Contrast-enhanced ultrasound-guided musculoskeletal biopsies: our experience and technique
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SCIENTIFIC ARTICLE
Contrast-enhanced ultrasound-guided musculoskeletal biopsies: our experience and technique Steven P. Daniels 1
&
Lori Mankowski Gettle 2 & Donna G. Blankenbaker 2 & Kenneth S. Lee 2 & Andrew B. Ross 2
Received: 8 June 2020 / Revised: 9 September 2020 / Accepted: 10 September 2020 # ISS 2020
Abstract Objective To present our experience with contrast-enhanced ultrasound (CEUS)-guided musculoskeletal soft tissue biopsies in a busy interventional clinic. Materials and methods After IRB approval was obtained and informed consent was waived, we retrospectively reviewed all CEUS-guided musculoskeletal biopsies performed from December 1, 2018 to March 2, 2020. Relevant pre-procedure imaging was reviewed. Number of samples, suspected necrosis on pre-procedure imaging, specimen adequacy for pathologic analysis, correlation with pathologic diagnosis of surgical resection specimens, and procedural complications were recorded. Results Thirty-six CEUS-guided musculoskeletal biopsies were performed in 32 patients (mean age 57, range 26–88; 22 males, 10 females). All procedures were performed using 16-gauge biopsy needles, and all procedures provided adequate samples for pathologic analysis as per the final pathology report. Between two and seven core specimens were obtained (mean 3.7). In 30/36 cases (83%), a contrast-enhanced MRI was obtained prior to biopsy, and 10/30 (33%) of these cases showed imaging features suspicious for necrosis. In 15/36 cases, surgical resection was performed, and the core biopsy and surgical resection specimens were concordant in 14/15 cases (93%). One patient noted transient leg discomfort at the time of microbubble bursting. Otherwise, no adverse reactions or procedural complications were observed. Conclusion CEUS is an accurate way to safely target representative areas of soft tissue lesions for biopsy and can be implemented in a busy interventional clinic. Our early experience has shown this to be a promising technique, especially in targeting representative areas of heterogeneous lesions and lesions with areas of suspected necrosis on prior imaging. Keywords Ultrasound contrast . Ultrasound . Soft tissue sarcoma . Liposarcoma . Biopsy
Introduction In cases of indeterminate bone or soft tissue lesions, percutaneous core needle biopsy has gained acceptance as an accurate, safe procedure that often obviates the need for a more invasive open surgical biopsy and effectively guides patient management [1–3]. In cases of soft tissue masses or bone This study has been accepted for presentation at the 2020 RSNA annual meeting scheduled for November 29–December 4, 2020. * Steven P. Daniels [email protected] 1
Department of Radiology, NYU Langone Heath, 660 First Avenue, New York, NY 10016, USA
2
Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI 53792, USA
lesions with a soft tissue component, ultrasound (US), MRI and CT-guided biopsy techniques have been described [4–8]. US-guided biopsy offers seve
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