JOURNAL CLUB: CT-Guided Bone Biopsies With Indeterminate Results in Pediatric Patients

The objective of our study was to determine the frequency of indeterminate percutaneous CT-guided bone biopsy results in a pediatric population, the subsequent management of indeterminate biopsy results, and the factors associated with an indeterminate biopsy result.

This retrospective study included 86 pediatric patients who underwent 89 CT-guided biopsies because of an unclear bone lesion in a tertiary referral center for bone tumors.

CT-guided bone biopsy results were indeterminate in 29 of 89 lesions (32.6%; 95% CI, 23.7-42.9%). Excluding two bone lesions with an uncertain diagnosis, all other 27 bone lesions proved to be benign on follow-up (0% malignancies; 95% CI, 0-12.5%). Compared with patients with diagnostic CT-guided bone biopsy results, patients with indeterminate biopsy results were significantly younger (median age, 14.0 vs 18.0 years; p = 0.0185), were female more frequently (72.4% vs 41.7%, p = 0.0007), and had bone lesion-related symptoms less frequently (62.1% vs 88.3%, p = 0.0094). Furthermore, bone lesions with indeterminate CT-guided bone biopsy results were significantly more frequently not visible at CT (24.1% vs 1.7%, p = 0.0021), more frequently had a sclerotic rim (40.9% vs 18.6%, p = 0.0477), less frequently showed cortical destruction (45.5% vs 72.9%, p = 0.0343), less frequently had an associated extraosseous soft-tissue mass (4.5% vs 32.2%, p = 0.0094), and were smaller (median diameter, 17.0 vs 31.0 mm; p = 0.0007) than bone lesions with diagnostic results; in addition, the maximum biopsy sample length was significantly shorter for bone lesions with indeterminate CT-guided bone biopsy results than for those with diagnostic results (mean length, 10.9 vs 17.8 mm; p = 0.0003).

A nondiagnostic CT-guided biopsy result in a child with an unclear bone lesion suggests benignity. Several clinical and CT features of bone lesions are associated with indeterminate CT-guided bone biopsy results.