title: Diagnosing musculoskeletal tumours: How accurate is CT-guided core needle biopsy?
abstract: Biopsy is a critical juncture in the diagnostic process for evaluating musculoskeletal tumours. The traditional diagnostic standard of open biopsy yields highly accurate diagnoses but associated with it is a significant rate of procedural complications. Imaging-guided needle biopsy is now being widely adopted as a competitive and minimally-invasive alternative with significantly lower complication rates. We assess its diagnostic outcomes at a tertiary referral centre in Melbourne, Australia.
  
  
  
  Data pertaining to biopsy and surgical histology were retrieved from the musculoskeletal tumour database at St Vincent's Hospital, Fitzroy following approval from the Human Research Ethics Committee (HREC 091/13). Data analyses were performed in STATA 12 to assess diagnostic parameters and related outcomes.
  
  
  
  Bone tumours (n = 380) yielded accuracy of 80.8% with diagnostic error of 7.1% and undiagnostic rates of 12.1%. Soft-tissue tumours (n = 751) yielded accuracy of 83.2% with diagnostic error of 10.5% and undiagnostic rates of 6.3%. Biopsy of benign tumours (n = 648, accuracy = 85.3%, error = 5.9%, undiagnostic 8.8%) was more accurate than malignant tumours (n = 501, accuracy = 75.8%, error 14.0%, undiagnostic 7.4%). The overall procedural complication rate was 0.7%.
  
  
  
  CT-guided core needle biopsy is a safe, accurate, and highly effective procedure that obviates the need for open and surgical biopsy in a significant number of cases. When combined with fusion imaging, CT guidance is an accurate method of targeting specific regions of interest.
authors.affiliation: St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Trieu
authors.affiliation: Department of Radiology, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Australia.
authors.forename: S M
authors.initials: SM
authors.lastname: Schlicht
authors.affiliation: Department of Orthopaedics, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Australia; Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne, Australia; University of Melbourne, Department of Surgery, St Vincent's Hospital, 29 Regent Street, Fitzroy, Australia. Electronic address: pchoong@unimelb.edu.au.
authors.forename: P F M
authors.initials: PF
authors.lastname: Choong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle / Q000379:methods*; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002648:Child; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D009379:Neoplasms, Muscle Tissue / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D060726:Torso; D034941:Upper Extremity
keywords: Biopsy; Diagnostic errors; Image-guided biopsy; Sarcoma