Ultrasound-Guided Percutaneous Bone Biopsy: Feasibility, Diagnostic Yield and Technical Notes

Abstract

While nowadays, CT-guided bone biopsy represents the gold standard tool for histopathological and microbiological diagnosis of skeletal lesions, the role of US-guided bone biopsy has not yet been fully explored. US-guided biopsy offers several advantages, such as the absence of ionizing radiation, fast acquisition time, as well as good intra-lesional echo, and structural and vascular characterization. Despite that, a consensus in regard to its applications in bone neoplasms has not been established. Indeed CT-guided technique (or fluoroscopic ones) still represents the standard choice in clinical practice. This review article aims to review the literature data about US-guided bone biopsy, underlying clinical-radiological indications, advantages of the procedure and future perspectives. Bone lesions taking the best advantages of the US-guided biopsy are osteolytic, determining the erosion of the overlying bone cortex and/or with an extraosseous soft-tissue component. Indeed, osteolytic lesions with extra-skeletal soft-tissue involvement represent a clear indication for US-guided biopsy. Moreover, even lytic bone lesions with cortical thinning and/or cortical disruption, especially located in the extremities or pelvis, can be safely sampled with US guidance with very good diagnostic yield. US-guided bone biopsy is proven to be fast, effective and safe. Additionally, it offers real-time needle evaluation, an advantage when compared to CT-guided bone biopsy. In the current clinical settings, it seems relevant to select the exact eligibility criteria for this imaging guidance since the effectiveness can vary depending on the type of lesion and body site involved.

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“…Most importantly, it can guide procedures in all skeletal areas (including spinal segments) (Figure 8) [67]. Ultrasound guidance is used in the spine only in selected cases, especially if a large paravertebral abscess is present [68].…”

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“…An ultrasound-guided skeletal biopsy is a very interesting tool, offering the advantages of a real-time evaluation and an accurate adjacent soft tissue assessment, with particular regard to neurovascular bundles [6]. Nonetheless, this procedure is particularly indicated when a cortical disruption is present, aiding the ultrasound waves to bone lesions/neoplasms, and/or in the case of superficial bone regions such as the ribs [7,8]. In these cases, the diagnostic accuracy and safety are reported to be comparable with CT-guided biopsies.…”

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“…One of the most popular supporting technique is ultrasound (US) imaging. Its advantages include fast acquisition time, real-time needle evaluation, lack of radiation exposure, avoidance of vessels through color Doppler imaging, availability, shorter procedure time, and decreased cost [3,4]. On the other hand, the feasibility of this method depends highly on operator experience and the presence of an adequate acoustic window, which is essential for visualizing the lesion [5].…”