Percutaneous CT-guided needle biopsies of musculoskeletal tumors: a 5-year analysis of non-diagnostic biopsies.
OBJECTIVE
To study non-diagnostic CT-guided musculoskeletal biopsies and take steps to minimize them. Specifically we asked: (1) What malignant diagnoses have a higher non-diagnostic rate? (2) What factors of a non-diagnostic biopsy may warrant more aggressive pursuit? (3) Do intra-procedural frozen pathology (FP) or point-of-care (POC) cytology reduce the non-diagnostic biopsy rate?


METHODS
This study was IRB-approved and HIPAA-compliant. We retrospectively reviewed 963 consecutive CT-guided musculoskeletal biopsies. We categorized pathology results as malignant, benign, or non-diagnostic and recorded use of FP or POC cytology. Initial biopsy indication, final diagnosis, method of obtaining the final diagnosis of non-diagnostic biopsies, age of the patient, and years of biopsy attending experience were recorded. Groups were compared using Pearson's χ(2) test or Fisher's exact test.


RESULTS
In all, 140 of 963 (15%) biopsies were non-diagnostic. Lymphoma resulted in more non-diagnostic biopsies (P < 0.0001). While 67% of non-diagnostic biopsies yielded benign diagnoses, 33% yielded malignant diagnoses. Patients whose percutaneous biopsy was indicated due to the clinical context without malignancy history almost always generated benign results (96%). Whereas 56% of biopsies whose indication was an imaging finding of a treatable lesion were malignant, 20% of biopsies whose indication was a history of malignancy were malignant. There was no statistically significant difference in the nondiagnostic biopsy rates of pediatric versus adult patients (P = 0.8) and of biopsy attendings with fewer versus more years of experience (P = 0.5). The non-diagnostic rates of biopsies with FP (8%), POC cytology (25%), or neither (24%) were significantly different (P < 0.0001).


CONCLUSIONS
Lymphoma is the malignant diagnosis most likely to result in a non-diagnostic biopsy. If the clinical and radiologic suspicion for malignancy is high, repeat biopsy is warranted. If the clinical context suggests a benign lesion, a non-diagnostic biopsy may be considered reassuring. Frozen pathology may decrease the non-diagnostic biopsy rate.
Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA. cychang@mgh.harvard.edu.
Connie Y
CY
Chang
Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA. ajhuang@mgh.harvard.edu.
Ambrose J
AJ
Huang
Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA. mbredella@mgh.harvard.edu.
Miriam A
MA
Bredella
Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA. mtorriani@mgh.harvard.edu.
Martin
M
Torriani
Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA. elk@ita-mgh.org.
Elkan F
EF
Halpern
Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA. dirosenthal@mgh.harvard.edu.
Daniel I
DI
Rosenthal
Department of Orthopedics, Massachusetts General Hospital, Boston, MA, USA. dsprin1927@gmail.com.
Dempsey S
DS
Springfield
D000293:Adolescent; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000706:statistics & numerical data; D001859:Bone Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D001900:Boston / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015925:Cryopreservation / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D000067716:Point-of-Care Testing / Q000706:statistics & numerical data; D015995:Prevalence; D015641:Radiography, Interventional / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012983:Soft Tissue Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D055815:Young Adult
CT-guided biopsy; Frozen pathology; Nondiagnostic; Percutaneous