Percutaneous Imaging-Guided versus Open Musculoskeletal Biopsy: Concepts and Controversies

Abstract

Bone and soft tissue tumors are a largely heterogeneous group of tumors. Biopsy of musculoskeletal (MSK) tumors is sometimes a challenging procedure. Although the open biopsy is still considered the gold standard for the biopsy of MSK lesions, core needle biopsy can replace it in most cases, with similar accuracy and a low complication rate. The biopsy should be performed in a tertiary sarcoma center where the multidisciplinary team consists of at minimum a tumor surgeon, an MSK pathologist, and an MSK radiologist who can assess all steps of the procedure. Several factors can influence the success of the biopsy including the lesion characteristics, the equipment, and the method used for the procedure. This review highlights some of the important aspects regarding the biopsy of the MSK tumors, with special attention to imaging a guided core needle biopsy and highlighting some of the recent advancements and controversies in the field.

Giant muscle hydatid in lower extremity: a rare case with neurological symptoms as the first manifestation

“…In cases of soft tissue echinococcosis, a palpable slow-growing mass is the most common clinical finding. The clinical manifestations are caused by compression of the affected organ [ 7 ]. However, to the best of our knowledge, there have been no previous reports of hydatid cysts in muscle tissue presenting with peripheral nerve symptoms as the initial manifestation.…”

“…Utilizing all available imaging methods significantly contributes to the preoperative diagnosis. Different imaging modalities are complementary and often provide a definitive preoperative diagnosis [ 7 ]. Ultrasound and CT imaging can reveal a calcified cyst wall, microcalcifications in daughter cysts, and different fluid densities between the cysts and surrounding organs [ 7 , 12 ].…”

Ultrasound-guided biopsy of musculoskeletal soft-tissue tumors: basic principles, usefulness and limitations

“…It is essential that all imaging-guided soft-tissue biopsies are performed in a tertiary sarcoma center, under a multidisciplinary team management. The lesion management in a sarcoma center can save valuable time to final diagnosis, but can also significantly increase the survival and reduce the reoccurrence rate (10) .…”

“…The track should be removed with the final surgery of the tumor. The biopsy path of every percutaneous biopsy should be discussed with the oncologic orthopedist performing the surgery (10) . Because of the typical radial growth of the tumors within a compartment, the anatomical compartments of the extremities have to be respected, and the needle should not breach their barrier (12) .…”

“…The site of the lesion and its distance to the skin are mentioned as factors that can influence the needle biopsy result. Some difficult-to-assess lesions such as paraspinal tumors with deep localization are associated with a low biopsy accuracy (10) . Conversely, a recent study by Yoon et al (22) , examining factors contributing to the failure of US-guided core-needle MSK biopsies showed that the size, depth and location of the biopsy did not affect the diagnostic success significantly.…”