purpose. To compare computed tomography (CT)-guided core needle biopsy (CNB) with incisional biopsy in diagnosing musculoskeletal lesions. Methods. 62 men and 50 women aged 12 to 83 (mean, 45) years who underwent a CT-guided CNB were compared with 31 men and 33 women aged 9 to 81 (mean, 53) years who underwent an incisional biopsy. All specimens had final pathology report to compare with. Comparisons were made in terms of (1) diagnostic rate, (2) accuracy in distinguishing benign from malignant lesions, (3) accuracy in distinguishing low-from high-grade sarcomas, (4) accuracy for histological diagnosis, and (5) p=1.00), the accuracy for specific diagnosis (75.9% vs. 85.2%, p=0.17), the repeated biopsy rate (6.3% vs. 4.7%, p=0.75), and the complication rate (0.9% vs. 4.7%, p=0.14). The accuracy for specific diagnosis was higher for bone than soft-tissue lesions for both CTguided CNB (87.0% vs. 59.5%, p=0.002) and incisional biopsy (87.0% vs. 77.3%, p=0.43). The accuracy of CT-guided CNB for specific diagnosis of benign softtissue tumours as well as infection and inflammation was relatively low. conclusion. CT-guided CNB is safe, easy to perform, efficient, and less invasive, and should be considered as a first-line biopsy for musculoskeletal lesions.

Background After total sacrectomy, many types of spinopelvic reconstruction have been described with good functional results. However, complications associated with reconstruction are not uncommon and usually result in further surgical interventions. Moreover,

BackgroundMetastatic bone disease involving the acetabulum is a debilitating condition causing significant pain and disability for patients. Many methods of reconstruction have been described for treating Harrington class II and III lesions with different results and complications. Our objectives were to report functional results, implant survival and complications following reconstruction for Harrington class II and III periacetabular metastases by using anti-protusio cages, screws and joint replacement.MethodsWe reviewed 22 patients undergoing acetabular reconstruction for metastatic disease. There were 5 Harrington class II and 17 class III lesions. Intralesional curettage, multiple screws and cemented total hip replacement were performed in all patients. Anti-protusio cages were used in 19 hips. No Steinmann pins were used. Sixteen patients died at a median survival time of 12 months (range, 4 to 28 months) after surgery. Six patients were alive at last follow-up at a median of 8 months (range, 3 to 15 months).ResultsPostoperatively, the average ECOG score was improved from 3.1 to 1.7 and Visual Analog Scale was improved from 8.4 to 2.2. One patient developed hip dislocation and one patient developed superficial infection. The mean Musculoskeletal Tumor Society (MSTS) functional score was 70 (range, 27 to 87). There was no prosthetic loosening or revision. Twenty patients were able to walk. Eight patients became community ambulators, twelve became household ambulators and two were bed-bound.ConclusionsGood functional outcome and better ambulation could be expected following class II and III periacetabular reconstruction using anti-protusio cages, screws and cemented hip replacement. Few complications were noted and manageable. Although most of these patients with metastatic disease had limited life expectancies, their quality of life would be improved with appropriate patient selection and surgical reconstruction.

We report on a 58-year-old woman who underwent total sacrectomy and spinopelvic reconstruction for a low-grade malignant peripheral nerve sheath tumour involving the sacrum. One week later, she developed deep wound infection, and the entire spinopelvic reconstruction was removed. At the 36-month followup, the patient had no pain and was able to walk with a walking frame. There was no sign of recurrence or metastasis.