Synovial biopsies in clinical practice and research: current developments and perspectives
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REVIEW ARTICLE
Synovial biopsies in clinical practice and research: current developments and perspectives Hanna Johnsson 1
&
Aurélie Najm 1
Received: 26 July 2020 / Revised: 31 October 2020 / Accepted: 15 November 2020 # The Author(s) 2020
Abstract Synovial biopsy techniques have developed and widely expanded over the past few years, in particular due to the development of ultrasound-guided procedures. This article reviews the different techniques, clinical applications, and the latest advances in translational research as well as current challenges and perspectives. The first part focuses on different techniques available for biopsy, along with their feasibility, success rate, tolerance, and training requirements. In the second part, clinical applications are described. Data on diagnostic performances are reported, especially regarding septic arthritis. Translational research applications are described and explained in the final part, from the early histological studies and the first description of pathotype to more recent technologies involving -omics. Latest developments involving single-cell RNA sequence analysis have allowed the discovery of new cell subpopulations with remarkable roles in RA pathophysiology. These studies pave the ground for the discovery of new therapeutic targets and the implementation of personalized therapy in RA. Key Point •This review provides an overview of synovial biopsy techinques and applications especially in clinical and translational research.
Keywords Arthritis . Biopsy . Synovial biopsy . Synovitis . Synovium . Ultrasound
Different biopsy techniques Brief history and introduction of techniques Arthroscopic synovial biopsy has traditionally been considered the gold standard for obtaining synovial tissue. It enables the operator to view the synovium macroscopically and choose where to take the biopsy [1]. The macroscopic inspection can also yield diagnostic information [2]. With the invention of thinner arthroscopes, the procedure became less invasive, and more rheumatologists performed arthroscopic biopsies throughout the 1990s [3]. However, arthroscopic synovial biopsies are invasive, expensive, and not widely available. Alongside the practice of
* Aurélie Najm [email protected] 1
Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow and Rheumatology Department Greater Glasgow and Clyde, Glasgow, UK
arthroscopic synovial biopsy procedures, less invasive, simpler, and cheaper techniques for obtaining synovial biopsies were developed. Early blind biopsy needles measured 5 mm across so remained invasive [4]. Subsequent blind biopsy needles, like the Parker and Pearson needle, were thinner (14G, 15G, and 18G) and widely used [5, 6]. Samples obtained from the suprapatellar pouch by blind needle biopsies show broadly similar features to samples taken using arthroscopy [4, 7], but sufficient tissue for histological analysis is only obtained in 61 to 85% of cases [8, 9]. The procedure is also limited to
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