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Novel method to biopsy aneurysmal bone cysts in children

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Abstract

Purpose

The thin and friable septations composing aneurysmal bone cysts (ABC) may be challenging to target for percutaneous biopsy. The purpose of this study was to describe and evaluate a novel method of ABC biopsy using endomyocardial biopsy forceps as an attempt to capture larger fragments of tissue for diagnosis.

Methods and materials

This was a retrospective study performed over a 17-year period. Patients <18 years old who underwent percutaneous biopsy for a presumed ABC, based on pre-procedure imaging, were included. Medical records were reviewed to identify age, sex, lesion location, biopsy procedure details, complications, and pathology results. A diagnostic biopsy was defined as conclusive histologic confirmation. Inconclusive findings or findings suggestive of but not diagnostic of an ABC were treated as non-diagnostic, even if imaging and clinical findings were characteristic. Biopsy device selection and quantity of tissue obtained was at the discretion of the pediatric interventional radiologist. Fisher’s exact test was used to compare the diagnostic yield of standard biopsies to those employing biopsy forceps.

Results

Twenty-three biopsies were performed in 18 patients (11 female) with a median age of 14.7 years (IQR 10.6–15.6). Lesions were located in the extremities (7, 30.4%), chest (6, 26.1%), pelvis (5, 21.7%), spine (4, 17.4%), and mandible (1, 4.3%). Specimens were obtained using a 13- or 15-gauge bone coring needle (11, 47.8%); 14-, 16-, or 18-gauge soft tissue needle (6, 26.1%); or a combination of bone and soft tissue (4, 17.4%) needles. Endomyocardial biopsy forceps were utilized in 7 cases (30.4%), 2 in which it was the only device used. Overall, a conclusive pathologic diagnosis was made in 13/23 (56.5%) biopsies. Of the diagnostic biopsies, 1 was a unicameral bone cyst and all others were ABCs. No malignancy was identified. Compared to the standard approach, the use of forceps was more likely to result in a diagnostic biopsy (40.0% vs 100.0%, p = 0.008). There were no complications.

Conclusions

Endomyocardial biopsy forceps offer an additional, novel technique to biopsy presumed ABCs and may improve diagnostic yield.

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Authors and Affiliations

  1. Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Marian Gaballah, Anne Marie Cahill & Michael R. Acord

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Marian Gaballah, Caitlin Alexander, Alexandre Arkader, Anne Marie Cahill & Michael R. Acord

  3. Department of Medicine, Mercy Catholic Medical Center, Darby, PA, 19023, USA

    Fikadu Worede

  4. Division of Anatomic Pathology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Caitlin Alexander

  5. Division of Orthopedic Surgery, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Alexandre Arkader

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  1. Marian Gaballah
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Correspondence to Marian Gaballah.

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Gaballah, M., Worede, F., Alexander, C. et al. Novel method to biopsy aneurysmal bone cysts in children. Skeletal Radiol 52, 2479–2486 (2023). https://doi.org/10.1007/s00256-023-04360-1

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  • DOI: https://doi.org/10.1007/s00256-023-04360-1

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