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Percutaneous image-guided sternal biopsy: a cross-institutional retrospective review of diagnostic yield and safety in 50 cases

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Abstract

Objective

Image-guided sternal biopsy may be technically daunting given the immediately subjacent critical structures. There is a paucity of literature describing technique, safety, and efficacy. This study aims to quantify the diagnostic yield and safety of image-guided sternal biopsies. Secondary aims include (1) describing the preferred approach/technique and (2) identifying imaging features and disease entities associated with higher and lower diagnostic yields.

Materials and methods

A retrospective review of 50 image-guided sternal biopsies performed at two quaternary care centers from 2000 to 2019 was performed. Recorded lesion-related variables included as follows: location, density, extraosseous extension, and size. Recorded variables from electronic medical records included as follows: patient demographics, histologic or microbiological diagnosis, and complications. Recorded technique-related variables included as follows: needle obliquity, type, and gauge; biopsy core number and length; and modality.

Results

Of the 50 biopsies, 88.0% resulted in a definitive histologic diagnosis. Six biopsies were non-diagnostic. The majority of biopsies were performed under computed tomography (88.0%), followed by ultrasound (12.0%). Tumor was the most common biopsy indication (90.0%), followed by infection (10.0%). Of the diagnostic biopsies indicated for tumor, 88.9% were malignant. Seventy-four percent of the lesions were predominantly lytic. Fifty percent of lesions had extraosseous extension. Lesion locations were as follows: manubrium (48.0%), sternal body (48.0%), and sternomanubrial joint (4.0%). No minor or major, acute, or delayed procedure-related complications were encountered.

Conclusion

Image-guided sternal biopsy is an efficacious and safe method of obtaining a definitive histologic diagnosis regardless of lesion-specific features or location.

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Acknowledgments

We give our most sincere thanks to Dr. Ningcheng (Peter) Li, Dr. Judy Gichoya, and Guy Maresh for their development and continuous support of the OHSU Radiology Search Engine.

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Authors and Affiliations

  1. Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA

    Ningcheng (Peter) Li, Molly A. Wingfield, Brooke R. Beckett & Barry G. Hansford

  2. Department of Radiology and Imaging Sciences, University of Utah, 50 N Medical Dr, Salt Lake City, UT, 84132, USA

    Megan K. Mills

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  1. Ningcheng (Peter) Li
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  2. Molly A. Wingfield
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Correspondence to Ningcheng (Peter) Li.

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The study received approval from the institutional review board.

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Li, N.(., Wingfield, M.A., Mills, M.K. et al. Percutaneous image-guided sternal biopsy: a cross-institutional retrospective review of diagnostic yield and safety in 50 cases. Skeletal Radiol 50, 495–504 (2021). https://doi.org/10.1007/s00256-020-03587-6

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  • DOI: https://doi.org/10.1007/s00256-020-03587-6

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