Skeletal Radiology

, Volume 35, Issue 3, pp 138–143 | Cite as

CT–guided percutaneous core needle biopsy in deep seated musculoskeletal lesions: a prospective study of 128 cases

  • A. Puri
  • V. U. Shingade
  • M. G. Agarwal
  • C. Anchan
  • S. Juvekar
  • S. Desai
  • N. A. Jambhekar
Scientific Article



Although large lesions of the limbs can easily be biopsied without image guidance, lesions in the spine, paraspinal area and pelvis are difficult to target, and benefit from CT guidance to improve the accuracy of targeting the lesion for biopsy purposes. A prospective study of CT-guided core needle biopsies for deep-seated musculoskeletal lesions was conducted at a referral cancer institute over a 4-year period with the aim of assessing the safety and efficacy of the procedure.

Patients & methods

From January 2000 to December 2003, 136 consecutive CT-guided biopsy sessions were undertaken for musculoskeletal lesions in 128 patients comprising 73 males and 55 females. The following data was recorded in all patients: demographic data, suspected clinicoradiological diagnosis, data related to core biopsy session (date, site, approach, total time required in minutes, number of cores, surgeon satisfaction with adequacy of cores), patient discomfort, complications, histopathology report and number of further sessions if material obtained during the first biopsy session was not confirmatory. The sample obtained during the biopsy session was considered inconclusive if, in the opinion of the pathologist, inadequate or non-representative tissue had been obtained. The diagnosis was considered inaccurate if the final histopathological diagnosis did not match with the biopsy diagnosis, or if subsequent clinicoradiological evaluation at follow up did not correlate with the biopsy diagnosis in those patients who were treated with modalities other than surgery.


In 121 patients, a single session was sufficient to obtain representative material, whilst for six patients two sessions, and for one patient three sessions were necessary. The time taken for biopsy, including the pre-biopsy CT examination time, varied from 15 min to 60 min (median 30 min). For 110 bony lesions 116 sessions were required, and for 18 soft-tissue lesions 20 sessions were required. 108 biopsy sessions yielded a diagnosis, whilst 28 were inconclusive (diagnostic yield of 79.41%). Of 108 diagnostic biopsies, five were considered inaccurate (accuracy rate of 95.37%). The overall diagnostic yield and accuracy rate for bony lesions were 81.03% and 95.74%; and those for soft-tissue lesions were 70% and 92.85%. There were two complications with no permanent sequelae.


CT-guided core needle biopsy is a safe, easy, and effective technique for the evaluation of deep-seated musculoskeletal lesions, with a high rate of diagnostic yield and accuracy. It facilitates definitive therapy without the patient having to undergo a major surgical procedure for diagnosis.


