Pediatric Radiology

, Volume 41, Issue 7, pp 848–857 | Cite as

Accuracy of CT-guided percutaneous core needle biopsy for assessment of pediatric musculoskeletal lesions

  • Anastasia L. HryhorczukEmail author
  • Peter J. Strouse
  • J. Sybil Biermann
Original Article



CT-guided percutaneous core needle biopsy has been shown in adults to be an effective diagnostic tool for a large number of musculoskeletal malignancies.


To characterize our experience with CT-guided percutaneous core needle biopsy of pediatric bone lesions and determine its utility in diagnosing pediatric osseous lesions, in a population where such lesions are commonly benign.

Materials and methods

From 2000 to 2009, 61 children underwent 63 CT-guided percutaneous biopsies. Radiological, pathological and clinical records were reviewed.


Fourteen biopsies (22%) were performed on malignant lesions, while 49 biopsies (78%) were performed on benign lesions. Forty-nine of the 63 biopsies (78%) were adequate; these children underwent no further tissue sampling. Fourteen of the 63 biopsies (22%) were inadequate or non-conclusive. Of these patients, 12 underwent open biopsy. Retrospective analysis of percutaneous biopsies in these patients demonstrates that 9/12 provided clinically relevant information, and 4/12 patients received final diagnoses that confirmed initial core biopsy findings. No malignancies were diagnosed as benign on percutaneous biopsy. Overall, percutaneous core needle biopsy provided accurate diagnostic information in 84% (53/63) of biopsies.


Our results demonstrate that CT-guided percutaneous biopsy is safe and beneficial in children. This study supports the use of CT-guided percutaneous core needle biopsy for primary diagnosis of pediatric bone lesions.


CT Musculoskeletal Biopsy Interventional Children 


  1. 1.
    Altuntas AO, Slavin J, Smith PJ et al (2005) Accuracy of computed tomography guided core needle biopsy of musculoskeletal tumours. ANZ J Surg 75:187–191PubMedCrossRefGoogle Scholar
  2. 2.
    Jelinek JS, Murphey MD, Welker JA et al (2002) Diagnosis of primary bone tumors with image-guided percutaneous biopsy: experience with 110 tumors. Radiology 223:731–737PubMedCrossRefGoogle Scholar
  3. 3.
    Puri A, Shingade VU, Agarwal MG et al (2006) CT-guided percutaneous core needle biopsy in deep seated musculoskeletal lesions: a prospective study of 128 cases. Skeletal Radiol 35:138–143PubMedCrossRefGoogle Scholar
  4. 4.
    Skrzynski MC, Biermann JS, Montag A et al (1996) Diagnostic accuracy and charge-savings of outpatient core needle biopsy compared with open biopsy of musculoskeletal tumors. J Bone Joint Surg Am 78:644–649PubMedGoogle Scholar
  5. 5.
    Bellaiche L, Hamze B, Parlier-Cuau C et al (1997) Percutaneous biopsy of musculoskeletal lesions. Semin Musculoskelet Radiol 1:177–188PubMedCrossRefGoogle Scholar
  6. 6.
    Bickels J, Jelinek JS, Shmookler BM et al (1999) Biopsy of musculoskeletal tumors: current concepts. Clin Orthop Relat Res 368:212–219PubMedCrossRefGoogle Scholar
  7. 7.
    Fraser-Hill MA, Renfrew DL (1992) Percutaneous needle biopsy of musculoskeletal lesions. 1. Effective accuracy and diagnostic utility. AJR 158:809–812PubMedGoogle Scholar
  8. 8.
    Fraser-Hill MA, Renfrew DL, Hilsenrath PE (1992) Percutaneous needle biopsy of musculoskeletal lesions. 2. Cost-effectiveness. AJR 158:813–818PubMedGoogle Scholar
  9. 9.
    Kattapuram SV, Rosenthal DI (1991) Percutaneous biopsy of skeletal lesions. AJR 157:935–942PubMedGoogle Scholar
  10. 10.
    Shin HJ, Amaral JG, Armstrong D et al (2007) Image-guided percutaneous biopsy of musculoskeletal lesions in children. Pediatr Radiol 37:362–369PubMedCrossRefGoogle Scholar
  11. 11.
    Espinosa LA, Jamadar DA, Jacobson JA et al (2008) CT-guided biopsy of bone: a radiologist’s perspective. AJR 190:W283–289PubMedCrossRefGoogle Scholar
  12. 12.
    Logan PM, Connell DG, O’Connell JX et al (1996) Image-guided percutaneous biopsy of musculoskeletal tumors: an algorithm for selection of specific biopsy techniques. AJR 166:137–141PubMedGoogle Scholar
  13. 13.
    White LM, Schweitzer ME, Deely DM (1996) Coaxial percutaneous needle biopsy of osteolytic lesions with intact cortical bone. AJR 166:143–144PubMedGoogle Scholar
  14. 14.
    Iemsawatdikul K, Gooding CA, Twomey EL et al (2005) Seeding of osteosarcoma in the biopsy tract of a patient with multifocal osteosarcoma. Pediatr Radiol 35:717–721PubMedCrossRefGoogle Scholar
  15. 15.
    Liu PT, Valadez SD, Chivers FS et al (2007) Anatomically based guidelines for core needle biopsy of bone tumors: implications for limb-sparing surgery. Radiographics 27:189–205, discussion 206PubMedCrossRefGoogle Scholar
  16. 16.
    Anderson MW, Temple HT, Dussault RG et al (1999) Compartmental anatomy: relevance to staging and biopsy of musculoskeletal tumors. AJR 173:1663–1671PubMedGoogle Scholar
  17. 17.
    Toomayan GA, Robertson F, Major NM et al (2006) Upper extremity compartmental anatomy: clinical relevance to radiologists. Skeletal Radiol 35:195–201PubMedCrossRefGoogle Scholar
  18. 18.
    Toomayan GA, Robertson F, Major NM (2005) Lower extremity compartmental anatomy: clinical relevance to radiologists. Skeletal Radiol 34:307–313PubMedCrossRefGoogle Scholar
  19. 19.
    Dupuy DE, Rosenberg AE, Punyaratabandhu T et al (1998) Accuracy of CT-guided needle biopsy of musculoskeletal neoplasms. AJR 171:759–762PubMedGoogle Scholar
  20. 20.
    Hau A, Kim I, Kattapuram S et al (2002) Accuracy of CT-guided biopsies in 359 patients with musculoskeletal lesions. Skeletal Radiol 31:349–353PubMedCrossRefGoogle Scholar
  21. 21.
    Hodge JC (1999) Percutaneous biopsy of the musculoskeletal system: a review of 77 cases. Can Assoc Radiol J 50:121–125PubMedGoogle Scholar
  22. 22.
    Yao L, Nelson SD, Seeger LL (1999) Primary musculoskeletal neoplasms: effectiveness of core-needle biopsy. Radiology 212:682–696PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Anastasia L. Hryhorczuk
    • 1
    • 2
    Email author
  • Peter J. Strouse
    • 1
  • J. Sybil Biermann
    • 3
  1. 1.Department of Radiology, C. S. Mott Children’s HospitalUniversity of MichiganAnn ArborUSA
  2. 2.Department of Radiology, Boston Children’s HospitalHarvard University School of MedicineBostonUSA
  3. 3.Department of Orthopaedic SurgeryUniversity of MichiganAnn ArborUSA

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