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 algorithm for selection of the most appropriate biopsy technique. MATERIALS AND METHODS. An algorithm was designed to maximize the tissue sampling and diagnostic accuracy of musculoskeletal tumor biopsy, We used fine-needle aspiration to sample small (<3 cm) soft-tissue masses, an 18-gauge 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 with this algorithm. RESULTS. The overall diagnostic accuracy was 96%, with one inadequate biopsy and one inaccurate biopsy, The diagnostic accuracies within subgroups of tumor types were: primary malignant tumors (n = 15), 93%; primary benign tumors (n = 9), 100%; secondary malignant tumors (n = 11), 100%; secondary benign tumors (n = 8), 88%; and infections (n = 3), 100%. CONCLUSION. This algorithm allows selection of the biopsy procedure most likely to safely provide adequate and accurate biopsy samples.