Abstracts

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E1481. Can I Get a Piece of That? Troubleshooting Challenging Musculoskeletal Biopsies
Authors
  1. Eddy Zandee van Rilland; Beth Israel Deaconess Medical Center
  2. Jennifer Ni Mhuircheartaigh; Beth Israel Deaconess Medical Center
  3. Aparna Komarraju; Beth Israel Deaconess Medical Center
  4. Daniel Droukas; Beth Israel Deaconess Medical Center
  5. Justin Kung; Beth Israel Deaconess Medical Center
  6. Jim Wu; Beth Israel Deaconess Medical Center
Background
Image-guided core needle biopsies play an important role in the diagnosis and management of patients with musculoskeletal (MSK) lesions. Various patient and lesion related factors can increase the complexity of the procedure. Identifying these factors and employing strategies during challenging biopsies is important to optimize diagnostic yield and minimize complications.

Educational Goals / Teaching Points
Provide a review of various patient and biopsy related factors that can complicate MSK core needle biopsies. Review strategies to adjust biopsy technique and optimize technical parameters for a variety of challenging cases. Review techniques to prevent and troubleshoot complications in challenging MSK biopsies.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Many factors can complicate MSK biopsies and must be considered while planning and performing the procedure to ensure safety and a high diagnostic yield. Patient related factors that may complicate a biopsy include large body habitus, poor pain tolerance, and altered anatomy due to prior surgery or hardware. Similarly, various lesion related factors can complicate the procedure and must be identified. Challenging lesion locations include lesions in certain bones (sternum, rib, finger, and anterior sacrum), deep lesions, intra-articular lesions, and lesions adjacent to vessels, nerves, or major organs. Lesion characteristics that may complicate the biopsy include lesions that are very sclerotic or lytic, hemorrhagic, small or occult, or necrotic. When approaching a challenging MSK biopsy, it is important to adjust and optimize various technical parameters including patient positioning, needle entry trajectory, biopsy device selection, sedation considerations, and bleeding parameters. Lastly, various complications can occur during a challenging MSK biopsy including bleeding, nerve damage, fracture, tumor seeding, and infection. Techniques to prevent and troubleshoot these complications will be reviewed in detail.

Conclusion
Various patient and lesion related factors can complicate MSK core needle biopsies. Identifying these factors and optimizing biopsy related technical parameters are important steps in ensuring a safe and successful procedure.