title: Ultrasound-guided synovial Tru-cut biopsy: indications, technique, and outcome in 111 cases.
abstract: OBJECTIVE
  To investigate the diagnostic performance of ultrasound-guided synovial biopsy.
  
  
  METHODS
  Clinical notes, pathology and microbiology reports, ultrasound and other imaging studies of 100 patients who underwent 111 ultrasound-guided synovial biopsies were reviewed. Biopsies were compared with the final clinical diagnosis established after synovectomy (n = 43) or clinical/imaging follow-up (n = 57) (mean 30 months).
  
  
  RESULTS
  Other than a single vasovagal episode, no complication of synovial biopsy was encountered. One hundred and seven (96 %) of the 111 biopsies yielded synovium histologically. Pathology ± microbiology findings for these 107 conclusive biopsies comprised synovial tumour (n = 30, 28 %), synovial infection (n = 18, 17 %), synovial inflammation (n = 45, 42 %), including gouty arthritis (n = 3), and no abnormality (n = 14, 13 %). The accuracy, sensitivity, and specificity of synovial biopsy was 99 %, 97 %, and 100 % for synovial tumour; 100 %, 100 %, and 100 % for native joint infection; and 78 %, 45 %, and 100 % for prosthetic joint infection. False-negative synovial biopsy did not seem to be related to antibiotic therapy.
  
  
  CONCLUSIONS
  Ultrasound-guided Tru-cut synovial biopsy is a safe and reliable technique with a high diagnostic yield for diagnosing synovial tumour and also, most likely, for joint infection. Regarding joint infection, synovial biopsy of native joints seems to have a higher diagnostic yield than that for infected prosthetic joints.
  
  
  CONCLUSIONS
  • Ultrasound-guided Tru-cut synovial biopsy has high accuracy (99 %) for diagnosing synovial tumour. • It has good accuracy, sensitivity, and high specificity for diagnosis of joint infection. • Synovial biopsy of native joints works better than biopsy of prosthetic joints. • A negative synovial biopsy culture from a native joint largely excludes septic arthritis. • Ultrasound-guided Tru-cut synovial biopsy is a safe and well-tolerated procedure.
authors.affiliation: Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
authors.forename: Jacqueline C M
authors.initials: JC
authors.lastname: Sitt
authors.affiliation: Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong. griffith@cuhk.edu.hk.
authors.forename: James F
authors.initials: JF
authors.lastname: Griffith
authors.affiliation: Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Fernand M
authors.initials: FM
authors.lastname: Lai
authors.affiliation: Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Mamie
authors.initials: M
authors.lastname: Hui
authors.affiliation: Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: K H
authors.initials: KH
authors.lastname: Chiu
authors.affiliation: Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
authors.forename: Ryan K L
authors.initials: RK
authors.lastname: Lee
authors.affiliation: Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
authors.forename: Alex W H
authors.initials: AW
authors.lastname: Ng
authors.affiliation: Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Jason
authors.initials: J
authors.lastname: Leung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015210:Arthritis, Gouty / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D015838:Chondromatosis, Synovial / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D002813:Chondrosarcoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D005260:Female; D045888:Ganglion Cysts / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012983:Soft Tissue Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D000074402:Synovectomy; D013583:Synovial Membrane / Q000000981:diagnostic imaging / Q000473:pathology*; D013585:Synovitis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D013586:Synovitis, Pigmented Villonodular / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D014463:Ultrasonography; D055815:Young Adult
keywords: Biopsy; Infection; Synovium; Tumour; Ultrasound