Percutaneous needle biopsy of lesions aftecting the musculoskeletal system should be considered a routine radiologic procedure.Although relatively safe, the procedure requires expertise. An experienced radiologist and the cooperation of a skilled pathologist are essential. Consultation with the orthopedic surgeon is also important, especially when resection of the lesion is contemplated.Recent advances in imaging techniques and the availability of various cuffing and trephine needles have made it easier to perform biopsies safely and accurately, even in difficult locations. The procedure obviates surgery in many instances and facilitates appropriate surgical planning in others. This review offers a pragmatic approach to percutaneous needle biopsy of skeletal lesions. It is hoped that more radiologists will be encouraged to undertake these valuable procedures.

Twenty-five patients who had histologically proved osteoid osteoma and whose major symptom was joint pain were studied. Retrospective study of clinical data and radiographs revealed that almost all of the lesions were located near the painful joint and that there had been significant delay in determination of the correct diagnosis. The delay was related to the nonspecificity of symptoms, the latency between the onset of symptoms and the appearance of the lesion on radiologic study, and the evaluation sequence used in some patients. The relative effectiveness of various diagnostic modalities is discussed. Radionuclide bone scanning, plain radiography, and guided tomography are the most useful diagnostic studies.

CT was used during the percutaneous needle biopsies of seven cervical spine lesions. Four were primary bone tumors, and there was one case each of metastasis, fibrous dysplasia, and infection. Two of the lesions were located in the lateral masses of Cl and one was in the pedicle of C2. The other four were in the lower cervical spine (C4-C6). Accurate diagnosis was obtained on the first attempt in six (86%) Materials and MethodsFour men and three women underwent percutaneous biopsy of cervical spine lesions using CT guidance. All of them presented with neck pain of varying duration. The lesion was solitary in all seven. Ages ranged from 19 to 72 years (mean, 45). Purely lytic, mixed lytic, and sclerotic lesions were all induded.Preoperative evaluation induded cervical spine radiographs and a radionudkle bone scan. Hematocrit, prothrombin time, partial thromboplastin time, and a platelet count were performed. A careful history of any bleeding tendency or ingestion of nonsteroidal anti-inflammatory drugs was obtained.The type of biopsy needle used was based in part on the size of the lesion and the necessity of having densely mineralized bone in the sample. When it was not necessary to transgress cortical bone, a Tru-Cut needle (Travenol Laboratories, Inc., Deerfield, IL) was used to obtain a large, soft-tissue core. For biopsies through an intact vertebral cortex, a trephine needle such as the Turkel needle (Turkel Instruments Inc., Southfield, Ml) was used. For small lesions or for lesions in particularly difficuft anatomic sites, a 20-gauge cutting needle was preferred.In the cervical spine, an anterior approach was used for the vertebral bodies. The patient was supine, and the needle was advanced between the pharynx and the carotid artery (Fig.

A retrospective review was made of the pretreatment radiographs of 20 patients with well-documented primary lymphoma of bone. Nine radiographic signs were defined, and the presence or absence of each was recorded for each patient. When the radiographic findings were compared with disease-free survival for each patient, it was found that patients who had a relapse had a higher mean number of positive radiographic signs than those who remained disease free (p less than 0.02). Also, those who relapsed early had more positive signs than those who relapsed late (p less than 0.05). Certain signs, i.e., pathologic fracture, layered periosteal new bone, broken periosteal new bone, cortical breakthrough, soft-tissue mass, and soft-tissue swelling, were more helpful than others for making a prognosis. These signs appear to be related to radiologic evidence of imminent or actual soft-tissue extension of the tumor.

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