The diagnostic outcome of CT-guided rib biopsies: a retrospective cohort study

Radiological appearance of benign and malignant rib lesions is often similar, making biopsy essential for accurate diagnosis. However, factors influencing rib biopsy success have not been thoroughly explored. This study aims to evaluate factors affecting the success of CT-guided rib biopsies in patients with suspected malignancy.

Retrospective analysis was conducted on CT-guided rib biopsies performed in our hospital between 2016 and 2023. The outcome reference was based on tissue examination and/or clinical and radiological follow-up to 6 months post-procedure. Biopsies were categorized as "diagnostic," "adequate," or "non-diagnostic" based on the outcome reference. The total success rate was calculated based on the sum of diagnostic and adequate biopsies.

Of a total of 38 rib biopsies, 20 were classified as diagnostic, six as adequate, and 12 as non-diagnostic based on the outcome reference. There were 20 voluminous lesions (volume > 500 mm³): 13 diagnostic, two adequate, and five non-diagnostic. Of the 18 non-voluminous biopsied lesions (volume < 500 mm³), seven were classified as diagnostic, four as adequate, and seven as non-diagnostic. Out of 24 osteolytic lesions, 16 were successfully diagnosed, while 8 were non-diagnostic. Among 14 sclerotic lesions, 10 were successfully diagnosed, and 4 were non-diagnostic. No statistically significant correlations were found between biopsy success and either the lesion volume or the needle insertion angle. Complications were encountered in 4 cases (11%).

CT-guided rib biopsy is an effective diagnostic method. However, given the relatively high complication rate, the procedure should be used judiciously and preferably performed by radiologists experienced in musculoskeletal biopsies.