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Bone and Soft-Tissue Lesions: What Factors Affect Diagnostic Yield of Image-guided Core-Needle Biopsy?¹

¹ From the Department of Radiology, Section of Musculoskeletal Radiology (J.S.W., P.J.H., S.K.S., M.G.H.), and Department of Pathology (J.D.G.), Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215. From the 2007 RSNA Annual Meeting. Received October 1, 2007; revision requested December 21; revision received February 4, 2008; accepted March 6; final version accepted March 28. Address correspondence to J.S.W. (e-mail: jswu{at}bidmc.harvard.edu).

Purpose: To assess lesion-related and technical factors that affect diagnostic yield in image-guided core-needle biopsy (CNB) of bone and soft-tissue lesions.

Materials and Methods: Institutional review board approval and verbal informed consent were obtained for a HIPAA-compliant prospective study of 151 consecutive CNBs of bone (n = 88) and soft-tissue (n = 63) lesions. Each CNB specimen was reported separately in the final pathology report. Diagnostic yield (total number of biopsies that yield a diagnosis divided by total number of biopsies) was calculated for all lesions and subgroups on the basis of lesion composition (lytic, sclerotic, soft tissue), lesion size (2, >2 to 5, or >5 cm), biopsy needle gauge, image guidance modality, number of specimens obtained, and specimen length (<5, 5–10, or >10 mm). The minimum number of specimens required to obtain a diagnosis was determined on the basis of the specimen number at which the diagnostic yield reached a plateau. ² And Wilcoxon rank-sum tests were performed in bivariate analyses to evaluate associations between each factor and diagnostic yield. Significant factors were evaluated with multivariate logistic regression.

Results: Diagnostic yield was 77% for all lesions. Yield was 87% for lytic bone lesions and 57% for sclerotic bone lesions (P = .002). Diagnostic yield increased with larger lesions (54% for lesions 2 cm, 75% for lesions > 2 to 5 cm, and 86% for lesions > 5 cm [P = .006]). There was no difference in diagnostic yield for bone versus soft-tissue lesions or according to needle gauge or image guidance modality. Diagnostic yield was 77% for bone lesions and 76% for soft-tissue lesions (P = .88). Yield was 83%, 72%, 77%, and 83% for biopsies performed with 14-, 15-, 16-, and 18-gauge needles, respectively (P = .57). Yield was 77% with computed tomographic guidance and 78% with ultrasonographic guidance (P = .99). Diagnostic yield increased with number of specimens obtained and with longer specimen length; it reached a plateau at three specimens for bone lesions and four specimens for soft-tissue lesions.

Conclusion: Diagnostic yield is higher in lytic than in sclerotic bone lesions, in larger lesions, and for longer specimens. Obtaining a minimum of three specimens in bone lesions and four specimens in soft-tissue lesions optimizes diagnostic yield.

© RSNA, 2008