Percutaneous bone biopsy

Abstract

Image guided percutaneous biopsy has become the initial procedure of choice in most cases for obtaining bone samples for histological and microbiological assessment. It is a minimally invasive procedure which offers multiple advantages over open surgical biopsy including maintenance of bone structure, minimal soft tissue injury, reduced need of general anesthesia, reduced hospital stay and a low rate of post-procedure complications. In some cases, it can be combined with therapeutic procedures such as cementoplasty and cryoablation via the same access route. For the radiologist, knowledge of the key principles is essential for a safe and effective procedure, particularly when a sarcoma of bone is in the differential diagnosis. In this article we cover the core concepts of percutaneous bone biopsy including indications and contraindications, essential planning steps, appropriate imaging modalities, equipment selection, common approaches, technique as well as avoiding, recognizing and treating complications. Recent technological advancements in this field are also discussed. Image guided percutaneous biopsy has become the initial procedure of choice in most cases for obtaining bone samples for histological and microbiological assessment. It is a minimally invasive procedure which offers multiple advantages over open surgical biopsy including maintenance of bone structure, minimal soft tissue injury, reduced need of general anesthesia, reduced hospital stay and a low rate of post-procedure complications. In some cases, it can be combined with therapeutic procedures such as cementoplasty and cryoablation via the same access route. For the radiologist, knowledge of the key principles is essential for a safe and effective procedure, particularly when a sarcoma of bone is in the differential diagnosis. In this article we cover the core concepts of percutaneous bone biopsy including indications and contraindications, essential planning steps, appropriate imaging modalities, equipment selection, common approaches, technique as well as avoiding, recognizing and treating complications. Recent technological advancements in this field are also discussed. IntroductionPercutaneous bone biopsy (PCBB) has become the initial procedure of choice over open surgical biopsy for most cases to establish a histopathological or bacteriological diagnosis. It is a minimally invasive technique that offers multiple advantages, including maintenance of bone structure, minimal soft tissue injury, avoidance of general anesthesia, reduced hospital stay, lower cost, and lower rates of post-procedure complications.1Gangi A. Guth S. Guermazi A. Bierry G. Buy X. Percutaneous Bone Biopsy, In: Imaging in percutaneous musculoskeletal interventions. 2009. Springer, Verlag Berlin Heidelberg2009: 15-36Google ScholarPercutaneous biopsy for diagnosis of skeletal lesions was first described by Coley et al in 19311Gangi A. Guth S. Guermazi A. Bierry G. Buy X. Percutaneous Bone Biopsy, In: Imaging in percutaneous musculoskeletal interventions. 2009. Springer, Verlag Berlin Heidelberg2009: 15-36Google Scholar and Lalli was the first to describe fluoroscopy-guided aspiration biopsy of skeletal lesions in 1970.2Gogna A. Peh W.C.G. Munk P.L Image-guided musculoskeletal biopsy.Radiol Clin North Am. 2008; 46: 455-473Google Scholar Since then, there have been multiple groundbreaking developments in imaging modalities and equipment such as needles and drills. Recently, there have been significant advancements, including fusion imaging, real-time 3D needle guidance, and the introduction of robotics.This article discusses the basic concepts of bone biopsy, including; indications and contraindications, common approaches, equipment and imaging modalities, complications, and recent advancements.IndicationsThe decision to biopsy and interpretation of the result should always be taken in the context of the clinical, laboratory, and diagnostic imaging findings. Some lesions have characteris