CT-guided percutaneous biopsy of sclerotic bone lesions: Diagnostic yield and accuracy

OBJECTIVE, We assessed the positive predictive value of percutaneous biopsy of sclerotic lesions to determine whether the reported success rate of the percutaneous technique could be generalized to sclerotic lesions or whethe r our diagnostic yield was too low to justify this added step before open s urgical confirmation. MATERIALS AND METHODS. We retrospectively studied all sclerotic bone lesion s biopsied by the percutaneous CT-guided technique at the Massachusetts Gen eral Hospital between 1988 and 1997. The 43 lesions were categorized by loc ation, maximum diameter, density (graded 1-4, relative to cortex), and patt ern of density (geographic, vague, or geographic with sclerotic margins). P athologic and clinical follow-up were used to determine the positive and ne gative predictive values. RESULTS. Of the 43 patients biopsied, neither the maximum diameter of the l esion nor its density was predictive of benignancy or malignancy. Fine-need le aspiration (FNA) complemented core biopsy results; for example, in one c ase, FNA showed findings indicating disease when the core biopsy showed non e, and in another case the reverse occurred. No complications were reported in these 43 patients. CONCLUSION. Percutaneous CT-guided biopsy of sclerotic bone lesions is a vi able alternative to open surgical biopsy. In this study, the positive predi ctive value of the combined FNA and bone biopsy results was 82% and the neg ative predictive value was 100%. No complications were reported.