Transosseous Soft Tissue Biopsy: Tips and Tricks

Congress:

ESSR 2019

Poster Number:

P-0149

Type:

Educational Poster

Keywords:

Tissue characterisation, Neoplasia, Metastases, Biopsy, CT, Musculoskeletal spine, Musculoskeletal soft tissue, Musculoskeletal bone

Authors:

T. Truneh¹, L. Coventry¹, S. Billingsley², C. O'Neill¹, F. McDonald ³, D. R. Warakaulle¹, J. N. Papanikitas¹, S. Yanny¹, R. J. Hughes¹, D. McKean⁴; ¹Aylesbury/UK, ²Aylesbury /UK, ³Belfast/UK, ⁴Oxford/UK

DOI:

10.26044/essr2019/P-0149

DOI-Link:

https://dx.doi.org/10.26044/essr2019/P-0149

Fig. 1: Axial CT demonstrating a large retrocrural soft tissue mass immediately...

Fig. 2: Axial CT image demonstrating a 13 gauge bone biopsy needle advanced through the...

Fig. 3: Axial fused PET-CT demonstrating an FDG avid mass in the right spinal canal...

Fig. 4: Axial T2-weighted image demonstrating a small paraspinal soft tissue mass, deep...

Learning objectives

To describe the technique and pitfalls of CT-guided transosseous biopsy of soft tissue lesions.

Background

Accurate staging of malignancy is crucial in guiding patient therapy and may have important prognostic implications. Radiologists increasingly rely on advanced image-guided techniques to safely access lesions in difficult to access locations. We describe the technique of traversing normal bone to reach soft tissue lesions.

Imaging findings OR Procedure Details

The transosseous approach typically involves using a bone needle to create a channel and co-axially advancing a soft tissue biopsy gun to sample the underlying soft tissue mass. Such an approach allow for access to lesions that may have otherwise required open surgical biopsy. Our procedures were performed using an Aquilion ONE Toshiba 320 slice CT scanner. Local anestheticwas administered to the skin at the level of the lesion and also infiltrated to the periosteum. Following this, a13-gauge bone biopsy needle was advanced under CT...

Conclusion

CT-guided transosseous soft tissue biopsy can be a safe means of tissue sampling and allow for biopsy of lesions in difficult to access locations. We discuss our experience of this approach, tips on performing the technique and potentialpitfalls.

References

1.Chehab M,Zintsmaster S,Jafri SZ,Richards M,Roy A.CT-guided Transosseous Soft Tissue Biopsy: Techniques, Outcomes and Complications in 50 Cases.Cardiovasc Intervent Radiol.2017 Sep;40(9):1461-1468. 2. D’Agostino HB, Sanchez RB, Laoide RM, et al. Anterior mediastinal lesions: transsternal biopsy with CT guidance. Work in progress. Radiology. 1993;189(3):703–5. 3. Hagberg H, Ahlstro¨m HK, Magnusson A, Sundstro¨m C, Astro¨m GK. Value of transsternal core biopsy in patients with a newly diagnosed mediastinal mass. Acta Oncol. 2000;39(2):195–8. 4. Audran M, Maury E, Bouvard B, Legrand E, Basle´ MF, Chappard D. Is transiliac bone...