title: Analysis of nondiagnostic results after image-guided needle biopsies of musculoskeletal lesions.
abstract: BACKGROUND
  Image-guided needle biopsies are commonly used to diagnose musculoskeletal tumors, but nondiagnostic (ND) results can delay diagnosis and treatment. It is important to understand which factors or diagnoses predispose to a ND result so that appropriate patient education or a possible change in the clinical plan can be made. Currently it is unclear which factors or specific lesions are more likely to lead to a ND result after image-guided needle biopsy.
  
  
  OBJECTIVE
  We therefore identified specific factors and diagnoses most likely to yield ND results. We also asked whether an image-guided needle biopsy of bone and soft tissue lesions is an accurate and clinically useful tool.
  
  
  METHODS
  We retrospectively reviewed data from a prospectively collected database for a case-control study of 508 image-guided needle biopsies of patients with suspected musculoskeletal tumors between 2003 and 2008.
  
  
  RESULTS
  The interpretations of 453 of the 508 (89%) needle biopsies were accurate and clinically useful. Forty-five biopsies (9%) were ND and 10 (2%) were incorrect (IC). Bone lesions had a higher ND rate than soft tissue lesions (13% vs. 4%). The specific diagnosis with the highest ND rate was histiocytosis. Elbow and forearm locations had higher ND rates than average. Malignant tumors had a higher IC rate than benign tumors (5% vs. 0%); fibromyxoid sarcoma and rare subtypes of osteosarcoma had higher IC rates than other diagnoses. Repeat needle or open biopsies were performed in 71 (14%) patients. Bone lesions were more likely than soft tissue lesions to require repeat biopsies (18% vs. 9%).
  
  
  CONCLUSIONS
  A high rate of accuracy and clinical usefulness is possible with image-guided needle biopsies of musculoskeletal lesions. We believe these biopsies appropriate in selected circumstances but a key factor for appropriate use is an experienced musculoskeletal tumor team with frequent communication to correlate clinical, radiographic, and histologic information for each patient.
authors.affiliation: Washington University Department of Orthopaedic Surgery, St Louis, MO, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Yang
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Frassica
authors.forename: Laura
authors.initials: L
authors.lastname: Fayad
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Clark
authors.forename: Kristy L
authors.initials: KL
authors.lastname: Weber
mesh_terms: D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods*; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D002983:Clinical Competence; D057210:Delayed Diagnosis / Q000517:prevention & control; D003951:Diagnostic Errors / Q000517:prevention & control; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D016017:Odds Ratio; D010348:Patient Care Team; D011237:Predictive Value of Tests; D015641:Radiography, Interventional; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional
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