(Ultrasound Review) Sonographically guided core needle biopsy of bone and soft tissue tumors is a safe and accurate procedure that avoids open biopsy, according to researchers at University Estadual de Campinas, Brazil.
They studied 74 patients that had image-guided needle biopsy of musculoskeletal tumors, and the results were published in Journal of Ultrasound in Medicine. Ultrasound-guidance was possible in 65 lesions mainly located in the extremities. There were 38 soft tissue lesions and 27 bone lesions. They described the main advantages of ultrasound as continuous real-time visualization of the needle, Doppler-enabled localization of vessels, lack of ionizing radiation, readily available, rapid and relatively inexpensive. These advantages only existed when the tumor intended for biopsy was apparent on ultrasound imaging.
The lesions selected for biopsy were at least 2 cm in diameter because the biopsy needle used (14-gauge Tru-Cut-type) had a throw of 2.2 cm. Fluoroscopy was used to image lesions without cortical disruption because these were not demonstrated using ultrasound imaging. An analysis of 48 biopsies performed under ultrasound guidance showed that an accurate diagnosis was possible in 97% of cases, with a sensitivity of 96% and specificity of 100%. In one case, a diagnosis was not possible due to insufficient tissue sample. Of the 65 biopsies performed, sufficient tissue specimen was obtained in 96% of lesions.
There were no complications due to needle biopsy during the study. This was consistent with the complication rate reported in the literature for the technique, which was mostly <1%.
"The most common complications are pain, hematoma, and infection, although there are isolated reports of severe neurologic damage, hemorrhage, pneumothorax and tuberculous sinus tracts," they stated. Tumor seeding along the needle tract is a valid concern, but according to the authors has minimal clinical impact if the procedure is correctly performed.
"On the basis of our experience, we strongly recommend adding sonographic examination to the work-up of bone and soft tissue tumors in an attempt to elicit areas amenable to percutaneous needle biopsy," they reported. The authors concluded, "the sonographically guided procedure is the most prompt and effective method for obtaining tissue samples."
"Sonographically guided core needle biopsy of bone and soft tissue tumors"M Torriani et al
Department of radiology, Hospital das Clinicas, Universidade Estadual de Campinas, Brazil.
J Ultrasound Med 2002 (March); 21:275-281
By Ultrasound Review
March 18, 2002
Copyright © 2002 AuntMinnie.com
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
