Abstract
Purpose
The thin and friable septations composing aneurysmal bone cysts (ABC) may be challenging to target for percutaneous biopsy. The purpose of this study was to describe and evaluate a novel method of ABC biopsy using endomyocardial biopsy forceps as an attempt to capture larger fragments of tissue for diagnosis.
Methods and materials
This was a retrospective study performed over a 17-year period. Patients <18 years old who underwent percutaneous biopsy for a presumed ABC, based on pre-procedure imaging, were included. Medical records were reviewed to identify age, sex, lesion location, biopsy procedure details, complications, and pathology results. A diagnostic biopsy was defined as conclusive histologic confirmation. Inconclusive findings or findings suggestive of but not diagnostic of an ABC were treated as non-diagnostic, even if imaging and clinical findings were characteristic. Biopsy device selection and quantity of tissue obtained was at the discretion of the pediatric interventional radiologist. Fisher’s exact test was used to compare the diagnostic yield of standard biopsies to those employing biopsy forceps.
Results
Twenty-three biopsies were performed in 18 patients (11 female) with a median age of 14.7 years (IQR 10.6–15.6). Lesions were located in the extremities (7, 30.4%), chest (6, 26.1%), pelvis (5, 21.7%), spine (4, 17.4%), and mandible (1, 4.3%). Specimens were obtained using a 13- or 15-gauge bone coring needle (11, 47.8%); 14-, 16-, or 18-gauge soft tissue needle (6, 26.1%); or a combination of bone and soft tissue (4, 17.4%) needles. Endomyocardial biopsy forceps were utilized in 7 cases (30.4%), 2 in which it was the only device used. Overall, a conclusive pathologic diagnosis was made in 13/23 (56.5%) biopsies. Of the diagnostic biopsies, 1 was a unicameral bone cyst and all others were ABCs. No malignancy was identified. Compared to the standard approach, the use of forceps was more likely to result in a diagnostic biopsy (40.0% vs 100.0%, p = 0.008). There were no complications.
Conclusions
Endomyocardial biopsy forceps offer an additional, novel technique to biopsy presumed ABCs and may improve diagnostic yield.
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References
Park HY, Yang SK, Sheppard WL, Hegde V, Zoller SD, Nelson SD, et al. Current management of aneurysmal bone cysts. Curr Rev Musculoskelet Med. 2016;9:435–44.
Kumar V, Path FRC, Abass AK, Aster JC. Bones, joints, and soft tissue tumors. Robbins Basic Pathology. p. 797–833.
Arrigoni F, Izzo A, Bruno F, Palumbo P, De Filippo M, Zugaro L, et al. Musculoskeletal interventional radiology in the pediatric population: state of the art. Semin Musculoskelet Radiol. 2021;25:176–83.
Cottalorda J, Kohler R, Sales de Gauzy J, Chotel F, Mazda K, Lefort G, et al. Epidemiology of aneurysmal bone cyst in children: a multicenter study and literature review. J Pediatr Orthop B. 2004;13:389–94.
Mascard E, Gomez-Brouchet A, Lambot K. Bone cysts: unicameral and aneurysmal bone cyst. Orthop Traumatol: Surg Res. 2015;101:S119–27.
Noordin S, Ahmad T, Umer M, Allana S, Hilal K, Uddin N, et al. Aneurysmal bone cyst of the pelvis and extremities: contemporary management. IJS Oncol. 2019;4:71.
Restrepo R, Zahrah D, Pelaez L, Temple HT, Murakami JW. Update on aneurysmal bone cyst: pathophysiology, histology, imaging and treatment. Pediatr Radiol. 2022;52:1601–14.
Oliveira AM, Perez-Atayde AR, Dal Cin P, Gebhardt MC, Chen C-J, Neff JR, et al. Aneurysmal bone cyst variant translocations upregulate USP6 transcription by promoter swapping with the ZNF9, COL1A1, TRAP150, and OMD genes. Oncogene. 2005;24:3419–26.
Mendenhall WM, Zlotecki RA, Gibbs CP, Reith JD, Scarborough MT, Mendenhall NP. Aneurysmal bone cyst. Am J Clin Oncol. 2006;29:311–5.
Ayala AG, Zornosa J. Primary bone tumors: percutaneous needle biopsy. Radiologic-pathologic study of 222 biopsies. Radiology. 1983;149:675–9.
Jelinek JS, Murphey MD, Welker JA, Henshaw RM, Kransdorf MJ, Shmookler BM, et al. Diagnosis of primary bone tumors with image-guided percutaneous biopsy: Experience with 110 Tumors. Radiology. 2002;223:731–7.
Rajeswaran G, Malik Q, Saifuddin A. The role of needle biopsy for focal bone lesions with complete fluid-fluid levels on magnetic resonance imaging. Skelet Radiol. 2013;42:765–9.
Cunningham KS. An approach to endomyocardial biopsy interpretation. J Clin Pathol. 2006;59:121–9.
Jeon TY, Choi MH, Yoon SB, Soh JS, Moon S-H. Systematic review and meta-analysis of percutaneous transluminal forceps biopsy for diagnosing malignant biliary strictures. Eur Radiol. 2022;32:1747–56.
Augustin AM, Steingrüber M, Fluck F, Goetze O, et al. Percutaneous endobiliary forceps biopsy of biliary strictures for histopathologic examination. Diagn Interv Radiol. 2020;26:339–44.
Inchingolo R, Spiliopoulos S, Nestola M, Nardella M. Outcomes of percutaneous transluminal biopsy of biliary lesions using a dedicated forceps system. Acta Radiol. 2019;60:602–7.
Park JG, Jung G-S, Yun JH, Yun BC, Lee SU, Han BH, et al. Percutaneous transluminal forceps biopsy in patients suspected of having malignant biliary obstruction: factors influencing the outcomes of 271 patients. Eur Radiol. 2017;27:4291–7.
Li Z-M, Wu G, Han X-W, Ren K-W, Zhu M. Radiology-guided forceps biopsy and airway stenting in severe airway stenosis. Diagn Interv Radiol. 2014;20:349–52.
Wang D, Wang L, Xu J, Zen Y, Zheng S, Wang G. Value of forceps biopsy and kyphoplasty in Kümmell’s disease. Orthopedics. 2013; [cited 2022 Mar 13];36. Available from: https://journals.healio.com/doi/10.3928/01477447-20130724-16
Wijeratna MD, Cook AJ, Powell J. A novel use of colonoscopy forceps for biopsy of intervertebral disc. Ann R Coll Surg Engl. 2013;95:157.
Iaccarino V, Sadile F, Vetrani A, Fulciniti F, Troncone G, Riccio R, et al. Percutaneous intralesional brushing of cystic lesions of bone: a technical improvement of diagnostic cytology. Skelet Radiol. 1990;19:187–90.
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Gaballah, M., Worede, F., Alexander, C. et al. Novel method to biopsy aneurysmal bone cysts in children. Skeletal Radiol 52, 2479–2486 (2023). https://doi.org/10.1007/s00256-023-04360-1
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DOI: https://doi.org/10.1007/s00256-023-04360-1