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Semin Musculoskelet Radiol 2021; 25(06): 711-724
DOI: 10.1055/s-0041-1735471
Review Article

Concepts in Musculoskeletal Bone and Soft Tissue Biopsy

Megan K. Mills 
1   Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
,
Richard L. Leake
1   Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
,
Amanda M. Crawford
1   Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
,
Maryam Soltanolkotabi
1   Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
,
Barry G. Hansford
2   Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon
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Abstract

Imaging-guided needle biopsy of musculoskeletal lesions is a high-yield and low-risk procedure that can be used for definitive characterization of indeterminate bone and soft tissue lesions. Familiarity with the preprocedural, technical, and postprocedural steps is vital for the appropriate management of these cases. Biopsy request triage requires an awareness of definitively benign conditions and other tumor mimics. A complete clinical, laboratory, and imaging work-up is essential for procedural planning and determining pathologic concordance. Consultation with an orthopaedic oncologist is a requisite step to ensure maximizing biopsy yield and to avoid interference with any future limb-sparing surgical intervention. Knowledge of the equipment, pertinent medications, and appropriate biopsy technique can minimize the risk of periprocedural complications. Finally, the radiologist may be required to discuss the concordance of histopathology with preprocedure imaging, perform repeat image-guided biopsy, and carefully interpret sarcoma surveillance imaging examinations.

