Percutaneous CT-guided bone biopsy: Diagnosis of malignancy in lesions with initially indeterminate biopsy results and CT features associated with diagnostic or indeterminate results Journal Article

  

Authors:	Hwang, S.; Lefkowitz, R. A.; Landa, J.; Zheng, J.; Moskowitz, C. S.; Maybody, M.; Hameed, M.; Panicek, D. M.
Article Title:	Percutaneous CT-guided bone biopsy: Diagnosis of malignancy in lesions with initially indeterminate biopsy results and CT features associated with diagnostic or indeterminate results
Abstract:	OBJECTIVE. The purpose of our study was to determine the proportion of bone lesions with indeterminate results after initial percutaneous CT-guided bone biopsy that ultimately are found to be malignant and whether CT features are associated with diagnostic outcomes. MATERIALS AND METHODS. The results of 800 consecutive percutaneous CTguided bone biopsies performed at a tertiary cancer center were reviewed. The initial histopathologic diagnosis was classified as diagnostic or indeterminate. On the basis of follow-up information, indeterminate results were subcategorized as benign, malignant, or persistently indeterminate. Two readers independently analyzed the CT images. RESULTS. Initial percutaneous CT-guided bone biopsy was diagnostic in 69% and indeterminate in 31%. Malignancy was diagnosed in 90% of initially diagnostic results. In lesions with initially indeterminate results, a diagnosis was subsequently made in 62%; 39% of subsequent diagnoses were malignant as of the last available follow-up. CT features associated with diagnostic results included cortical destruction and large extraosseous mass (p < 0.05). More lesional sclerosis and presence of fat were associated with indeterminate results (p < 0.001). CT features associated with malignant results included less-extensive sclerosis and lesser sclerotic rim (p < 0.05). Increased age, female sex, and a cancer history were associated with higher risk of malignancy among patients with diagnostic results at initial biopsy. CONCLUSION. Bone lesions that initially yield indeterminate results at percutaneous CT-guided bone biopsy often are subsequently shown to be malignant; vigorous pursuit of a diagnosis is recommended if initial results are indeterminate. Lesions showing fat or more sclerosis are more likely to be indeterminate; lesions with less sclerosis or smaller sclerotic rim are more likely to yield malignant results. © American Roentgen Ray Society.
Keywords:	adolescent; adult; child; aged; aged, 80 and over; bone neoplasms; child, preschool; middle aged; fracture; humerus; retrospective studies; major clinical study; clinical feature; cancer risk; bone metastasis; follow up; cancer diagnosis; pelvis; diagnostic accuracy; computer assisted tomography; multiple myeloma; breast cancer; image analysis; diagnosis, differential; logistic models; tomography, x-ray computed; medical record review; biopsy; age; bone lesion; radiography, interventional; malignant neoplastic disease; malignancy; benign tumor; biopsy technique; gender; femur; sternum; bone necrosis; sacrum; hemangioma; sclerosis; bone destruction; cortical bone; bone cancer; neurilemoma; clavicle; medical history; lumbar spine; thoracic spine; osteomyelitis; paget bone disease; bone biopsy; cervical spine; aneurysmal bone cyst; rib; scapula; ct-guided bone biopsy; indeterminate bone lesion; osseous metastases; percutaneous ct guided bone biopsy
Journal Title:	American Journal of Roentgenology
Volume:	197
Issue:	6
ISSN:	0361-803X
Publisher:	American Roentgen Ray Society
Date Published:	2011-12-01
Start Page:	1417
End Page:	1425
Language:	English
DOI:	10.2214/ajr.11.6820
PROVIDER:	scopus
PUBMED:	22109298
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-82455181469&partnerID=40&md5=6fc25a420b9664e373de449dbed0e080
Notes:	--- - "Export Date: 3 January 2012" - "CODEN: AJROA" - "Source: Scopus"

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