title: Relevance of compartmental anatomic guidelines for biopsy of musculoskeletal tumors: retrospective review of 363 biopsies over a 6-year period.
abstract: OBJECTIVE
  To retrospectively assess percutaneous core needle biopsies performed by radiologists and the association with tumor seeding along the biopsy tract when anatomic compartment guidelines are not consistently observed.
  
  
  METHODS
  Retrospective data from computerized patient records and digital images from 363 consecutive computed tomography-guided biopsies of the lower extremity (thigh and leg) performed by radiologists at a single institution from August 2002 to August 2008 were analyzed for breaches of biopsy guidelines.
  
  
  RESULTS
  Of the 363 biopsies, 243 (67%) were of soft tissue lesions and 120 (33%) were of bony lesions. There were 188 (52%) malignant and 175 (48%) benign lesions. The following biopsy breaches were observed: 13 (3.6%) of anatomic compartment, 42 (11.6%) of "vital structures," and 82 (68.3%) of needle path for bony tumors. Vital structures as defined by the literature included, but were not limited to, the following: knee joint capsule, greater trochanteric bursa, rectus femoris and vastus intermedius muscles, tibial tubercle, peroneus brevis and peroneus longus distal tendons, and neurovascular bundles. No cases of tumor recurrences could be attributed to needle seeding along a biopsy tract for any of these biopsy guideline breaches.
  
  
  CONCLUSIONS
  The concern for needle tract seeding with musculoskeletal tumors is more widespread than the evidence supporting it as a significant or frequent complication. In this study, breaching anatomic compartment, vital structures (other than neurovascular structures), and suggested exact needle path guidelines were not associated with needle tract seeding in the lower extremity.
authors.affiliation: Department of Radiology, Section of Musculoskeletal Imaging, David Geffen School of Medicine, University of California, Los Angeles, 200 Medical Plaza, Suite 165-59, Los Angeles, CA 90095, USA.
authors.forename: Stacy J
authors.initials: SJ
authors.lastname: UyBico
authors.forename: Kambiz
authors.initials: K
authors.lastname: Motamedi
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Omura
authors.forename: Scott D
authors.initials: SD
authors.lastname: Nelson
authors.forename: Fritz C
authors.initials: FC
authors.lastname: Eilber
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Eckardt
authors.forename: Leanne L
authors.initials: LL
authors.lastname: Seeger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000592:standards* / Q000706:statistics & numerical data*; D001859:Bone Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D002648:Child; D005260:Female; D057918:Fiducial Markers / Q000592:standards; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007866:Leg / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D009366:Neoplasm Seeding; D017410:Practice Guidelines as Topic; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D055815:Young Adult