Keywords

biopsy - sarcoma - tumor


Publikationsverlauf

Artikel online veröffentlicht:
22. Dezember 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Miller TT. Bone tumors and tumorlike conditions: analysis with conventional radiography. Radiology 2008; 246 (03) 662-674
    CrossrefPubMedGoogle Scholar
  • 2 Lehotska V. Soft-tissue tumors—role of diagnostic imaging. Bratisl Lek Listy 2005; 106 (6-7): 236-237
    PubMedGoogle Scholar
  • 3 Rougraff BT, Aboulafia A, Biermann JS, Healey J. Biopsy of soft tissue masses: evidence-based medicine for the Musculoskeletal Tumor Society. Clin Orthop Relat Res 2009; 467 (11) 2783-2791
    CrossrefPubMedGoogle Scholar
  • 4 Fayad LM, Kawamoto S, Kamel IR. et al. Distinction of long bone stress fractures from pathologic fractures on cross-sectional imaging: how successful are we?. AJR Am J Roentgenol 2005; 185 (04) 915-924
    CrossrefPubMedGoogle Scholar
  • 5 Kransdorf MJ, Meis JM, Jelinek JS. Myositis ossificans: MR appearance with radiologic-pathologic correlation. AJR Am J Roentgenol 1991; 157 (06) 1243-1248
    CrossrefPubMedGoogle Scholar
  • 6 Ward Sr WG, Rougraff B, Quinn R. et al. Tumors masquerading as hematomas. Clin Orthop Relat Res 2007; 465 (465) 232-240
    CrossrefPubMedGoogle Scholar
  • 7 Lex JR, Gregory J, Allen C, Reid JP, Stevenson JD. Distinguishing bone and soft tissue infections mimicking sarcomas requires multimodal multidisciplinary team assessment. Ann R Coll Surg Engl 2019; 101 (06) 405-410
    CrossrefPubMedGoogle Scholar
  • 8 Grey AC, Davies AM, Mangham DC, Grimer RJ, Ritchie DA. The ‘penumbra sign’ on T1-weighted MR imaging in subacute osteomyelitis: frequency, cause and significance. Clin Radiol 1998; 53 (08) 587-592
    CrossrefPubMedGoogle Scholar
  • 9 Martí-Bonmatí L, Aparisi F, Poyatos C, Vilar J. Brodie abscess: MR imaging appearance in 10 patients. J Magn Reson Imaging 1993; 3 (03) 543-546
    CrossrefPubMedGoogle Scholar
  • 10 Hui CL, Naidoo P. Extramedullary fat fluid level on MRI as a specific sign for osteomyelitis. Australas Radiol 2003; 47 (04) 443-446
    CrossrefPubMedGoogle Scholar
  • 11 Le HB, Lee ST, Munk PL. Image-guided musculoskeletal biopsies. Semin Intervent Radiol 2010; 27 (02) 191-198
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 12 Bestic JM, Wessell DE, Beaman FD. et al; Expert Panel on Musculoskeletal Imaging. ACR Appropriateness Criteria® Primary Bone Tumors. J Am Coll Radiol 2020; 17 (5S): S226-S238
    CrossrefPubMedGoogle Scholar
  • 13 Meek RD, Mills MK, Hanrahan CJ. et al. Pearls and pitfalls for soft-tissue and bone biopsies: a cross-institutional review. Radiographics 2020; 40 (01) 266-290
    CrossrefPubMedGoogle Scholar
  • 14 Siddiqi MA, Kim HS, Jede F, Han I. Association of core needle biopsy tract resection with local recurrence in extremity soft tissue sarcoma. Skeletal Radiol 2017; 46 (04) 507-512
    CrossrefPubMedGoogle Scholar
  • 15 Omura MC, Motamedi K, UyBico S, Nelson SD, Seeger LL. Revisiting CT-guided percutaneous core needle biopsy of musculoskeletal lesions: contributors to biopsy success. AJR Am J Roentgenol 2011; 197 (02) 457-461
    CrossrefPubMedGoogle Scholar
  • 16 Soliman MM, Aguado A, Sutton C. et al. Technical and nidus-specific factors associated with adequacy of intraprocedural biopsy samples preceding radiofrequency ablation of osteoid osteoma. Clin Imaging 2020; 61: 27-32
    CrossrefPubMedGoogle Scholar
  • 17 Barrientos-Ruiz I, Ortiz-Cruz EJ, Serrano-Montilla J, Bernabeu-Taboada D, Pozo-Kreilinger JJ. Are biopsy tracts a concern for seeding and local recurrence in sarcomas?. Clin Orthop Relat Res 2017; 475 (02) 511-518
    CrossrefPubMedGoogle Scholar
  • 18 Tan A, Rajakulasingam R, Saifuddin A. Diagnostic concordance between ultrasound-guided core needle biopsy and surgical resection specimens for histological grading of extremity and trunk soft tissue sarcoma. Skeletal Radiol 2021; 50 (01) 43-50
    CrossrefPubMedGoogle Scholar
  • 19 Yang J, Frassica FJ, Fayad L, Clark DP, Weber KL. Analysis of nondiagnostic results after image-guided needle biopsies of musculoskeletal lesions. Clin Orthop Relat Res 2010; 468 (11) 3103-3111
    CrossrefPubMedGoogle Scholar
  • 20 Hau A, Kim I, Kattapuram S. et al. Accuracy of CT-guided biopsies in 359 patients with musculoskeletal lesions. Skeletal Radiol 2002; 31 (06) 349-353
    CrossrefPubMedGoogle Scholar
  • 21 Michel SC, Pfirrmann CW, Boos N, Hodler J. CT-guided core biopsy of subchondral bone and intervertebral space in suspected spondylodiskitis. AJR Am J Roentgenol 2006; 186 (04) 977-980
    CrossrefPubMedGoogle Scholar
