title: Ultrasound-guided synovial biopsy: a systematic review according to the OMERACT filter and recommendations for minimal reporting standards in clinical studies.
abstract: OBJECTIVE
  To describe existing techniques of US-guided synovial biopsy (USG-SB) and critically appraise the literature on this technology through the OMERACT filter.
  
  
  METHODS
  USG-SB techniques are described and compared. A systematic literature search of PubMed and Embase was performed for original research reports including US and SB. The subjects, procedure protocols and reported results were analysed. A future research agenda is proposed.
  
  
  RESULTS
  USG-SB can be performed using a portal-and-forceps or a dedicated semi-automatic guillotine-type biopsy needle approach. Of 50 reports identified, 7 were included in the review. Large, intermediate and small joints were all amenable to USG-SB. We found great heterogeneity with regard to indications for and definition of a successful procedure and of synovitis. Adverse events were assessed in most papers with an overall major complication rate of 0.4%. However, there was a lack of construct validity using a histological comparator. Relatively few papers reported details on the technique used, tissue processing, synovitis scoring and blinding for tissue analysis.
  
  
  CONCLUSIONS
  USG-SB can be regarded as a valuable tool for large-scale synovial tissue sampling. Standardization of the techniques of USG-SB and tissue processing is needed. Future research should focus on the reliability, responsiveness and feasibility of this procedure in prospective studies.
authors.affiliation: Queen Mary University of London, Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK.
authors.forename: Ilias
authors.initials: I
authors.lastname: Lazarou
authors.affiliation: Université Versailles Saint Quentin en Yvelines, Service de Rhumatologie Hôpital Ambroise Paré, Boulogne-Billancourt, France.
authors.forename: Maria-Antonietta
authors.initials: MA
authors.lastname: D'Agostino
authors.affiliation: Rheumatology Department, Hospital General Universitario Gregorio Marañón and Universidad Complutense, Madrid, Spain.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Naredo
authors.affiliation: Queen Mary University of London, Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK.
authors.forename: Frances
authors.initials: F
authors.lastname: Humby
authors.affiliation: University of Birmingham, Division of Immunity and Infection, Birmingham, UK and.
authors.forename: Andrew
authors.initials: A
authors.lastname: Filer
authors.affiliation: Rheumatology Department, Mile End Hospital, Barts Health NHS Trust, London, UK Stephen.kelly@bartshealth.nhs.uk.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Kelly
mesh_terms: D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods*; D015510:Clinical Medicine / Q000592:standards*; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging / Q000473:pathology; D017063:Outcome Assessment, Health Care / Q000592:standards*; D061214:Patient Safety; D011642:Publications / Q000592:standards; D015203:Reproducibility of Results; D012107:Research Design / Q000592:standards*; D013583:Synovial Membrane / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography / Q000295:instrumentation / Q000379:methods*
keywords: histology; joint; procedure; synovial biopsy; ultrasound