Percutaneous CT-Guided Biopsy of the Craniovertebral Junction: Safety, Diagnostic Yield, and Technical Notes

The craniovertebral junction defined as the occiput, the atlas, and the axis is a complex bony region that contains vital neural and vascular structures. We report the experience of a single academic institution regarding CT-guided biopsy of this skeletal region. We reviewed all of the CT-guided biopsies performed in our department, completed in the craniovertebral junction. We collected data in regard to biopsy procedures, patients’ vital statistics, and histopathological diagnosis. In total, 16 patients (8M and 8F; mean age 52; range 16–86 years old) were included in this series. In eight patients, the lesions were located in the atlas vertebra (8/16—50%), in six patients in the axis (37.5%), and in two patients in the occiput (12.5%). No complications were observed during or after the procedures. All of the procedures were technically successful. The biopsy was diagnostic in 13/16 patients (81.3%): four metastatic lesions (25%—three breast and one prostate cancers), four multiple myeloma bone lesions (25%), three aneurismal bone cysts (18.8%), one aggressive hemangioma (6.3%), and one pseudogout (6.3%). Moreover, in two-thirds (66.6%) of non-diagnostic histological reports, malignancies were excluded. CT-guided percutaneous biopsy is a safe tool and allows obtaining a histological diagnosis, in most cases, even in the most delicate site of the human skeleton—the craniovertebral junction.

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Percutaneous C-Arm Free O-Arm Navigated Biopsy for Spinal Pathologies: A Technical Note

Diagnostics ◽

10.3390/diagnostics11040636 ◽

2021 ◽

Vol 11 (4) ◽

pp. 636

Author(s):

Masato Tanaka ◽

Sumeet Sonawane ◽

Koji Uotani ◽

Yoshihiro Fujiwara ◽

Kittipong Sessumpun ◽

...

Keyword(s):

Histopathological Examination ◽

Correct Diagnosis ◽

Standard Technique ◽

Percutaneous Biopsy ◽

Technical Note ◽

Spinal Tumors ◽

Histopathological Diagnosis ◽

Ct Guided ◽

Ct Guided Biopsy ◽

The Right

Background: Percutaneous biopsy under computed tomography (CT) guidance is a standard technique to obtain a definitive diagnosis when spinal tumors, metastases or infections are suspected. However, specimens obtained using a needle are sometimes inadequate for correct diagnosis. This report describes a unique biopsy technique which is C-arm free O-arm navigated using microforceps. This has not been previously described as a biopsy procedure. Case description: A 74-year-old man with T1 vertebra pathology was referred to our hospital with muscle weakness of the right hand, clumsiness and cervicothoracic pain. CT-guided biopsy was performed, but histopathological diagnosis could not be obtained due to insufficient tissue. The patient then underwent biopsy under O-arm navigation, so we could obtain sufficient tissue and small cell carcinoma was diagnosed on histopathological examination. A patient later received chemotherapy and radiation. Conclusions: C-arm free O-arm navigated biopsy is an effective technique for obtaining sufficient material from spine pathologies. Tissue from an exact pathological site can be obtained with 3-D images. This new O-arm navigation biopsy may provide an alternative to repeat CT-guided or open biopsy.

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

American Journal of Roentgenology ◽

10.2214/ajr.172.5.10227522 ◽

1999 ◽

Vol 172 (5) ◽

pp. 1389-1392 ◽

Cited By ~ 72

Author(s):

S G Leffler ◽

F S Chew

Keyword(s):

Diagnostic Yield ◽

Percutaneous Biopsy ◽

Bone Lesions ◽

Ct Guided ◽

Sclerotic Bone ◽

Sclerotic Bone Lesions

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Surgical percutaneous biopsy of discitis and vertebral osteomyelitis is significantly better than CT guided biopsy in identifying the causative organism

The Spine Journal ◽

10.1016/j.spinee.2014.12.055 ◽

2015 ◽

Vol 15 (3) ◽

pp. S58

Author(s):

Radu Popa ◽

Luigi Magnano ◽

Hanny Anwar ◽

Lester Wilson

Keyword(s):

Vertebral Osteomyelitis ◽

Percutaneous Biopsy ◽

Causative Organism ◽

Ct Guided ◽

Guided Biopsy ◽

Ct Guided Biopsy ◽

Better Than

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Percutaneous CT Guided Vertebral Biopsy: Anatomy and Technical Considerations

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0041-1729778 ◽

2021 ◽

Author(s):

Kunal Bharat Gala ◽

Nitin S. Shetty ◽

Amit Kumar Janu ◽

Neeraj Shetty ◽

Suyash S. Kulkarni

Keyword(s):

Age Groups ◽

Percutaneous Biopsy ◽

Histopathological Analysis ◽

Histopathological Diagnosis ◽

Microbiological Analysis ◽

Ct Guided ◽

Image Guided ◽

Multiple Cores ◽

Ct Guided Biopsy ◽

Vertebral Biopsy

AbstractIn this review article, the authors discuss the anatomy and technical aspects of CT-guided biopsy of vertebral lesions. CT guidance is highly useful for vertebral biopsies, as the anatomy of the spine is complex and varies widely across the levels. Prebiopsy imaging should be reviewed and later correlated with the final histopathological diagnosis. The majority of the spine biopsies are performed under local anesthesia, except those in critical locations and pediatric age groups. The biopsy sample is sent for histopathological analysis and/or microbiological analysis depending on the indications. It is preferable to use a coaxial system for biopsies, so multiple cores can be obtained with a single needle puncture, thus minimizing the negative yield and complications. Complications after image-guided percutaneous biopsy are rare and can be managed easily.

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Diagnostic yield, accuracy, and complication rate of CT-guided biopsy for spinal lesions: a systematic review and meta-analysis

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017419 ◽

2021 ◽

pp. neurintsurg-2021-017419

Author(s):

Giorgos D Michalopoulos ◽

Yagiz Ugur Yolcu ◽

Abdul Karim Ghaith ◽

Mohammed Ali Alvi ◽

Carrie M Carr ◽

...

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Complication Rate ◽

Diagnostic Performance ◽

Diagnostic Yield ◽

Meta Analysis ◽

Ct Guided ◽

Spinal Lesions ◽

Guided Biopsy ◽

Ct Guided Biopsy

BackgroundCT-guided biopsy is a commonly used diagnostic procedure for spinal lesions. This meta-analysis aims to investigate its diagnostic performance and complications, as well as factors influencing outcomes.MethodsA systematic review of the literature was performed to identify studies reporting outcomes of CT-guided biopsies for spinal lesions. Diagnostic yield (ie, the rate of procedures resulting in a specific pathological diagnosis) and diagnostic accuracy (ie, the rate of procedures resulting in the correct diagnosis) were the primary outcomes of interest. Complications following biopsy procedures were also included.ResultsThirty-nine studies with 3917 patients undergoing 4181 procedures were included. Diagnostic yield per procedure was 91% (95% CI 88% to 94%) among 3598 procedures. The most common reason for non-diagnostic biopsies was inadequacy of sample. No difference in diagnostic yield between different locations and between lytic, sclerotic, and mixed lesions was found. Diagnostic yield did not differ between procedures using ≤13G and ≥14G needles. Diagnostic accuracy per procedure was 86% (95% CI 82% to 89%) among 3054 procedures. Diagnostic accuracy among 2426 procedures that yielded a diagnosis was 94% (95% CI 92% to 96%). Complication rate was 1% (95% CI 0.4% to 1.9%) among 3357 procedures. Transient pain and minor hematoma were the most common complications encountered.ConclusionIn our meta-analysis of 39 studies reporting diagnostic performance and complications of CT-guided biopsy, we found a diagnostic yield of 91% and diagnostic accuracy of 86% with a complication rate of 1%. Diagnostic yield did not differ between different locations, between lytic, sclerotic and mixed lesions, and between wide- and thin-bore needles.

