title: CT-guided biopsy of bone and soft-tissue lesions: role of on-site immediate cytologic evaluation.
abstract: OBJECTIVE
  To assess the impact of on-site immediate cytologic assessment (ICA) on the diagnostic success rate of computed tomography (CT)-guided percutaneous needle biopsy (PNB) of musculoskeletal lesions and the long-term outcome in inconclusive PNB findings.
  
  
  METHODS
  A total of 299 CT-guided PNBs of musculoskeletal lesions performed between January 1997 and December 2009 were retrospectively reviewed. The lesions were categorized by their morphology, location, and size, and by biopsy type. The diagnostic success rates, impact of ICA, and outcome in inconclusive PNBs were studied, with final histopathologic findings and/or clinical follow-up as a reference.
  
  
  RESULTS
  The overall diagnostic success rate of PNBs was 72.9% (218 of 299). The success rate increased with larger lesions (> 2 cm to 4 cm; P = .009). Biopsies performed with ICA had a higher success rate (77.0% vs 63.3%; P = .015). PNBs had inconclusive results in 109 of 299 cases (36.5%). In 66 of these, repeat open biopsy or clinical follow-up demonstrated 19 malignant/aggressive lesions (28.8%) and 47 benign/nonaggressive lesions (71.2%).
  
  
  CONCLUSIONS
  CT-guided PNB had a satisfactory success rate, which significantly increased when performed with ICA. Inconclusive results in PNB were most frequently associated with benign findings during further workup.
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, 400 Parnassus Ave, A 367, Box 0628, San Francisco, CA 94143-0628, USA.
authors.forename: Warapat
authors.initials: W
authors.lastname: Virayavanich
authors.forename: Michael D
authors.initials: MD
authors.lastname: Ringler
authors.forename: Cynthia T
authors.initials: CT
authors.lastname: Chin
authors.forename: Thomas
authors.initials: T
authors.lastname: Baum
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Giaconi
authors.forename: Richard J
authors.initials: RJ
authors.lastname: O'Donnell
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Horvai
authors.forename: Kirk D
authors.initials: KD
authors.lastname: Jones
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Link
mesh_terms: D001707:Biopsy, Needle / Q000379:methods*; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D016009:Chi-Square Distribution; D006801:Humans; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D012495:San Francisco; D012983:Soft Tissue Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed