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01.11.2010 | Clinical Research | Ausgabe 11/2010

Clinical Orthopaedics and Related Research® 11/2010

Analysis of Nondiagnostic Results after Image-guided Needle Biopsies of Musculoskeletal Lesions

Clinical Orthopaedics and Related Research® > Ausgabe 11/2010
MD Justin Yang, MD Frank J. Frassica, MD Laura Fayad, MD Douglas P. Clark, MD Kristy L. Weber
Wichtige Hinweise
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.



Image-guided needle biopsies are commonly used to diagnose musculoskeletal tumors, but nondiagnostic (ND) results can delay diagnosis and treatment. It is important to understand which factors or diagnoses predispose to a ND result so that appropriate patient education or a possible change in the clinical plan can be made. Currently it is unclear which factors or specific lesions are more likely to lead to a ND result after image-guided needle biopsy.


We therefore identified specific factors and diagnoses most likely to yield ND results. We also asked whether an image-guided needle biopsy of bone and soft tissue lesions is an accurate and clinically useful tool.


We retrospectively reviewed data from a prospectively collected database for a case-control study of 508 image-guided needle biopsies of patients with suspected musculoskeletal tumors between 2003 and 2008.


The interpretations of 453 of the 508 (89%) needle biopsies were accurate and clinically useful. Forty-five biopsies (9%) were ND and 10 (2%) were incorrect (IC). Bone lesions had a higher ND rate than soft tissue lesions (13% vs. 4%). The specific diagnosis with the highest ND rate was histiocytosis. Elbow and forearm locations had higher ND rates than average. Malignant tumors had a higher IC rate than benign tumors (5% vs. 0%); fibromyxoid sarcoma and rare subtypes of osteosarcoma had higher IC rates than other diagnoses. Repeat needle or open biopsies were performed in 71 (14%) patients. Bone lesions were more likely than soft tissue lesions to require repeat biopsies (18% vs. 9%).


A high rate of accuracy and clinical usefulness is possible with image-guided needle biopsies of musculoskeletal lesions. We believe these biopsies appropriate in selected circumstances but a key factor for appropriate use is an experienced musculoskeletal tumor team with frequent communication to correlate clinical, radiographic, and histologic information for each patient.

Level of Evidence

Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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