REGULAR CONTENT
Final ID
636
Type
Educational Exhibit-Poster Only
Authors
S Abboud1, V Kosaraju1, M Wolf2, P Young1, M Robbin1, C Kosmas1
Institutions
1University Hospitals Cleveland Medical Center, Cleveland, OH, 2University Hospitals Cleveland Medical Center, United States
Purpose
Adequate and precise sampling of suspicious musculoskeletal (MSK) lesions is becoming increasingly important in an era of emerging targeted therapies. Strategies and success rates for initial percutaneous image-guided biopsy of MSK lesions have been well documented; however, success rates for repeat MSK biopsy (RMB) following initially non-diagnostic sampling of MSK lesions have not been well documented in the literature. The purpose of this study is to 1) evaluate the success rates of CT-guided RMB following initial non-diagnostic sampling at a single large academic medical center and 2) describe strategies that may help increase RMB success rates.
Materials & Methods
IRB approval was obtained for this retrospective study. A search of the electronic medical record yielded 42 patients that received 1 or more repeat biopsies for a single musculoskeletal pathologic process, defined as a lesion (or group of similar lesions in disparate locations) in the skeleton, extremities, or wall or musculature of the pelvis, abdomen, or chest after an initial non-diagnostic biopsy attempt. Lesion location, initial and RMB imaging and histopathology results, type and size of biopsy needle, and change in technique and/or biopsy strategy between biopsy attempts was documented. Successful repeat biopsy attempts were categorized as employing 1 of 5 technique strategies to improve diagnostic yield.
Results
Four of 42 patients were excluded due to lack of final histopathology results for the first or second biopsy attempt. 24 of 38 (63%) RMB attempts were successful. Most common results for successful RMB were neoplasm in 18/24 (75%) and infection in 3/24 (13%). Successful RMB were described as employing 1) Improved lesion targeting using prior diagnostic MRI or CT (9/24), 2) specific targeting of a soft tissue component of the lesion (6/24), 3) increasing number/size of core-biopsy samples (4/24), 4) targeting an enhancing portion of the lesion as seen on prior contrast-enhanced MRI (2/24), 5) sampling a separate lesion (2/24), and 6) no change in strategy (1/24).
Conclusions
Repeat image-guided biopsy of MSK lesions can often yield new diagnostic information, and certain strategies may optimize success rates.
Final ID
636
Type
Educational Exhibit-Poster Only
Authors
S Abboud1, V Kosaraju1, M Wolf2, P Young1, M Robbin1, C Kosmas1
Institutions
1University Hospitals Cleveland Medical Center, Cleveland, OH, 2University Hospitals Cleveland Medical Center, United States
Purpose
Adequate and precise sampling of suspicious musculoskeletal (MSK) lesions is becoming increasingly important in an era of emerging targeted therapies. Strategies and success rates for initial percutaneous image-guided biopsy of MSK lesions have been well documented; however, success rates for repeat MSK biopsy (RMB) following initially non-diagnostic sampling of MSK lesions have not been well documented in the literature. The purpose of this study is to 1) evaluate the success rates of CT-guided RMB following initial non-diagnostic sampling at a single large academic medical center and 2) describe strategies that may help increase RMB success rates.
Materials & Methods
IRB approval was obtained for this retrospective study. A search of the electronic medical record yielded 42 patients that received 1 or more repeat biopsies for a single musculoskeletal pathologic process, defined as a lesion (or group of similar lesions in disparate locations) in the skeleton, extremities, or wall or musculature of the pelvis, abdomen, or chest after an initial non-diagnostic biopsy attempt. Lesion location, initial and RMB imaging and histopathology results, type and size of biopsy needle, and change in technique and/or biopsy strategy between biopsy attempts was documented. Successful repeat biopsy attempts were categorized as employing 1 of 5 technique strategies to improve diagnostic yield.
Results
Four of 42 patients were excluded due to lack of final histopathology results for the first or second biopsy attempt. 24 of 38 (63%) RMB attempts were successful. Most common results for successful RMB were neoplasm in 18/24 (75%) and infection in 3/24 (13%). Successful RMB were described as employing 1) Improved lesion targeting using prior diagnostic MRI or CT (9/24), 2) specific targeting of a soft tissue component of the lesion (6/24), 3) increasing number/size of core-biopsy samples (4/24), 4) targeting an enhancing portion of the lesion as seen on prior contrast-enhanced MRI (2/24), 5) sampling a separate lesion (2/24), and 6) no change in strategy (1/24).
Conclusions
Repeat image-guided biopsy of MSK lesions can often yield new diagnostic information, and certain strategies may optimize success rates.