title: Gamma probe assisted biopsy of suspected metastatic rib lesions.
abstract: Retrieving diagnostic tissue from a rib lesion can be challenging. Using a hand-held intraoperative gamma probe to target and biopsy the areas of increased radioisotope uptake has been limited largely to use by thoracic surgeons and interventional radiologists. Such techniques also have been used by orthopaedic oncologists in localizing osteoid osteomas. We pursued a similar technique in localizing the rib lesion. During the 10 months, two patients with a history of cancer and recent bone scans indicative of possible rib metastasis required biopsies for definitive tissue diagnosis. Both patients had gamma-probe localization of their rib lesions intraoperatively using minimally invasive techniques. The operation of the probe was simple with a short learning curve. Both patients had biopsies that yielded diagnoses verifying the abnormality on the staging bone scan. Localization was sensitive and accurate with histologic confirmation in both patients. The length and extent of surgery were markedly reduced with no complications. These results match those reported in the literature by thoracic surgeons and radiologists. The hand-held gamma probe assisted biopsy of suspicious rib abnormalities can be an effective surgical technique that the orthopaedic surgeon should consider. Additional experience with the technique will allow an assessment of the sensitivity and specificity.
authors.affiliation: Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: Sodha
authors.forename: Sameer
authors.initials: S
authors.lastname: Nagda
authors.forename: Richard D
authors.initials: RD
authors.lastname: Lackman
authors.forename: Rakesh
authors.initials: R
authors.lastname: Donthineni
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000295:instrumentation* / Q000379:methods; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D004867:Equipment Design; D005260:Female; D015902:Gamma Cameras; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery; D011877:Radionuclide Imaging; D012272:Ribs; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013669:Technetium Tc 99m Medronate; D014057:Tomography, X-Ray Computed
chemical_list: D013669:Technetium Tc 99m Medronate