Who Performs CT-Guided Bone Biopsies
CT-guided bone biopsies are primarily performed by interventional radiologists who specialize in image-guided procedures, though in some specialized centers, orthopedic oncologic surgeons may also perform these procedures in collaboration with radiologists. 1
Key Personnel Involved in CT-Guided Bone Biopsies
Primary Proceduralists
- Interventional Radiologists: These specialists have specific training in image-guided procedures and are the most common providers of CT-guided bone biopsies 2, 3
- Musculoskeletal Radiologists: Subspecialized radiologists with expertise in bone and soft tissue imaging who often perform these procedures 1
Collaborative Team Members
- Orthopedic Oncologic Surgeons: May collaborate in planning the biopsy route and sometimes perform the procedure in specialized centers 1
- Pathologists: Essential team members who analyze the biopsy specimens, particularly those specializing in bone pathology 4
- Infectious Disease Specialists: Often involved in cases of suspected osteomyelitis 1
Importance of Multidisciplinary Approach
The NCCN guidelines emphasize that biopsy placement is critical to the planning of limb-sparing surgery in cases of suspected bone tumors. A multidisciplinary approach including the radiologist and orthopedic oncologic surgeon should be taken to follow appropriate biopsy procedures and decrease risk of adverse patient outcomes 1.
Key considerations include:
- The biopsy route must be carefully selected in collaboration with the surgeon to ensure it lies within the planned resection bed 1
- The biopsy tract should be resectable with the same wide margins as the primary tumor during surgery 1
- Communication between the surgeon, radiologist, and bone pathologist is critical in planning the biopsy route 1
Procedural Aspects
Types of Bone Biopsies
Percutaneous (core needle) biopsy: Performed under CT guidance with accuracy rates of 88-96% 1
Open (incisional) biopsy: Traditionally performed by orthopedic surgeons
- More accurate due to larger sample size
- Requires general or regional anesthesia and operating room facilities
- Higher risk of tissue contamination and complications 1
Diagnostic Yield
- CT-guided core needle biopsy has a diagnostic accuracy of approximately 90% 4
- Highest accuracy rates are obtained in primary and secondary malignant lesions 2
- For non-diagnostic samples, repeat biopsy can increase the overall diagnostic accuracy to 94% 2
Special Considerations
Osteomyelitis Cases
In cases of suspected chronic osteomyelitis, the Society of Academic Bone Radiologists recommends:
- MRI as an important initial step for guiding care 1
- Percutaneous image-guided biopsies when MRI findings are positive and surgical or alternative microbiological culture sites are unavailable 1
- In some cases, sampling and microbial cultures of sinus tract wounds can determine the causative organisms, obviating the need for bone biopsy 1
Occult Bone Lesions
- CT-guided biopsies of lesions not visible on CT but detected by MRI or PET/CT have lower diagnostic yield (37.1% vs 76.9% for visible lesions) 5
- These procedures require targeting anatomic landmarks using prebiopsy MRI or PET/CT 5
Potential Complications
Complication rates for CT-guided bone biopsies are generally low (0-10%, usually under 5%) 6, but may include:
- Transient paresis
- Hematoma formation
- Risk of tumor seeding along the biopsy tract (lower with core needle than open biopsy) 1
- Risk of causing new or worsening infections in cases of osteomyelitis 1
In conclusion, while interventional radiologists are the primary providers of CT-guided bone biopsies, the procedure is optimally performed within a multidisciplinary framework involving orthopedic surgeons, pathologists, and other specialists as needed for specific clinical scenarios.