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Ultrasound-guided synovial Tru-cut biopsy: indications, technique, and outcome in 111 cases

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To investigate the diagnostic performance of ultrasound-guided synovial biopsy.

Methods

Clinical notes, pathology and microbiology reports, ultrasound and other imaging studies of 100 patients who underwent 111 ultrasound-guided synovial biopsies were reviewed. Biopsies were compared with the final clinical diagnosis established after synovectomy (n = 43) or clinical/imaging follow-up (n = 57) (mean 30 months).

Results

Other than a single vasovagal episode, no complication of synovial biopsy was encountered. One hundred and seven (96 %) of the 111 biopsies yielded synovium histologically. Pathology ± microbiology findings for these 107 conclusive biopsies comprised synovial tumour (n = 30, 28 %), synovial infection (n = 18, 17 %), synovial inflammation (n = 45, 42 %), including gouty arthritis (n = 3), and no abnormality (n = 14, 13 %). The accuracy, sensitivity, and specificity of synovial biopsy was 99 %, 97 %, and 100 % for synovial tumour; 100 %, 100 %, and 100 % for native joint infection; and 78 %, 45 %, and 100 % for prosthetic joint infection. False-negative synovial biopsy did not seem to be related to antibiotic therapy.

Conclusion

Ultrasound-guided Tru-cut synovial biopsy is a safe and reliable technique with a high diagnostic yield for diagnosing synovial tumour and also, most likely, for joint infection. Regarding joint infection, synovial biopsy of native joints seems to have a higher diagnostic yield than that for infected prosthetic joints.

Key Points

• Ultrasound-guided Tru-cut synovial biopsy has high accuracy (99 %) for diagnosing synovial tumour.

• It has good accuracy, sensitivity, and high specificity for diagnosis of joint infection.

• Synovial biopsy of native joints works better than biopsy of prosthetic joints.

• A negative synovial biopsy culture from a native joint largely excludes septic arthritis.

• Ultrasound-guided Tru-cut synovial biopsy is a safe and well-tolerated procedure.

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Acknowledgments

The scientific guarantor of this publication is Prof. James F. Griffith. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: retrospective, cross sectional study, performed at one institution.

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Authors and Affiliations

  1. Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong

    Jacqueline C. M. Sitt, James F. Griffith, Ryan K. L. Lee & Alex W. H. Ng

  2. Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong

    Fernand M. Lai

  3. Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong

    Mamie Hui

  4. Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong

    K. H. Chiu

  5. Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong

    Jason Leung

Authors
  1. Jacqueline C. M. Sitt
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  2. James F. Griffith
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  3. Fernand M. Lai
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  4. Mamie Hui
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  7. Alex W. H. Ng
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Corresponding author

Correspondence to James F. Griffith.

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Sitt, J.C.M., Griffith, J.F., Lai, F.M. et al. Ultrasound-guided synovial Tru-cut biopsy: indications, technique, and outcome in 111 cases. Eur Radiol 27, 2002–2010 (2017). https://doi.org/10.1007/s00330-016-4545-6

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  • DOI: https://doi.org/10.1007/s00330-016-4545-6

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