:epidemiology / Q000473:pathology*; D001842:Bone and Bones / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012598:Sclerosis; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed