Reduction of Radiation Dose and Scanning Time While Preserving Diagnostic Yield: A Comparison of Battery-Powered and Manual Bone Biopsy Systems

Abstract

BACKGROUND AND PURPOSE:There is scarcity of data on the comparative efficacy between bone biopsy drill systems across various types of bone lesions. Our aim was to investigate differences in diagnostic yield, scanning time, and radiation dose between manual and battery-powered bone biopsy systems in CT-guided biopsies of lytic, sclerotic, and infectious bone lesions. MATERIALS AND METHODS:This was a retrospective single-center institutional review board-approved study. A total of 585 CT-guided core needle biopsies were performed at 1 institution from May 2010 to February 2019. Classification of bone lesions, location, bone biopsy system, suspected origin of primary disease, final pathologic diagnosis, diagnostic yield, presence of crush artifacts, radiation dose, and scanning times were collected. For the battery-powered system, OnControl was used. For the manual drill system, Bonopty, Osteosite, and Laurane drill systems were used. Comparisons in lytic and sclerotic lesions and suspected discitis/osteomyelitis were made using the Fisher exact test. Subgroup analysis of the drill systems for scanning time and radiation dose was performed by 1-way ANOVA. RESULTS:Our patient cohorts consisted of a total of 585 patients with 422 lytic, 110 sclerotic, and 53 suspected infectious lesions. The mean age was 62 6 13 years with a male/female ratio of 305:280 for all lesions. The diagnostic yield was 85.5% (362/422) for lytic, 82.7% (91/110) for sclerotic, 50.9% (27/53) for infectious lesions, and 82.1% (480/585) for all lesions. No statistical difference was found when comparing diagnostic yields of powered drills with the manual systems for lytic, sclerotic, and infectious lesions. However, in a subgroup analysis, radiation dose and scanning time were significantly lower for powered drill compared with manual drill systems in lytic (P ¼ .001 for both) and sclerotic lesions (P ¼ .028 and P ¼ .012, respectively). No significant differences were seen between the drill systems for suspected infectious lesions. CONCLUSIONS:Our findings demonstrate that there was no statistically significant difference in diagnostic yield when comparing battery-powered and manual bone biopsy systems for CT-guided bone biopsies; however, the use of the power drill system resulted in significantly reduced scanning time and radiation dose in lytic and sclerotic lesions.

Differences in Radiation Exposure of CT-Guided Percutaneous Manual and Powered Drill Bone Biopsy

“…Comparable to the results of Cohen et al, our study demonstrated that procedural duration of all evaluated anatomical locations was slightly lower with the powered drill biopsy system, although this time saving was not significant [4]. Although the powered drill approach is reported to offer shorter scanning time for biopsies of densely sclerotic lesions in addition to less specimen artifacts [10,18], no significant difference in procedural duration between biopsies of osteolytic and osteoblastic lesions was observed in our study. Aside from considerations related to radiation exposure and duration, many factors influence the choice of a bone biopsy system such as availability, costs and operator preference [10].…”

“…Although the powered drill approach is reported to offer shorter scanning time for biopsies of densely sclerotic lesions in addition to less specimen artifacts [10,18], no significant difference in procedural duration between biopsies of osteolytic and osteoblastic lesions was observed in our study. Aside from considerations related to radiation exposure and duration, many factors influence the choice of a bone biopsy system such as availability, costs and operator preference [10]. Therefore, not only do local preferences differ with respect to biopsy systems and procedures, but also the radiation exposures of CT examinations can vary significantly by institution [20,21].…”

“…Alongside these benefits of manual and powered drill CT-guided bone biopsies, CT entails a radiation burden and is a high-dose imaging technique, which causes the major part of collective effective dose of all medical imaging [8,9]. While some recent studies reported radiation doses of CT-guided bone biopsies [4,[10][11][12], further detailed dose assessment and comparison between different anatomical regions are needed to optimize radiation protection. Additionally, specific reports of diagnostic reference levels (DRL) are rare [13].…”

Prostate cancer bone metastases confined to the distal left lower limb

“…The biopsy was technically difficult, due to increased bone density, and was non-diagnostic as the core samples taken were found to contain compacted bone fragments only. Biopsies of sclerotic bone lesions performed using similar equipment have been reported in the literature to have a diagnostic yield of between 55.9% and 82.7%[ 1 , 2 ]. A subsequent surgical biopsy was considered, however, it was felt that on balance the bone lesions were most likely to be prostate cancer metastases despite the unusual presentation and a further biopsy was not pursued.…”

Evaluation of potential tissue heating during percutaneous drill-assisted bone sampling in an in vivo porcine study

“…Minimally invasive, percutaneous image-guided biopsy techniques have become the preferred method for obtaining representative samples from bone lesions [1]. In recent years, a device for battery-powered drill-assisted bone tissue harvesting was introduced as a valuable alternative to conventional manual drilling [2][3][4]. Advantages of this battery-powered drill device include higher rotation speed with shorter intervention time, easier application and the possibility to collect larger core samples with less patient discomfort [3].…”