Pearls and Pitfalls for Soft-Tissue and Bone Biopsies: A Cross-Institutional Review

Abstract

Management of soft-tissue and bone neoplasms depends on a definitive histologic diagnosis. Percutaneous image-guided biopsy of bone and soft-tissue tumors is a cost-effective and accurate method to obtain a histopathologic diagnosis. Biopsy requests must be approached thoughtfully to avoid numerous potential pitfalls. Hasty biopsy planning places the patient at increased risk for misdiagnosis, delayed therapy, repeated invasive procedures, and substantial morbidity. Biopsy planning begins with a thorough review of the relevant clinical history and pertinent imaging. The biopsy route must be planned in concert with the referring orthopedic oncologist to preserve limb-sparing options. Carefully selecting the most appropriate imaging modality to guide the biopsy increases the chances of reaching a definitive diagnosis. It is also critical to identify and target with expertise the part of the lesion that is most likely to yield an accurate diagnosis. Percutaneous biopsy is a safe procedure, and familiarity with preprocedural laboratory testing parameters, anticoagulation guidelines, and commonly used sedation medications minimizes the risk of complications while ensuring patient comfort. Nondiagnostic biopsy results are not infrequent and may still have value in guiding patient treatment. Awareness of the imaging manifestations of tumor recurrence is also important. The aim of this article is to provide a comprehensive review of pertinent preprocedural, periprocedural, and postprocedural considerations for bone and soft-tissue musculoskeletal biopsies.

Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part I. Ablation

“…6c) maximizing the benefits of the procedure by ensuring full coverage of the tumor while minimizing complications to surrounding vital structures. 65,80 Advantages of Cryoablation 1. Better visualization and control of the region ablated and direct visualization of the cryoablation zone (ice ball) both on CT and MRI, allowing for better planning while avoiding surrounding nontarget structures, particularly nerves.…”

Application of Machine Learning for Differentiating Bone Malignancy on Imaging: A Systematic Review

“…Moreover, more accurate characterizations of bone lesions would be valuable for radiologists to identify high-risk bone lesions that will benefit from biopsy to rule in malignancy with greater certainty. Unnecessary biopsies of benign bone lesions leave patients at risk of post-procedural complications, and hasty biopsy planning can increase the risk of misdiagnosis, creating unwarranted patient stress [ 188 , 189 ]. Biopsies can also be non-diagnostic in up to 30% of bone lesions, which requires repeat biopsies and an associated higher risk of complications [ 190 ].…”

Application of Indocyanine Green Fluorescence Imaging in Assisting Biopsy of Musculoskeletal Tumors

“…Biopsy has been found to be a safe, reliable, and accurate diagnostic tool in the diagnosis of musculoskeletal tumors. However, the positive rate of puncture biopsy of musculoskeletal tumors reported in the literature varies (70–97%) in different hospitals [ 7 , 18 , 19 , 20 , 21 , 22 ], and it is still necessary to improve the accuracy of biopsy. Near-infrared fluorescence imaging based on ICG has been used in tumor surgery by using clathrin-mediated endocytosis and the EPR effect of indocyanine green [ 23 , 24 , 25 ].…”

“…Bone tumors have deep lesions and are more difficult to puncture than prostate and breast cancers. At the same time, more musculoskeletal tumors have heterogeneous characteristics, which further increases the difficulty of obtaining accurate puncture specimens [ 7 ]. In the current biopsy process, there is no real-time method to determine whether the tumor biopsy lesions are successfully obtained to improve the accuracy rate of biopsy and then provide early detection, correct diagnosis, and timely treatment to patients.…”