Study Finds Image-Guided Bone Biopsy Faster, Easier, Safer

5/28/2002

From: Maureen Morley, 630-590-7754, mmorley@rsna.org or Marijo Millette Zerfoss, 630-590-7727, mzerfoss@rsna.org, both of RSNA

OAK BROOK, Ill., May 28 -- As many as nine out of ten patients who have a bone tumor may now be able to get an exact tissue diagnosis without having to undergo open surgical biopsy, suggests a study published in the June issue of the journal Radiology. The alternative outlined in the study is a percutaneous (through-the-skin) needle biopsy closely guided by an imaging procedure, either computed tomography or fluoroscopy.

"The single most outstanding attribute of this method," said lead author James S. Jelinek, M.D., of the Washington Cancer Institute at Washington Hospital Center in Washington, D.C., "is that a patient can have a biopsy the same day he or she sees the orthopedic oncologist about a tumor."

The study showed that percutaneous biopsy, in most cases guided by CT, was performed on 110 patients with primary bone tumors and provided a conclusively correct tissue diagnosis 88 percent of the time, which is comparable to an open surgery biopsy result. The procedure correctly identified whether a given tumor was benign or malignant in all but two instances, for an impressive 98 percent rate of accuracy -- again, the same as surgical biopsy. Complications were limited to a single small blood clot at the biopsy site; no blood vessels or nerves were injured.

An open biopsy requires a general anesthetic and an incision that takes about 10 days to heal and leaves a two- to five-inch scar. No tumor treatment is recommended for two weeks.

In contrast, needle biopsy can be done immediately in the outpatient department. If indicated, treatment may begin the following day. The surgical incision is replaced by a small needle hole. Instead of general anesthesia, the patient is given a combination of intravenous sedation and local anesthetic. The procedure itself takes less than an hour to remove an average of five tissue samples, and the anesthesia wears off within two hours.

Among the advantages of percutaneous bone biopsy, compared to the traditional surgical method:

-- Specimens may be taken from different parts of a tumor, not just the exposed portion. -- It is much less invasive, allowing the treatment team to proceed almost immediately with tumor chemotherapy, radiation or surgery if needed. -- It is at least three times more cost effective. -- Complications are far less frequent.

With a skilled bone radiologist, pathologist and orthopedic surgeon working together, Dr. Jelinek believes that "today there is very little reason for an open surgical biopsy of a musculoskeletal tumor."

Radiology is a monthly scientific journal devoted to clinical radiology and allied sciences. The journal is edited by Anthony V. Proto, M.D., School of Medicine, Virginia Commonwealth University, Richmond, Virginia. Radiology is owned and published by the Radiological Society of North America (RSNA), Inc. The RSNA is an association of more than 30,000 radiologists and physicists in medicine dedicated to education and research in the science of radiology.