title: Diagnostic accuracy of computed tomography-guided biopsy in pathological fractures.
abstract: BACKGROUND
  Obtaining a histological diagnosis is essential for appropriate management of pathological fractures. Computed tomography (CT) is an accurate method of obtaining diagnosis for musculoskeletal tumours. We analysed whether diagnostic accuracy was maintained in the evaluation of pathological fractures.
  
  
  METHODS
  A retrospective review of 101 consecutive patients presenting to our tertiary musculoskeletal tumour centre with pathological fracture was performed. Patients underwent core needle biopsy under CT guidance of pathological fractures diagnosed by plain radiography and either CT or magnetic resonance imaging. The histopathology of the CT-guided biopsy was compared with the sample obtained from open biopsy or definitive surgery to determine diagnostic accuracy.
  
  
  RESULTS
  The mean age at diagnosis was 52 ± 20 years (range: 18-85) in a cohort of 46 men and 55 women. Diagnostic accuracy of CT-guided biopsy was 82.18%. There were 65 malignant and 36 benign tumours with diagnostic accuracy of 86.15% and 80.56%, respectively. The positive predictive value for a malignant tumour was 98.21% whilst it was 93.1% for benign tumours. The femur (53 cases) and humerus (25 cases) were the commonest bones fractured. The most frequent diagnoses were metastasis (20.79%), giant cell tumour (17.82%), osteosarcoma (9.90%) and myeloma (9.90%). There were no complications of CT-guided biopsy.
  
  
  CONCLUSIONS
  Pathological fracture does not confound the diagnosis of musculoskeletal tumours. CT-guided biopsy is an accurate diagnostic tool in the evaluation of pathological fractures. Final diagnosis and management should be made in the context of appropriate anatomical and functional imaging using a multidisciplinary approach.
authors.affiliation: Department of Orthopaedics, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Stokes
authors.affiliation: Department of Orthopaedics, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: Osama
authors.initials: O
authors.lastname: Elsewaisy
authors.affiliation: Department of Orthopaedics, St Vincent's Hospital, Melbourne, Victoria, Australia.|Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Grant
authors.initials: G
authors.lastname: Pang
authors.affiliation: Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.|Department of Pathology, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: John L
authors.initials: JL
authors.lastname: Slavin
authors.affiliation: Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.|Department of Medical Imaging, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Schlicht
authors.affiliation: Department of Orthopaedics, St Vincent's Hospital, Melbourne, Victoria, Australia.|Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.|Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Peter F M
authors.initials: PFM
authors.lastname: Choong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D006801:Humans; D061705:Image-Guided Biopsy; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: biopsy; computed tomography-guided biopsy; musculoskeletal tumour; open biopsy; pathological fracture