  • 22 Hillen TJ, Talbert RJ, Friedman MV. et al. Biopsy of CT-occult bone lesions using anatomic landmarks for CT guidance. AJR Am J Roentgenol 2017; 209 (01) 214-221
    CrossrefPubMedGoogle Scholar
  • 23 Peer S, Freuis T, Loizides A, Gruber H. Ultrasound guided core needle biopsy of soft tissue tumors; a foolproof technique?. Med Ultrason 2011; 13 (03) 187-194
    PubMedGoogle Scholar
  • 24 Espinosa LA, Jamadar DA, Jacobson JA. et al. CT-guided biopsy of bone: a radiologist's perspective. AJR Am J Roentgenol 2008; 190 (05) W283-9
    CrossrefPubMedGoogle Scholar
  • 25 Patel IJ, Rahim S, Davidson JC. et al. Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2019; 30 (08) 1168-1184.e1 , e1
    CrossrefPubMedGoogle Scholar
  • 26 Zandee van Rilland E, Kim S, Ni Mhuircheartaigh J, Shif Y, Kung J, Wu JS. Association of aspirin and other non-steroidal anti-inflammatory drugs with bleeding complications in image-guided musculoskeletal biopsies. Skeletal Radiol 2020; 49 (11) 1849-1854
    CrossrefPubMedGoogle Scholar
  • 27 Shif Y, Kung JW, McMahon CJ. et al. Safety of omitting routine bleeding tests prior to image-guided musculoskeletal core needle biopsy. Skeletal Radiol 2018; 47 (02) 215-221
    CrossrefPubMedGoogle Scholar
  • 28 Vanhelleputte P, Nijs K, Delforge M, Evers G, Vanderschueren S. Pain during bone marrow aspiration: prevalence and prevention. J Pain Symptom Manage 2003; 26 (03) 860-866
    CrossrefPubMedGoogle Scholar
  • 29 Anderson MW, Temple HT, Dussault RG, Kaplan PA. Compartmental anatomy: relevance to staging and biopsy of musculoskeletal tumors. AJR Am J Roentgenol 1999; 173 (06) 1663-1671
    CrossrefPubMedGoogle Scholar
  • 30 Liu PT, Valadez SD, Chivers FS, Roberts CC, Beauchamp CP. Anatomically based guidelines for core needle biopsy of bone tumors: implications for limb-sparing surgery. Radiographics 2007; 27 (01) 189-205 ; discussion 206
    CrossrefPubMedGoogle Scholar
  • 31 UyBico SJ, Motamedi K, Omura MC. et al. Relevance of compartmental anatomic guidelines for biopsy of musculoskeletal tumors: retrospective review of 363 biopsies over a 6-year period. J Vasc Interv Radiol 2012; 23 (04) 511-518 , 518.e1–518.e2
    CrossrefPubMedGoogle Scholar
  • 32 Rosenberg MB, Phero JC. Airway assessment for office sedation/anesthesia. Anesth Prog 2015; 62 (02) 74-80 ; quiz 80–81
    CrossrefPubMedGoogle Scholar
  • 33 Pino RM, Dunn PF, Kacmarek RM, Bryan RJ, Bigatello LM. An algorithm for the sedation of patients with obstructive sleep apnea by non-anesthesiologists. Curr Med Res Opin 2021; 37 (04) 531-534
    CrossrefPubMedGoogle Scholar
  • 34 Jakanani GC, Saifuddin A. Percutaneous image-guided needle biopsy of rib lesions: a retrospective study of diagnostic outcome in 51 cases. Skeletal Radiol 2013; 42 (01) 85-90
    CrossrefPubMedGoogle Scholar
  • 35 Li NP, Wingfield MA, Mills MK, Beckett BR, Hansford BG. Percutaneous image-guided sternal biopsy: a cross-institutional retrospective review of diagnostic yield and safety in 50 cases. Skeletal Radiol 2021; 50 (03) 495-504
    CrossrefPubMedGoogle Scholar
  • 36 Fursevich DM, LiMarzi GM, O'Dell MC, Hernandez MA, Sensakovic WF. Bariatric CT imaging: challenges and solutions. Radiographics 2016; 36 (04) 1076-1086
    CrossrefPubMedGoogle Scholar
  • 37 Modica MJ, Kanal KM, Gunn ML. The obese emergency patient: imaging challenges and solutions. Radiographics 2011; 31 (03) 811-823
    CrossrefPubMedGoogle Scholar
  • 38 Wu JS, Goldsmith JD, Horwich PJ, Shetty SK, Hochman MG. Bone and soft-tissue lesions: what factors affect diagnostic yield of image-guided core-needle biopsy?. Radiology 2008; 248 (03) 962-970
    CrossrefPubMedGoogle Scholar
  • 39 Datir A, Pechon P, Saifuddin A. Imaging-guided percutaneous biopsy of pathologic fractures: a retrospective analysis of 129 cases. AJR Am J Roentgenol 2009; 193 (02) 504-508
    CrossrefPubMedGoogle Scholar
  • 40 Altuntas AO, Slavin J, Smith PJ. et al. Accuracy of computed tomography guided core needle biopsy of musculoskeletal tumours. ANZ J Surg 2005; 75 (04) 187-191
    CrossrefPubMedGoogle Scholar
  • 41 Chang CY, Huang AJ, Bredella MA. et al. Percutaneous CT-guided needle biopsies of musculoskeletal tumors: a 5-year analysis of non-diagnostic biopsies. Skeletal Radiol 2015; 44 (12) 1795-1803
    CrossrefPubMedGoogle Scholar
  • 42 Roberts CC, Kransdorf MJ, Beaman FD. et al. ACR Appropriateness Criteria Follow-Up of Malignant or Aggressive Musculoskeletal Tumors. J Am Coll Radiol 2016; 13 (04) 389-400
    CrossrefPubMedGoogle Scholar
  • 43 Noebauer-Huhmann IM, Weber MA, Lalam RK. et al. Soft tissue tumors in adults: ESSR-approved guidelines for diagnostic imaging. Semin Musculoskelet Radiol 2015; 19 (05) e1
