Method for assuring accuracy of bone biopsy using technetium 99 bone scan

Abstract

In the clinical staging of malignancy, radionuclide bone scanning has played an increasingly important role. An area of increased radionuclide uptake on technetium 99 ( V c ) bone scan which is not visualized on skeletal radiographs can present a significant diagnostic dilemma. This can be further compounded by nonrevealing percutaneous or open surgical biopsies. The authors present a method of definitively localizing the appropriate site for bone biopsy in such circumstances. Use of this technique has allowed us to ascertain that isolated rib lesions in two patients with extra-osseous malignancies were not due to metastatic disease.Cancer 59 zontal planes (Figs. 1 and 2). A slun mark is placed directly over the rib lesion. Alternatively, a small quantity of sterile methylene blue dye may be injected directly onto the periosteal surface of the underlying rib. The patient is then transported to the surgical unit, anesthetized, and positioned on the operating table. Due to the degree of skin mobility over the thoracic cage, the accuracy of the skin mark should at this point be reconfirmed with a portable gamma camera. Open biopsy is then performed with a 3-cm segment of rib resected on either side of the skin mark. Anatomic orientation is maintained and the specimen is scanned using a pinhole collimator (Fig. 3) to confirm that the suspicious lesion has been entirely removed. Needles are placed into the resected rib to outline the area of increased radionuclide uptake and the specimen is submitted for decalcification and histologic examination.

Use of the Navigator Probe after Radiotracer Injection to Identify Nonpalpable Rib Lesions Requiring Surgical Resection

“…In a situation where lesions are not palpable, difficulty in identification may lead to a larger incision and resection of more rib than is necessary. Methods that have been used to aid in the localization of rib lesions include rib counting, 1 preoperative marking of the skin overlying the lesion, 2 wire-guided biopsies, 3 image-guided percutaneous biopsies, 4 preoperative methylene blue staining, 5 and serial x-ray films or scintigraphy with radiopaque markers. 6 The Navigator probe is a hand-held gamma counter (C-Trak Automatic, Carewise Medical Products Corp, Morgan Hill, CA) ( Fig.…”