2011 Mid-America Orthopaedic Association Dallas B. Phemister Physician in Training Award: Can musculoskeletal tumors be diagnosed with ultrasound fusion-guided biopsy?
BACKGROUND
Percutaneous biopsy for musculoskeletal tumors commonly relies on imaging adjuncts including ultrasound (US), CT, or MRI. These modalities however have disadvantages (US) or are cumbersome, not universally available, and costly (CT and MRI). US fusion is a novel technique that fuses previously obtained CT or MRI data with real-time US, which allows biopsies to be performed in an US suite. It has proven useful in various body systems but musculoskeletal applications remain scarce. Our goal is to evaluate the fusion technology and determine its ability to diagnose musculoskeletal tumors.


OBJECTIVE
We determined whether biopsies performed via US fusion compared with CT guidance provide equivalent diagnostic yield and accuracy and allow quicker biopsy scheduling and procedure times.


METHODS
Forty-seven patients were assigned to undergo either US fusion (with MR, n = 16 or CT, n = 15) or CT-guided biopsies (n = 16). We evaluated adequacy of the histologic specimen (diagnostic yield) and correlation with surgical pathology (diagnostic accuracy). We determined scheduling times and lengths of the biopsy.


RESULTS
US fusion and CT-guided biopsy groups had comparable diagnostic yields (CT = 94%; US/MRI = 94%; US/CT = 93%) and accuracy (CT = 83%; US/MRI = 90%; US/CT = 100%). US fusion biopsies were faster to schedule and perform. All procedures were safe with minimal complications.


CONCLUSIONS
US fusion provides a high diagnostic yield and accuracy comparable to CT-guided biopsy while performed in the convenience of an US suite. This may have resulted in the observed faster scheduling and biopsy times.


METHODS
Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
Department of Orthopaedics, Henry Ford Hospital, Detroit, MI 48202, USA. jadkhalil@gmail.com
Jad G
JG
Khalil
Michael P
MP
Mott
Theodore W
TW
Parsons
Trevor R
TR
Banka
Marnix
M
van Holsbeeck
D001363:Awards and Prizes; D001706:Biopsy; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D009985:Orthopedics; D015203:Reproducibility of Results; D012955:Societies, Medical; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*; D014481:United States