AI Article Synopsis
- CT-guided biopsies can be useful for investigating indeterminate bone lesions found via MRI or PET/CT that don't show up on CT scans.
- The study focused on 1,033 adults from 2004 to 2020, comparing outcomes between biopsies of "occult" (hidden) and visible nonspinal bone lesions.
- Results indicated that biopsies of occult lesions had lower diagnostic yield and malignancy rates compared to visible lesions, with specific findings highlighting the types of benign and malignant conditions diagnosed.
Article Abstract
CT guidance may be used for biopsy of indeterminate bone lesions detected by MRI or PET/CT that are not visible (i.e., occult) on CT owing to equipment-, patient-, and operator-related factors. The purpose of this study was to assess diagnostic yield (DY) and diagnostic performance of CT-guided core needle biopsy (CNB) of occult nonspinal bone lesions and to identify the most common benign and malignant diagnoses for occult lesions undergoing CNB. This retrospective study included 1033 adult patients who underwent CT-guided nonspinal bone CNB between January 2004 and December 2020. Lesions were classified as occult or visible on CT; biopsies of occult lesions were performed by targeting anatomic landmarks using prebiopsy MRI or PET/CT. Pathologic results of CNB were classified as diagnostic or nondiagnostic to calculate DY of CNB. For nondiagnostic CNBs, final diagnoses were established by subsequent pathologic, clinical, and imaging follow-up. The sample included 70 patients with occult lesions (mean age, 56.8 years; 38 women, 32 men) and 963 patients with visible lesions (mean age, 59.6 years; 475 women, 488 men). Malignancy rate was lower for occult than for visible lesions (42.9% vs 60.9%, = .004). DY was lower for occult than for visible lesions (37.1% vs 76.9%, < .001). Diagnostic performance for detecting malignancy on the basis of final diagnoses was lower for occult than for visible lesions in terms of sensitivity (76.7% vs 93.7%, = .003), specificity (7.9% vs 56.5%, < .001), and accuracy (38.2% vs 80.0%, < .001). Final diagnoses among malignant occult and visible lesions included metastasis (frequencies of 63.3% vs 65.4%), leukemia/lymphoma (33.3% vs 11.6%), and myeloma (3.3% vs 10.4%); final diagnoses among benign occult and visible lesions included red marrow (34.2% vs 8.2%), reactive marrow (26.3% vs 11.8%), and fracture (18.4% vs 3.8%). Occult lesions detected by MRI versus PET/CT had lower malignancy rate (39.3% vs 68.0%, = .03) and lower DY (30.4% vs 60.0%, = .01). At CT-guided CNB, malignancy rate and DY are lower for occult than for visible lesions. Leukemia/lymphoma and red marrow are more common among occult than visible lesions. Understanding these characteristics can help guide radiologists', referring providers', and patients' expectations when CNB of occult bone lesions is requested and performed.
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| http://dx.doi.org/10.2214/AJR.22.27842 | DOI Listing |
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