ACCURACY OF CT-GUIDED NEEDLE-BIOPSY OF MUSCULOSKELETAL NEOPLASMS

OBJECTIVE. The purpose of our study was to assess the accuracy of CT-g uided biopsy of musculoskeletal neoplasms with respect to technique, a natomic site, and histology. MATERIALS AND METHODS. During a 3-year pe riod (January 1992 to December 1994), 176 core needle biopsies and 45 fine-needle aspirations were performed under CT guidance on patients w ith musculoskeletal neoplasms. To assess the accuracy of these procedu res, compared the diagnosis at biopsy with the final diagnosis as dete rmined at the time of definitive treatment of the lesion. All biopsy f indings were categorized as a primary malignancy (excluding round cell lesions), round cell lesion, local recurrence, or metastatic carcinom a. In addition. each lesion was analyzed according to which biopsy tec hnique was used, whether frozen tissue section or rapid cytologic eval uation was used, and at which anatomic site the mass was found. RESULT S. The accuracy for needle biopsy was 93% and that for fine-needle asp iration was 80%, The complication rate for both techniques was less th an 1%. Accuracy rates for the four categories of primary malignancy, r ound cell lesion, local recurrence, and metastatic carcinoma were 87%, 75%, 94%, and 100%, respectively. The mismatch rates were similar in soft-tissue lesions (5/52) and bone lesions (16/169). Diminished accur acy was associated with round cell lesions (20%) and lesions located i n the spine or the perivertebral region (20%). Nondiagnostic and insuf ficient specimens were found in 18 (8%) of the 221 patients. CONCLUSIO N. CT-guided biopsy of musculoskeletal malignancies is a safe and effe ctive procedure if performed by a team of clinicians, pathologists, an d radiologists who pos sess subspecialty expertise.