Percutaneous image-guided needle biopsy of rib lesions: a retrospective study of diagnostic outcome in 51 cases.

OBJECTIVE: To assess the diagnostic yield and diagnostic accuracy of image-guided percutaneous needle biopsy of rib lesions and to analyse the diagnostic spectrum of rib lesions referred to a tertiary musculoskeletal oncology centre.

MATERIALS AND METHODS: A retrospective review of all patients that underwent image-guided rib biopsy and/or excision during the period from 1 January 2003 to 31 July 2011. A total of 51 consecutive subjects were identified and included in this study. Image-guided percutaneous biopsy was performed using either CT (n = 43) or ultrasound (n = 8).

RESULTS: There were 28 males and 23 females, with a mean age of 49.9 years (range 10-84 years). Forty-five of the 51 biopsies (88%) yielded a diagnostic sample, and 6 (12%) were non-diagnostic. Thirty-one of 45 (69%) lesions were malignant, and 14 (31%) were benign. The commonest malignant lesions were metastases, 16 of 31 (51.6%), and primary bone or cartilaginous tumours, 15 of 31 (48.4%). The commonest benign lesion was fibrous dysplasia (6 of 14, 43%) followed by infection (5 of 14, 36%). All non-diagnostic samples were from lesions which had no extra-osseous component, and all were subsequently confirmed as benign on rib resection. There was complete agreement between needle and surgical resection in 18 of 19 subjects (96%).

CONCLUSION: Image-guided percutaneous rib biopsy has high diagnostic yield and accuracy. Intra-osseous lesions which have no associated extra-osseous component have a lower biopsy success rate.