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Diagnostic yield and safety of percutaneous CT-guided biopsy of retroperitoneal lesions and analysis of imaging features

Acta Radiologica ◽

10.1177/0284185121990286 ◽

2021 ◽

pp. 028418512199028

Author(s):

Anil Kumar Singh ◽

Zafar Neyaz ◽

Ritu Verma ◽

Anshul Gupta ◽

Richa Mishra ◽

...

Keyword(s):

Diagnostic Yield ◽

Final Diagnosis ◽

Microbiological Analysis ◽

Imaging Features ◽

Imaging Findings ◽

Chi Square ◽

Tissue Samples ◽

Ct Guided ◽

Guided Biopsy ◽

Ct Guided Biopsy

Background Computed tomography (CT)-guided biopsy is emerging as a preferred method for obtaining tissue samples from retroperitoneal lesions due to clear visualization of needle and vessels. Purpose To assess diagnostic yield and safety of CT-guided biopsy of retroperitoneal lesions and compare CT findings in different disease categories. Material and Methods This retrospective analytical study included 86 patients with retroperitoneal lesions who underwent CT-guided biopsy from December 2010 to March 2020. All procedures were performed with co-axial technique and multiple cores were obtained and subjected to histopathology. Additional tests like immunohistochemistry or microbiological analysis were done depending on clinical suspicion. Diagnostic yield calculation and comparison of imaging findings was done by one-way ANOVA, chi-square, and Fisher’s exact tests. Results CT-guided biopsy was technically successful in all cases with a diagnostic yield of 91.9%. Minor complications in the form of small hematomas were seen in two patients. Major disease categories on final diagnosis were lymphoma, tuberculosis, and metastases. A variety of malignant and benign soft-tissue neoplasms were also noted less commonly. With help of immunohistochemistry, lymphoma subtype was established in 88.8% of cases. Addition of microbiological tests like the GeneXpert assay helped in the diagnosis of tuberculosis in some cases. A mass-like appearance and vascular encasement was common in metastatic group and lymphoma. Conclusion Percutaneous CT-guided biopsy is a safe method for the sampling of retroperitoneal lesions with high diagnostic yield. Imaging findings are mostly overlapping; however, some features are more common in a particular disease condition.

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The impact of antibiotic pre‐treatment on diagnostic yield of CT‐guided biopsy for spondylodiscitis: A multi‐centre retrospective study and meta‐analysis

Journal of Medical Imaging and Radiation Oncology ◽

10.1111/1754-9485.13118 ◽

2020 ◽

Author(s):

Hayley Wong ◽

Gregory P Tarr ◽

Kunaal Rajpal ◽

Lara Sweetman ◽

Anthony Doyle

Keyword(s):

Retrospective Study ◽

Diagnostic Yield ◽

Meta Analysis ◽

Ct Guided ◽

Guided Biopsy ◽

Ct Guided Biopsy ◽

Pre Treatment ◽

The Impact

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Results of Percutaneous Computed Tomography-Guided Biopsy of Adrenal Lesions and Spectrum of Computed Tomography Findings

Journal of Clinical Imaging Science ◽

10.25259/jcis_3_2020 ◽

2020 ◽

Vol 10 ◽

pp. 16

Author(s):

Sriharsha Gunna ◽

Zafar Neyaz ◽

Eesh Bhatia ◽

Rungmei S Marak ◽

Richa Mishra ◽

...

