Musculoskeletal biopsies using computed tomography fluoroscopy

To determine the diagnostic yield, accuracy, and safety of computed tomography (CT) fluoroscopy guidance for musculoskeletal biopsies.

A retrospective analysis of musculoskeletal biopsies performed with CT fluoroscopy guidance over a 2-year period was made. Data collected were biopsy sites, CT fluoroscopic times, and biopsy results. Results were categorized as the following: positive, negative (but diagnostic), or nondiagnostic. Reference standard consisted of 5 years of follow-up to verify results.

Ninety-five CT fluoroscopy-guided musculoskeletal biopsies were performed. Bone biopsies comprised 83% (79/95), and soft tissue biopsies comprised 17% (16/95). The mean age was 54 years (range, 16-90 years); 40.0% (38/95) were male subjects, and 60.0% (57/95) were female subjects. For all subjects, CT fluoroscopic times ranged from 2 to 310 seconds, with a mean time of 63 seconds and a median time of 34 seconds. The diagnostic yield was 96% (91/95), with a nondiagnostic result in 4% (4/95) of subjects. Diagnostic biopsy specimens showed a positive result in 63% (60/95) of subjects and a negative but diagnostic result in 33% (31/95) of subjects. There were no major complications.

Computed tomography fluoroscopic-guided musculoskeletal biopsies show a high diagnostic yield and are accurate and safe. The biopsy results are similar or superior to other published reports using conventional CT guidance with only a small overall fraction being nondiagnostic. The benefits of real-time imaging are at the cost of operator exposure to ionizing radiation and the risk of potentially high exposures to both patient and operator. The impact on indications for which lesions are most amenable to percutaneous biopsy using CT fluoroscopy and procedure time has yet to be determined.