European Radiology

, Volume 27, Issue 5, pp 2002–2010 | Cite as

Ultrasound-guided synovial Tru-cut biopsy: indications, technique, and outcome in 111 cases

  • Jacqueline C. M. Sitt
  • James F. Griffith
  • Fernand M. Lai
  • Mamie Hui
  • K. H. Chiu
  • Ryan K. L. Lee
  • Alex W. H. Ng
  • Jason Leung



To investigate the diagnostic performance of ultrasound-guided synovial biopsy.


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).


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.


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.

Key Points

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.


Synovium Ultrasound Biopsy Infection Tumour 



The scientific guarantor of this publication is Prof. James F. Griffith. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: retrospective, cross sectional study, performed at one institution.


  1. 1.
    Torriani M, Etchebehere M, Amstalden E (2002) Sonographically guided core needle biopsy of bone and soft tissue tumors. J Ultrasound Med 21:275–281CrossRefPubMedGoogle Scholar
  2. 2.
    Liu JC, Chiou HJ, Chen WM et al (2004) Sonographically guided core needle biopsy of soft tissue neoplasms. J Clin Ultrasound 32:294–298CrossRefPubMedGoogle Scholar
  3. 3.
    Hung EH, Griffith JF, Ng AW, Lee RK, Lau DT, Leung JC (2014) Ultrasound of musculoskeletal soft-tissue tumors superficial to the investing fascia. AJR Am J Roentgenol 202:W532–W540CrossRefPubMedGoogle Scholar
  4. 4.
    Epis O, Bruschi E (2014) Interventional ultrasound: a critical overview on ultrasound-guided injections and biopsies. Clin Exp Rheumatol 32:S78–S84PubMedGoogle Scholar
  5. 5.
    Gerlag DM, Tak PP (2009) How to perform and analyse synovial biopsies. Best Pract Res Clin Rheumatol 23:221–232CrossRefPubMedGoogle Scholar
  6. 6.
    Marin F, Lasbleiz J, Albert JD et al (2006) Synovial biopsy under US guidance: technical considerations and results. J Radiol 87:561–565CrossRefPubMedGoogle Scholar
  7. 7.
    Kelly S, Humby F, Filer A et al (2015) Ultrasound-guided synovial biopsy: a safe, well-tolerated and reliable technique for obtaining high-quality synovial tissue from both large and small joints in early arthritis patients. Ann Rheum Dis 74:611–617CrossRefPubMedGoogle Scholar
  8. 8.
    Gerlag DM, Tak PP (2013) How to perform and analyse synovial biopsies. Best Pract Res Clin Rheumatol 27:195–207CrossRefPubMedGoogle Scholar
  9. 9.
    van Vugt RM, van Dalen A, Bijlsma JW (1997) Ultrasound guided synovial biopsy of the wrist. Scand J Rheumatol 26:212–214CrossRefPubMedGoogle Scholar
  10. 10.
    Koski JM, Helle M (2005) Ultrasound guided synovial biopsy using portal and forceps. Ann Rheum Dis 64:926–929CrossRefPubMedGoogle Scholar
  11. 11.
    Scire CA, Epis O, Codullo V et al (2007) Immunohistological assessment of the synovial tissue in small joints in rheumatoid arthritis: validation of a minimally invasive ultrasound-guided synovial biopsy procedure. Arthritis Res Ther 9:R101CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Schweitzer ME, Deely DM, Beavis K, Gannon F (1995) Does the use of lidocaine affect the culture of percutaneous bone biopsy specimens obtained to diagnose osteomyelitis? An in vitro and in vivo study. AJR Am J Roentgenol 164:1201–1203CrossRefPubMedGoogle Scholar
  13. 13.
    Sams VG, Lawson CM, Coan P et al (2012) Effect of local anesthetic on microorganisms in a murine model of surgical site infection. J Trauma Acute Care Surg 73:441–445, discussion 5-6Google Scholar
  14. 14.
    Johnson SM, Saint John BE, Dine AP (2008) Local anesthetics as antimicrobial agents: a review. Surg Infect (Larchmt) 9:205–213CrossRefGoogle Scholar
  15. 15.
    Griffith JF (2014) Diagnostic ultrasound: musculoskeletal, 1st edn. Amirsys, Elsevier (II-7-38 to II-7-49; II-6-20 to II-6-25)Google Scholar
  16. 16.
    Chung CB, Boucher R, Resnick D (2009) MR imaging of synovial disorders of the knee. Semin Musculoskelet Radiol 13:303–325CrossRefPubMedGoogle Scholar
  17. 17.
    Frick MA, Wenger DE, Adkins M (2007) MR imaging of synovial disorders of the knee: an update. Radiol Clin N Am 45:1017–1031CrossRefPubMedGoogle Scholar
  18. 18.
    Narvaez JA, Narvaez J, Aguilera C, De Lama E, Portabella F (2001) MR imaging of synovial tumors and tumor-like lesions. Eur Radiol 11:2549–2560CrossRefPubMedGoogle Scholar
  19. 19.
    Wilson DJ (2004) Soft tissue and joint infection. Eur Radiol 14:E64–E71PubMedGoogle Scholar
  20. 20.
    Garner HW, Bestic JM (2013) Benign synovial tumors and proliferative processes. Semin Musculoskelet Radiol 17:177–178CrossRefPubMedGoogle Scholar
  21. 21.
    Parlier-Cuau C, Hamze B, Champsaur P, Nizard R, Laredo JD (1997) Percutaneous biopsy of the synovial membrane. Semin Musculoskelet Radiol 1:189–196CrossRefPubMedGoogle Scholar
  22. 22.
    Mueller T, Barthel T, Cramer A, Werner A, Gohlke F (2000) Primary synovial chondromatosis of the elbow. J Shoulder Elb Surg 9:319–322CrossRefGoogle Scholar
  23. 23.
    Yee DK, Chiu KY, Yan CH, Ng FY (2013) Review article: joint aspiration for diagnosis of periprosthetic infection. J Orthop Surg (Hong Kong) 21:236–240CrossRefGoogle Scholar
  24. 24.
    Cipriano C, Maiti A, Hale G, Jiranek W (2014) The host response: toll-like receptor expression in periprosthetic tissues as a biomarker for deep joint infection. J Bone Joint Surg Am 96:1692–1698CrossRefPubMedGoogle Scholar
  25. 25.
    Mavrogenis AF, Papagelopoulos PJ, Coll-Mesa L, Pala E, Guerra G, Ruggieri P (2011) Infected tumor prostheses. Orthopedics 34:991–998, quiz 9-1000Google Scholar

Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Jacqueline C. M. Sitt
    • 1
  • James F. Griffith
    • 1
  • Fernand M. Lai
    • 2
  • Mamie Hui
    • 3
  • K. H. Chiu
    • 4
  • Ryan K. L. Lee
    • 1
  • Alex W. H. Ng
    • 1
  • Jason Leung
    • 5
  1. 1.Department of Imaging & Interventional Radiology, Prince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong
  2. 2.Department of Anatomical and Cellular PathologyThe Chinese University of Hong KongShatinHong Kong
  3. 3.Department of MicrobiologyThe Chinese University of Hong KongShatinHong Kong
  4. 4.Department of Orthopedics and Traumatology, Prince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong
  5. 5.Jockey Club Centre for Osteoporosis Care and ControlThe Chinese University of Hong KongShatinHong Kong

Personalised recommendations