CT Needle biopsy Musculoskeletal lesions 


  1. 1.
    Ayala AG, Ro JY, Fanning CV, Flores JP, Yasko AW (1995) Core needle biopsy and fine needle aspiration in the diagnosis of bone and soft tissue lesions. Hematol Oncol 9:633–651Google Scholar
  2. 2.
    Fraser-Hill MA, Renfrew DL, Hilsenrath PE (1992) Percutaneous needle biopsy of musculoskeletal lesions: 2 Cost-effectiveness. AJR Am J Roentgenol 158:813–818PubMedGoogle Scholar
  3. 3.
    Simon MA (1982) Current concepts review: biopsy of musculoskeletal tumors. J Bone Joint Surg Am 64:1253–1257PubMedGoogle Scholar
  4. 4.
    Murphy WA, Destouet JM, Gilula LA (1981) Percutaneous skeletal biopsy 1981: A procedure for radiologists—results, review, and recommendations. Radiology 139:545–549PubMedGoogle Scholar
  5. 5.
    Moore TM, Meyers MH, Patzakis MJ, Terry R, Harvey JP Jr (1979) Closed biopsy of musculoskeletal lesions. J Bone Joint Surg Am 61:375–380PubMedGoogle Scholar
  6. 6.
    Kattapuram SV, Rosenthal DI (1991) Percutaneous biopsy of skeletal lesions. AJR Am J Roentgenol 157:935–942PubMedGoogle Scholar
  7. 7.
    Pramesh CS, Deshpande MS, Pardiwala DN, Agarwal MG, Puri A (2001) Core needle biopsy for bone tumours. EJSO 27:668–671CrossRefPubMedGoogle Scholar
  8. 8.
    Tehranzadeh J, Freiberger RH, Ghelman B (1983) Closed skeletal needle biopsy: review of 120 cases. AJR Am J Roentgenol 140:113–115PubMedGoogle Scholar
  9. 9.
    Fraser-Hill MA, Renfrew DL (1992) Percutaneous needle biopsy of musculoskeletal lesions. Effective accuracy and diagnostic utility. AJR Am J Roentgenol 158:809–812PubMedGoogle Scholar
  10. 10.
    Mink J (1986) Percutaneous bone biopsy in the patient with known or suspected osseous metastases. Radiology 161:191–194PubMedGoogle Scholar
  11. 11.
    Ayala AG, Zornosa J (1983) Primary bone tumors: percutaneous needle biopsy. Radiologic–pathologic study of 222 biopsies. Radiology 149:675–679PubMedGoogle Scholar
  12. 12.
    DeSantos LA, Murray JA, Ayala AG (1979) The value of percutaneous needle biopsy in the management of primary bone tumors. Cancer 43:735–744PubMedCrossRefGoogle Scholar
  13. 13.
    Schajowicz F, Derqui JC (1968) Puncture biopsy in lesions of the locomotor system—review of results in 4050 cases, including 941 vertebral punctures. Cancer 21:531–548PubMedCrossRefGoogle Scholar
  14. 14.
    Goldschmidt N, Libson E, Bloom A, Amir G, Paltiel O (2003) Clinical utility of computed tomography-guided core needle biopsy in the diagnostic re-evaluation of patients with lymphoproliferative disorders and suspected disease progression. Annals of Oncology 14:1438–1441CrossRefPubMedGoogle Scholar
  15. 15.
    Agid R, Sklair-Levy M, Bloom AI et al (2003) CT-guided biopsy with cutting-edge needle for the diagnosis of malignant lymphoma: experience of 267 biopsies. Clinical Radiology 58:143–147CrossRefPubMedGoogle Scholar
  16. 16.
    Dupuy DE, Rosenberg AE, Punyaratabandhu T, Tan MH, Mankin HJ (1998) Accuracy of CT-guided needle biopsy of musculoskeletal neoplasms. AJR Am J Roentgenol 171(3):759–762PubMedGoogle Scholar
  17. 17.
    Kornblum MB, Wesolowski DP, Fischgrund JS, Herkowitz HN (1998 Jan 1) Computed tomography-guided biopsy of the spine. A review of 103 patients. Spine 23(1):81–85CrossRefPubMedGoogle Scholar
  18. 18.
    Hau A, Kim I, Kattapuram S, Hornicek FJ, Rosenberg AE, Gebhardt MC, Mankin HJ (2002 Jun) Accuracy of CT-guided biopsies in 359 patients with musculoskeletal lesions. Skeletal Radiol 31(6):349–353 Epub 2002 Mar 07CrossRefPubMedGoogle Scholar
  19. 19.
    Logan PM, Connell DG, Munk PL, Janzen DL (1996) Image-guided percutaneous biopsy of musculoskeletal tumors: an algorithm for selection of specific biopsy techniques. AJR Am J Roentgenol 166:137–141PubMedGoogle Scholar
  20. 20.
    Altuntas AO, Slavin J, Smith PJ, Schlict SM, Powell GJ, Ngan S, Toner G, Choong PF (2005 Apr) Accuracy of computed tomography guided core needle biopsy of musculoskeletal tumours. ANZ J Surg 75(4):187–191CrossRefPubMedGoogle Scholar
  21. 21.
    Issakov J, Flusser G, Kollender Y, Merimsky O, Lifschitz-Mercer B, Meller I (2003 Jan) Computed tomography–guided core needle biopsy for bone and soft tissue tumors. Isr Med Assoc J 5(1):28–30 (abstract only)PubMedGoogle Scholar
  22. 22.
    Jelinek JS, Murphey MD, Welker JA, Henshaw RM, Kransdorf MJ, Shmookler BM, Malawer MM (2002 Jun) Diagnosis of primary bone tumors with image-guided percutaneous biopsy—experience with 110 tumors. Radiology 223(3):731–737PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2005

Authors and Affiliations

  • A. Puri
    • 1
  • V. U. Shingade
    • 1
  • M. G. Agarwal
    • 1
  • C. Anchan
    • 1
  • S. Juvekar
    • 2
  • S. Desai
    • 2
  • N. A. Jambhekar
    • 3
  1. 1.Orthopaedic Oncology ServiceTata Memorial HospitalParel, MumbaiIndia
  2. 2.Department of RadiologyTata Memorial HospitalParel, MumbaiIndia
  3. 3.Department of PathologyTata Memorial HospitalParel, MumbaiIndia

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