IMAGE-GUIDED PERCUTANEOUS BIOPSY OF MUSCULOSKELETAL TUMORS - AN ALGORITHM FOR SELECTION OF SPECIFIC BIOPSY TECHNIQUES

OBJECTIVE. The purpose of this study was to design and use an algorith m for selection of the most appropriate biopsy technique. MATERIALS AN D METHODS. An algorithm was designed to maximize the tissue sampling a nd diagnostic accuracy of musculoskeletal tumor biopsy, We used fine-n eedle aspiration to sample small (<3 cm) soft-tissue masses, an 18-gau ge automated Biopty Gun to sample large (>3 cm) soft-tissue masses, a bone-cutting core biopsy needle to sample sclerotic bone tumors, and a combination technique to sample lytic bone tumors with an intact bony shell. We reviewed the results of 46 consecutive biopsies obtained wi th this algorithm. RESULTS. The overall diagnostic accuracy was 96%, w ith one inadequate biopsy and one inaccurate biopsy, The diagnostic ac curacies within subgroups of tumor types were: primary malignant tumor s (n = 15), 93%; primary benign tumors (n = 9), 100%; secondary malign ant tumors (n = 11), 100%; secondary benign tumors (n = 8), 88%; and i nfections (n = 3), 100%. CONCLUSION. This algorithm allows selection o f the biopsy procedure most likely to safely provide adequate and accu rate biopsy samples.