Utility of Core Needle Rebiopsy of Initially Non-diagnostic Musculoskeletal Lesions

Abstract

Objective: To assess the utility of repeat image guided core needle biopsy (CNB) of musculoskeletal lesions in the setting of an initially non-diagnostic CNB biopsy. Materials and Methods: Following IRB approval, a retrospective review was conducted of 1302 consecutive CNBs performed on bone or soft tissue lesions at a single institution. All cases where a repeat biopsy of the same lesion was requested by the referring physician due to non-diagnostic biopsy results were included in the study. Tumor characteristics such as lesion size and type (bone versus soft tissue) were correlated with diagnostic yield on repeat biopsy. Technical factors including the modality used, number of passes performed, gauge of the biopsy device, radiologist performing the procedure and portion of the lesion biopsied were also correlated. Results: Of the 1302 CNBs performed, 26 (2.0%) were referred for repeat biopsy. A diagnosis was obtained in 38.5% (10/26) of cases following a repeat CNB. In 5 out of the 26 cases (19.2%), a repeat CNB yielded malignancy. Overall, eleven cases were ultimately of malignant histology, of which 5 (45.4%) were diagnostic following rebiopsy. Fourteen cases were benign, of which 5 (35.7%) were diagnostic following rebiopsy. One case was lost to follow-up. A statistically significant difference in diagnostic yield was found between cases where an increased number of passes were made between the initial and repeat (p=0.047) biopsies. Conclusion: Repeat core needle biopsy of initially non-diagnostic musculoskeletal lesions can be potentially useful. Increasing the number of passes on the second biopsy attempt is recommended.