Iliac crest bone biopsy by interventional radiologists to improve access to bone biopsy in chronic kidney disease populations: technical note and a case series

Lavigne, Félix; Desbiens, Louis‐Charles; Garneau, Guillaume; Côté, François

doi:10.1007/s40620-020-00798-x

Cited by 8 publications

(7 citation statements)

References 12 publications

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“…Using a fluoroscopy-guided procedure with a standard 7.5-mm-diameter trephine (Rochester Kit), we have been able to further refine the bone biopsy technique allowing us to obtain a nearly perfect biopsy specimen in all cases. (8) Because standard bone markers are not reliable enough to estimate bone turnover level in CKD, bone histomorphometry analyses thus provide nephrologists essential information on the type of bone disease to guide anti-fracture therapy. (10,11) However, its invasiveness and highly specialized nature restricts its wide utilization.…”

Section: Discussionmentioning

confidence: 99%

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Division of an Iliac Crest Bone Biopsy Specimen to Allow Histomorphometry, Immunohistochemical, Molecular Analysis, and Tissue Banking: Technical Aspect and Applications

et al. 2020

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The evaluation of bone complications in chronic kidney disease (CKD) often requires a bone biopsy, the analysis of which can refine the diagnosis of bone defects. Bone histomorphometry performed on sections of the iliac crest biopsy remains the reference procedure for the quantitative assessment of bone health in CKD patients, whereas immunohistochemistry and other molecular biology analyses are indispensable tools for studying the disrupted signaling pathways. Traditionally, the whole iliac crest biopsy was included in methyl‐methacrylate (MMA) and was exclusively used for bone histomorphometry to describe static, dynamic, and structural parameters. Therefore, further molecular analysis of the bone tissue or the need for tissue banking would require a second biopsy to be made, because inclusion in MMA prevents the extraction of good‐quality nucleic acids. In this work, we describe a simple approach to divide a single iliac crest bone biopsy into multiple parts. This allows for simultaneous assessments of histology, immunohistochemistry, biomolecular analysis, and tissue banking while preserving the same bone surface area for histomorphometry. © 2020 American Society for Bone and Mineral Research © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 99%

“…All iliac crest biopsies were performed under fluoroscopy by an interventional radiologist, a new procedure that we recently described. ( 8 ) All procedures were conducted in accordance with the Declaration of Helsinki and were approved by local ethics committee. Written informed consent was obtained for all participants.…”

Section: Methodsmentioning

confidence: 99%

Division of an Iliac Crest Bone Biopsy Specimen to Allow Histomorphometry, Immunohistochemical, Molecular Analysis, and Tissue Banking: Technical Aspect and Applications

et al. 2020

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“…8 However, a Canadian study showed that the procedure, performed under fluoroscopy in interventional radiology, could restore biopsy to its central place in the management of complex cases. 9…”

Section: Renal Osteodystrophymentioning

confidence: 99%

Bone and Chronic Kidney Disease

Lafage-Proust

2023

Semin Musculoskelet Radiol

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Chronic kidney disease (CKD) induces mineral and bone disorders (CKD-MBD) that affect calcium and phosphate metabolism. This review links pathophysiology, histologic aspects, and radiologic signs. CKD leads to bone lesions, namely renal osteodystrophy, which may combine low or high bone remodeling, impaired mineralization, and bone loss. CKD-MBD also comprises vascular calcifications, which, together with bone disease, lead to a high risk of cardiovascular events and osteoporotic fractures that increase both morbidity and mortality. Osteoporosis assessment is based on screening for classic risk factors and CKD-related factors (disease duration/severity, transplantation history, dialysis vintage). Treatment of mineral disorders may combine serum phosphate lowering drugs, natural vitamin D or its 1-α derivatives, or calcium-sensing receptor agonists. Treatment of osteoporosis is conventional in mild to moderate stages but more complex in severe CKD because evidence about the efficacy and safety of anti-osteoporosis drugs is scant.

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“…The main reasons for the infrequent use of bone biopsy, other than the lack of widespread expertise in performing or interpreting bone biopsy results and the high costs, are the invasiveness and potential pain associated with the procedure. In this regard, various solutions are proposed, e.g., the use of fluoroscopy for a more precise localization of the biopsy site and the standardization of the intervention [ 10 ] or the use of a smaller trephine providing a halved biopsy [ 12 ].…”

Section: Limitations Of Bone Biopsymentioning

confidence: 99%

“…In recent decades the definition, classification and treatment of ROD were changed as a consequence of the introduction of new drugs and the prolonged survival of patients ( Table 1 [ 4 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]). Indeed, Malluche et al highlighted [ 18 ], in 630 bone biopsies carried out in CKD patients, both in Europe and the USA, from 2003 to 2008, a switch from a high bone turnover, as revealed in the past studies, to 58% of patients with a low bone turnover.…”

Section: Introductionmentioning

confidence: 99%

Bone Biopsy for Histomorphometry in Chronic Kidney Disease (CKD): State-of-the-Art and New Perspectives

Carbonare

Valenti

Giannini

et al. 2021

JCM

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The use of bone biopsy for histomorphometric analysis is a quantitative histological examination aimed at obtaining quantitative information on bone remodeling, structure and microarchitecture. The labeling with tetracycline before the procedure also allows for a dynamic analysis of the osteoblastic activity and mineralization process. In the nephrological setting, bone biopsy is indicated to confirm the diagnosis of subclinical or focal osteomalacia and to characterize the different forms of renal osteodystrophy (ROD). Even if bone biopsy is the gold standard for the diagnosis and specific classification of ROD, the use of this approach is very limited. The main reasons for this are the lack of widespread expertise in performing or interpreting bone biopsy results and the cost, invasiveness and potential pain associated with the procedure. In this regard, the sedation, in addition to local anesthesia routinely applied in Italian protocol, significantly reduces pain and ameliorates the pain perception of patients. Concerning the lack of widespread expertise, in Italy a Hub/Spokes model is proposed to standardize the analyses, optimizing the approach to CKD patients and reducing the costs of the procedure. In addition, new tools offer the possibility to evaluate the osteogenic potential or the ability to form bone under normal and pathological conditions, analyzing mesenchymal stem cells and their ability to differentiate in the osteogenic lineage. In the same way, circulating microRNAs are suggested as a tool for exploring osteogenic potential. The combination of different diagnostic approaches and the optimization of the bioptic procedure represent a concrete solution to spread the use of bone biopsy and optimize CKD patient management.

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Iliac crest bone biopsy by interventional radiologists to improve access to bone biopsy in chronic kidney disease populations: technical note and a case series

Cited by 8 publications

References 12 publications

Division of an Iliac Crest Bone Biopsy Specimen to Allow Histomorphometry, Immunohistochemical, Molecular Analysis, and Tissue Banking: Technical Aspect and Applications

Division of an Iliac Crest Bone Biopsy Specimen to Allow Histomorphometry, Immunohistochemical, Molecular Analysis, and Tissue Banking: Technical Aspect and Applications

Bone and Chronic Kidney Disease

Bone Biopsy for Histomorphometry in Chronic Kidney Disease (CKD): State-of-the-Art and New Perspectives

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