title: Percutaneous CT-guided bone biopsy: diagnosis of malignancy in lesions with initially indeterminate biopsy results and CT features associated with diagnostic or indeterminate results.
abstract: OBJECTIVE
  The purpose of our study was to determine the proportion of bone lesions with indeterminate results after initial percutaneous CT-guided bone biopsy that ultimately are found to be malignant and whether CT features are associated with diagnostic outcomes.
  
  
  METHODS
  The results of 800 consecutive percutaneous CT-guided bone biopsies performed at a tertiary cancer center were reviewed. The initial histopathologic diagnosis was classified as diagnostic or indeterminate. On the basis of follow-up information, indeterminate results were subcategorized as benign, malignant, or persistently indeterminate. Two readers independently analyzed the CT images.
  
  
  RESULTS
  Initial percutaneous CT-guided bone biopsy was diagnostic in 69% and indeterminate in 31%. Malignancy was diagnosed in 90% of initially diagnostic results. In lesions with initially indeterminate results, a diagnosis was subsequently made in 62%; 39% of subsequent diagnoses were malignant as of the last available follow-up. CT features associated with diagnostic results included cortical destruction and large extraosseous mass (p < 0.05). More lesional sclerosis and presence of fat were associated with indeterminate results (p < 0.001). CT features associated with malignant results included less-extensive sclerosis and lesser sclerotic rim (p < 0.05). Increased age, female sex, and a cancer history were associated with higher risk of malignancy among patients with diagnostic results at initial biopsy.
  
  
  CONCLUSIONS
  Bone lesions that initially yield indeterminate results at percutaneous CT-guided bone biopsy often are subsequently shown to be malignant; vigorous pursuit of a diagnosis is recommended if initial results are indeterminate. Lesions showing fat or more sclerosis are more likely to be indeterminate; lesions with less sclerosis or smaller sclerotic rim are more likely to yield malignant results.
authors: Department of Radiology, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY 10065, USA. hwangs1@mskcc.org
authors: Sinchun
authors: S
authors: Hwang
authors: Robert A
authors: RA
authors: Lefkowitz
authors: Jonathan
authors: J
authors: Landa
authors: Junting
authors: J
authors: Zheng
authors: Chaya S
authors: CS
authors: Moskowitz
authors: Majid
authors: M
authors: Maybody
authors: Meera
authors: M
authors: Hameed
authors: David M
authors: DM
authors: Panicek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*