Percutaneous biopsy of musculo-skeletal lesions

Abstract

Modern treatment of skeletal disorders has become more complex and specific, increasing the demand for precise histologic and bacteriologic diagnosis. In many clinical situations, percutaneous biopsy (PB) of musculoskeletal lesions can establish a definitive diagnosis without the disadvantages of surgery, making it a useful alternative to open biopsy. Although PB of musculo-skeletal lesions is an established technique, its potential contribution to the management of the patient with bone or joint disorders is not fully appreciated. Technologic advances in radiology have dramatically improved the capabilities of PB. With either fluoroscopic guidance or CT scan control, a biopsy of most lesions of bones, joints and muscles can be readily performed using a percutaneous approach. Preoperative CT scan is also a useful tool for determining the most adequate biopsy technique in each particular case. At the same time, progress in pathologic and bacteriologic capabilities have also improved the accuracy of PB results. Radiologists are in a unique position to perform PB of skeletal disorders [44] since they administer the multiple imaging procedures most likely to identify and evaluate the significance of the abnormality [39]. In addition, they have a dynamic three-dimensional approach to anatomy and spatial needle placement. With current levels of radiologic invasive diagnosis and therapeutic intervention, radiologists have the skills required for PB [39]. However, the radiologist must be a member of a team including the referring physician, a pathologist and a microbiologist. Biopsies should be planned and performed in a way that would not adversely affect subsequent definitive surgical procedures. Surgical advice concerning the biopsy approach should be sought each time surgical treatment of the lesion is considered.