Diagnostic efficacy of pediatric image-guided core needle biopsy of musculoskeletal lesions

To evaluate the diagnostic success of image-guided core needle biopsy (ICNB) of bone and soft tissue lesions in the pediatric population and what factors influence diagnostic success.

For 370 biopsies performed on 350 patients 18 years of age and younger, the diagnostic yield (proportion of biopsies histopathologically sufficient for diagnosis) and accuracy (proportion of biopsies in which ICNB specimen concordant with the reference standard histopathology from surgical excision) of the biopsies, as well as a series of patient, lesion-related, and technical factors, were retrospectively analyzed. Multivariate statistical analysis was performed to evaluate what factors predicted diagnostic yield and accuracy.

Diagnostic yield was 95.1% (213/224) for bone biopsies and 97.1% (132/136) for soft tissue biopsies. Diagnostic accuracy was 93.1% (27/29) for bone biopsies and 88.4% (38/43) for soft tissue biopsies. Lesions of suspected benign etiology were found to be associated with lower diagnostic yield (OR = 15.2, p = 0.002) for bone biopsies, and increased total core length (OR = 3.3, p = 0.047) was found to be associated with higher yield for soft tissue biopsies. Increased needle gauge (OR = 2.9, p = 0.03) was found to be associated with higher accuracy for bone biopsies, and using a manual drill (compared to a battery-powered drill) was associated with lower accuracy (OR = 0.03, p = 0.03). Overall, 88.9% (32/36) of samples from the biopsy were sufficient for additional cytogenetic analysis. Complications occurred in 0.3% (1/370) of biopsies.

ICNB has a high rate of diagnostic success and a low complication rate and should be considered an alternative to open biopsy.