Guided biopsies of abnormalities on nuclear bone scans. Technique and indications

A guided biopsy technique has been developed for evaluation of solitary bone abnormalities, identified by gallium 67 or technetium 99 bone scans, in patients with normal or ambiguous x-ray findings. Continuous gamma camera monitoring is used to guide staining of the bone abnormality and overlying tissues with methylene blue. This staining is followed by open biopsy of the marked bone. This technique was utilized in 15 patients, 12 of whom had bronchogenic carcinoma. The most commonly involved bones (13/15) were ribs. None of the patients had an identifiable, gross abnormality at operation, and the marked area was indistinguishable from neighboring tissues. Diagnostic tissue was obtained by each biopsy and there were no complications associated with this technique. The primary applicability of this technique is for both pretreatment and re-treatment staging of bronchogenic carcinoma in patients who have ambiguous nuclear bone scan abnormalities.