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 44 Erfanian Y, Grueneisen J, Kirchner J. et al. Integrated 18F-FDG PET/MRI compared to MRI alone for identification of local recurrences of soft tissue sarcomas: a comparison trial. Eur J Nucl Med Mol Imaging 2017; 44 (11) 1823-1831
    CrossrefPubMedGoogle Scholar
  • 45 Cheney MD, Giraud C, Goldberg SI. et al. MRI surveillance following treatment of extremity soft tissue sarcoma. J Surg Oncol 2014; 109 (06) 593-596
    CrossrefPubMedGoogle Scholar
  • 46 Labarre D, Aziza R, Filleron T. et al. Detection of local recurrences of limb soft tissue sarcomas: is magnetic resonance imaging (MRI) relevant?. Eur J Radiol 2009; 72 (01) 50-53
    CrossrefPubMedGoogle Scholar
  • 47 Rothermundt C, Whelan JS, Dileo P. et al. What is the role of routine follow-up for localised limb soft tissue sarcomas? A retrospective analysis of 174 patients. Br J Cancer 2014; 110 (10) 2420-2426
    CrossrefPubMedGoogle Scholar
  • 48 Sabolch A, Feng M, Griffith K. et al. Risk factors for local recurrence and metastasis in soft tissue sarcomas of the extremity. Am J Clin Oncol 2012; 35 (02) 151-157
    CrossrefPubMedGoogle Scholar
  • 49 Mark RJ, Poen JC, Tran LM, Fu YS, Juillard GF. Angiosarcoma. A report of 67 patients and a review of the literature. Cancer 1996; 77 (11) 2400-2406
    CrossrefPubMedGoogle Scholar
  • 50 Gaballah AH, Jensen CT, Palmquist S. et al. Angiosarcoma: clinical and imaging features from head to toe. Br J Radiol 2017; 90 (1075): 20170039
    CrossrefPubMedGoogle Scholar
  • 51 Gladdy RA, Qin LX, Moraco N, Agaram NP, Brennan MF, Singer S. Predictors of survival and recurrence in primary leiomyosarcoma. Ann Surg Oncol 2013; 20 (06) 1851-1857
    CrossrefPubMedGoogle Scholar
  • 52 Waters B, Panicek DM, Lefkowitz RA. et al. Low-grade myxofibrosarcoma: CT and MRI patterns in recurrent disease. AJR Am J Roentgenol 2007; 188 (02) W193-8
    CrossrefPubMedGoogle Scholar
  • 53 Lin CN, Chou SC, Li CF. et al. Prognostic factors of myxofibrosarcomas: implications of margin status, tumor necrosis, and mitotic rate on survival. J Surg Oncol 2006; 93 (04) 294-303
    CrossrefPubMedGoogle Scholar
  • 54 Zagars GK, Mullen JR, Pollack A. Malignant fibrous histiocytoma: outcome and prognostic factors following conservation surgery and radiotherapy. Int J Radiat Oncol Biol Phys 1996; 34 (05) 983-994
    CrossrefPubMedGoogle Scholar
  • 55 Alpert JS, Boland P, Hameed M, Panicek DM. Undifferentiated pleomorphic sarcoma: indolent, tail-like recurrence of a high-grade tumor. Skeletal Radiol 2018; 47 (01) 141-144
    CrossrefPubMedGoogle Scholar
  • 56 Alamanda VK, Delisca GO, Archer KR, Song Y, Schwartz HS, Holt GE. Incomplete excisions of extremity soft tissue sarcomas are unaffected by insurance status or distance from a sarcoma center. J Surg Oncol 2013; 108 (07) 477-480
    CrossrefPubMedGoogle Scholar
  • 57 Alramdan MHA, Kasalak Ö, Been LB, Suurmeijer AJH, Yakar D, Kwee TC. MRI after Whoops procedure: diagnostic value for residual sarcoma and predictive value for an incomplete second resection. Skeletal Radiol 2021; April 26
    PubMedGoogle Scholar
  • 58 Lantos JE, Hwang S, Panicek DM. Benign mural nodules within fluid collections at MRI after soft-tissue sarcoma resection. AJR Am J Roentgenol 2014; 202 (06) 1297-1302
    CrossrefPubMedGoogle Scholar
  • 59 Caracciolo JT, Letson GD. Radiologic approach to bone and soft tissue sarcomas. Surg Clin North Am 2016; 96 (05) 963-976
    CrossrefPubMedGoogle Scholar
  • 60 Bluemke DA, Fishman EK, Scott Jr WW. Skeletal complications of radiation therapy. Radiographics 1994; 14 (01) 111-121
    CrossrefPubMedGoogle Scholar
  • 61 Moore LF, Kransdorf MJ, Buskirk SJ, O'Connor MI, Menke DM. Radiation-induced pseudotumor following therapy for soft tissue sarcoma. Skeletal Radiol 2009; 38 (06) 579-584
    CrossrefPubMedGoogle Scholar
  • 62 Fox MG, Bancroft LW, Peterson JJ, Kransdorf MJ, Terkonda SP, O'Connor MI. MRI appearance of myocutaneous flaps commonly used in orthopedic reconstructive surgery. AJR Am J Roentgenol 2006; 187 (03) 800-806
    CrossrefPubMedGoogle Scholar
  • 63 Manzella A, Filho PB, Albuquerque E, Farias F, Kaercher J. Imaging of gossypibomas: pictorial review. AJR Am J Roentgenol 2009; 193 (6, Suppl): S94-S101
    CrossrefPubMedGoogle Scholar
  • 64 Noebauer-Huhmann IM, Weber MA, Lalam RK. et al. Soft tissue tumors in adults: ESSR-approved guidelines for diagnostic imaging. Semin Musculoskelet Radiol 2015; 19 (05) 475-482
    Artikel in Thieme ConnectPubMedGoogle Scholar