Keyword(s):

Computed Tomography ◽

Multidetector Ct ◽

Diagnostic Yield ◽

Major Complication ◽

Malignant Neoplasms ◽

Safe Procedure ◽

Ct Scanner ◽

Ct Guided ◽

Guided Biopsy ◽

Ct Guided Biopsy

Objective: Adrenal enlargement occurs in various conditions such as infections, benign, and malignant neoplasms. Percutaneous computed tomography (CT)-guided adrenal biopsy is a safe method for obtaining tissue specimen in cases where diagnosis cannot be established on imaging and biochemical grounds. The study aims to evaluate diagnostic yield, accuracy, and complications of percutaneous CT-guided adrenal biopsies. Furthermore, CT findings of various adrenal lesions have been described. Materials and Methods: Data of CT-guided adrenal biopsies performed from September 2009 to May 2019 were analyzed. Biopsies were performed on a 64-slice or a 128-slice multidetector CT scanner using a coaxial technique. Pathological and microbiological reports were retrieved from the hospital information system. Clinical details were obtained from clinical case records. Results: CT-guided adrenal biopsies were performed in 48 patients, 37 males and 11 females. Adrenal insufficiency was present in 31 (64%) cases and bilateral adrenal glands were affected in 35 (73%). Biopsy yielded a diagnosis in 35 cases (72.9%). The final diagnosis was achieved in 43 (90%) cases. Combined accuracy of CT-guided biopsy for identifying malignancy and infection was 88.3%. Adrenal histoplasmosis (AH) was the most common entity diagnosed (44%). After combining histopathology and microbiology results, the sensitivity for diagnosing AH was 100%. One (2%) patient had a major complication in the form of intra-abdominal hemorrhage requiring transfusion. Local hematoma and mild stable pneumothorax were noted in one patient each. Conclusion: Percutaneous CT-guided biopsy is a safe procedure for the diagnosis of adrenal lesions. It has good accuracy for diagnosing adrenal conditions such as infections and malignancies. However, the specific diagnosis of benign adrenal lesions was difficult to make. AH, tuberculosis, and metastasis have overlapping imaging findings.

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Diagnostic Yield and Safety of Image-Guided Pleural Biopsy: A Systematic Review and Meta-Analysis

Respiration ◽

10.1159/000511626 ◽

2020 ◽

pp. 1-11

Author(s):

Federico Mei ◽

Martina Bonifazi ◽

Matteo Rota ◽

Laura Cirilli ◽

Martina Grilli ◽

...

Keyword(s):

Systematic Review ◽

Selection Criteria ◽

Diagnostic Yield ◽

Meta Analysis ◽

Pleural Biopsy ◽

Ultrasound Technique ◽

Ct Guided ◽

Guided Biopsy ◽

Ct Guided Biopsy ◽

Over Time

Background: Diagnostic yield (DY) and safety of computed tomography (CT)- and thoracic ultrasound (TUS)-guided biopsies in the diagnosis of pleural lesions have been investigated in a number of studies, but no synthesis of data from the literature has ever been performed. Objectives: We aimed to provide the first systematic review and meta-analysis on the DY and safety of CT- versus TUS-guided biopsy in the diagnosis of pleural lesions. Method: We searched MEDLINE and EMBASE for all studies reporting outcomes of interest published up to April 2018. Two authors reviewed all titles/abstracts and retrieved selected full text to identify studies according to predefined selection criteria. Summary estimates were derived using the random-effects model. Cumulative meta-analysis assessed the influence of increasing adoption of the procedures over time. Results: Thirty original studies were included in the present review; the number of studies on TUS-guided biopsy was almost three-fold higher than those on CT-guided biopsy. The pooled DYs of the 2 procedures were overall excellent and differed <10%, being 84% for TUS-guided biopsy and 93% for CT-guided biopsy. Safety profiles were reassuring for both the techniques, being 7 and 3% for CT- and TUS-guided biopsy, respectively. DY of ultrasound technique significantly improved over time, while no time effect was observed for CT-guided biopsy. Conclusions: Data show that CT- and TUS-guided biopsies in the diagnosis of pleural lesions are both excellent procedures, without meaningful differences in DYs and safety. Considering that TUS is non-ionizing and easily performed at the bedside, it should be the preferred approach in presence of adequate skills.

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