Relevance of compartmental anatomic guidelines for biopsy of musculoskeletal tumors: retrospective review of 363 biopsies over a 6-year period.

PURPOSE: To retrospectively assess percutaneous core needle biopsies performed by radiologists and the association with tumor seeding along the biopsy tract when anatomic compartment guidelines are not consistently observed. MATERIALS AND METHODS: Retrospective data from computerized patient records and digital images from 363 consecutive computed tomography-guided biopsies of the lower extremity (thigh and leg) performed by radiologists at a single institution from August 2002 to August 2008 were analyzed for breaches of biopsy guidelines. RESULTS: Of the 363 biopsies, 243 (67%) were of soft tissue lesions and 120 (33%) were of bony lesions. There were 188 (52%) malignant and 175 (48%) benign lesions. The following biopsy breaches were observed: 13 (3.6%) of anatomic compartment, 42 (11.6%) of "vital structures," and 82 (68.3%) of needle path for bony tumors. Vital structures as defined by the literature included, but were not limited to, the following: knee joint capsule, greater trochanteric bursa, rectus femoris and vastus intermedius muscles, tibial tubercle, peroneus brevis and peroneus longus distal tendons, and neurovascular bundles. No cases of tumor recurrences could be attributed to needle seeding along a biopsy tract for any of these biopsy guideline breaches. CONCLUSIONS: The concern for needle tract seeding with musculoskeletal tumors is more widespread than the evidence supporting it as a significant or frequent complication. In this study, breaching anatomic compartment, vital structures (other than neurovascular structures), and suggested exact needle path guidelines were not associated with needle tract seeding in the lower extremity.

Revisiting CT-guided percutaneous core needle biopsy of musculoskeletal lesions: contributors to biopsy success.

OBJECTIVE: The purpose of this article is to investigate potential technical, imaging, and histopathologic contributors to the success of CT biopsy. MATERIALS AND METHODS: Four hundred forty-four consecutive CT biopsies of musculoskeletal lesions performed from 2005 to 2008 were retrospectively classified as diagnostic or nondiagnostic and as accurate or inaccurate. A biopsy was considered as diagnostic if it provided a definitive pathologic diagnosis or was clinically useful; as accurate if it was concordant with the ultimate diagnosis with respect to identification of malignancy, grade, and histopathologic features; and as successful if it was both diagnostic and accurate. Biopsy success rate, diagnostic yield, and accuracy were assessed according to lesion location, use of sedation, biopsy equipment type, bone lesion matrix type, and lesion histologic type (i.e., bone or soft-tissue origin, malignant or benign neoplasm, and low-or intermediate-to-high-grade neoplasm). RESULTS: Of 444 biopsies, 71% were diagnostic, 86% were accurate, and 70% were successful. Biopsy success and diagnostic yield were greater in bone lesions, malignant neoplasms, and intermediate-to-high-grade neoplasms compared with soft-tissue lesions (p < 0.01), benign neoplasms (p < 0.0001), and low-grade neoplasms (p < 0.0001). Success and diagnostic yield were not significantly associated with technical or imaging factors. Biopsy accuracy was not associated with any of the tested variables. Of the 128 nondiagnostic biopsy results, 53% were accurate with respect to subsequent surgical pathologic findings. Most of these biopsy results were of benign soft-tissue lesions. CONCLUSION: CT biopsy of musculoskeletal lesions is accurate and effective. It may be limited in the evaluation of benign and low-grade soft-tissue neoplasms.

Endovascular workforce for peripheral vascular disease: current and future needs.

BACKGROUND: The current status and future needs of peripheral endovascular utilization and training have not been well defined. This topic is particularly relevant to the future of four specialties: interventional cardiology, cardiothoracic surgery, interventional radiology, and peripheral vascular surgery. We attempt to analyze the current numbers of cardiovascular patients and procedures and the numbers of treating physicians and surgeons to make predictions and recommendations for the future. METHODS: The numbers of cardiovascular patients and procedures were obtained from the Healthcare Cost and Utilization Project Trend Query web site. The number of endovascular abdominal aortic aneurysm repairs was obtained with telephone or e-mail contact with the aortic endograft manufacturers. The numbers of different cardiovascular specialists were obtained with contact with different cardiovascular professional societies and the American Board of Specialists via telephone, e-mail, or web site. The numbers of accredited US cardiovascular fellowship programs and first year spots were obtained from the Graduate Medical Education Directory 2000 to 2001. Finally, the numbers of endovascular fellowship programs and first year spots were obtained with contact with the individual programs. RESULTS: The numbers of cardiovascular patients and procedures have risen from 1993 to 1997. This trend is expected to continue as the population ages. Despite the rapid rise of endovascular procedures, the number of open cases has continued to rise as well. However, the number of cardiovascular specialists is predicted to remain stable. Specific numbers and trends are depicted in the manuscript. CONCLUSION: Our analysis shows that a critical shortage of endovascular trained specialists will exist in the future. More surgeons need to receive endovascular training to meet these future needs.