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Efficacy of image-guided synovial biopsy

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Abstract

Objective

A variety of benign and neoplastic lesions can affect the synovium, including pigmented villonodular synovitis (PVNS) and synovial chondromatosis. Prior to surgical resection, accurate characterization of synovial lesions is necessary for appropriate treatment planning. Additionally, recent advances in potential medical therapies for PVNS could decrease or eliminate the need for surgery in some cases. Such treatment options demand accurate characterization of synovial lesions prior to treatment.

Methods and materials

Institutional IRB approval was obtained. We identified 54 synovial biopsies performed at our institution using a comprehensive database search under ultrasound (US) or computed tomography (CT) guidance. Cases were reviewed for pre-procedure imaging, location, biopsy approach, biopsy results, post-procedure complications, and surgical pathology if synovectomy was performed.

Result

A total of 54 image-guided synovial biopsies were performed, 36 using CT guidance and 18 using US guidance. Six different anatomic locations were biopsied (the hip, knee, shoulder, elbow, ankle, and temporomandibular joint). Synovial tissue was obtained in 89% of cases (48/54). CT-guided biopsies had a positive yield of 86% (31/36) and US-guided biopsies had a positive yield of 94% (17/18). Surgical pathology was obtained in 30 of the cases and image-guided biopsy concordance was 90% (27/30). Of the patients taken for synovectomy, biopsy concordance of suspected neoplastic lesions was 100% (23/23). In cases of suspected neoplasm, the concordance between image-guided biopsy and surgical pathology was 96% (22/23). There were no reported complications.

Conclusion

Image-guided biopsy of synovial lesions is safe and effective for establishing a definitive diagnosis prior to surgical or other intervention.

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Authors and Affiliations

  1. Department of Radiology, Thomas Jefferson University Hospital, 132 S. 10th Street, 10th Floor, Philadelphia, PA, 19107, USA

    T. Conor McKee, Jeffrey A. Belair & William Morrison

  2. Sidney Kimmel Medical College, 1025 Walnut St. #100, Philadelphia, PA, 19107, USA

    Keenan Sobol

  3. Rothman Orthopedic Institute at Jefferson, 925 Chestnut St. 5th Floor, Philadelphia, PA, 19107, USA

    Scot A. Brown & John Abraham

Authors
  1. T. Conor McKee
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  2. Jeffrey A. Belair
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  3. Keenan Sobol
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  4. Scot A. Brown
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  5. John Abraham
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  6. William Morrison
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Corresponding author

Correspondence to T. Conor McKee.

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Conflict of interest

T. Conor McKee, MD has nothing to disclose.

Jeffrey A. Belair, MD has nothing to disclose.

Keenan Sobol, BS has nothing to disclose.

Scot A. Brown, MD has nothing to disclose.

John Abraham, MD has nothing to disclose.

William B. Morrison, MD is a consultant at AprioMed AB Patent agreement; AprioMed AB; Zimmer Biomet Holdings, Inc.; Samsung; and Medical Metrics Incorporated.

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IRB statement:

This was an IRB-approved single-center retrospective analysis.

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McKee, T.C., Belair, J.A., Sobol, K. et al. Efficacy of image-guided synovial biopsy. Skeletal Radiol 49, 921–928 (2020). https://doi.org/10.1007/s00256-019-03370-2

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  • DOI: https://doi.org/10.1007/s00256-019-03370-2

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