Contrast-enhanced ultrasound-guided musculoskeletal biopsies: our experience and technique

• Published in: Skeletal radiology Vol. 50; no. 4; pp. 673 - 681
• Main Authors: Daniels, Steven P., Mankowski Gettle, Lori, Blankenbaker, Donna G., Lee, Kenneth S., Ross, Andrew B.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-04-2021; Springer; Springer Nature B.V
• Subjects: Adequacy; Biopsy; Correlation analysis; Early experience; Health aspects; Imaging; Informed consent; Lesions; Magnetic resonance imaging; Medical imaging; Medical imaging equipment; Medicine; Medicine & Public Health; Necrosis; Nuclear Medicine; Orthopedics; Pathology; Perflutren; Radiology; Sarcoma; Scientific Article; Soft tissues; Ultrasonic imaging; Ultrasound; Soft tissue sarcoma; Biopsy; Ultrasound; Ultrasound contrast; Liposarcoma
• ISSN: 0364-2348; 1432-2161
• DOI: 10.1007/s00256-020-03604-8

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.