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Qaisar Alam
Naeem Ullah
Muhammad Salman
Zulfiqar Ullah
Sajjad Haider


musculoskeletal lesions, open biopsy, percutaneous core needle biopsy (CNB), diagnostic accuracy, healthcare costs, comparative analysis, musculoskeletal malignancies


Background: Musculoskeletal lesions pose diagnostic challenges, requiring histopathologic verification for precise characterization. This study compares open biopsy and percutaneous core needle biopsy (CNB) for musculoskeletal malignancies.

Methods: The study was conducted at National Institute of Rehabilitation Medicine Islamabad during the period from January 2021 to July 2023. A retrospective analysis of medical records and diagnostic reports included patients undergoing either open biopsy or percutaneous CNB. Diagnostic accuracy, complication rates, hospitalization duration, and healthcare costs were assessed.

Results: Percutaneous CNB demonstrated superior diagnostic accuracy (46%) compared to open biopsy (42%), aligning with existing literature. Complication rates favored CNB (16%) over open biopsy (24%). CNB led to a significantly shorter hospitalization duration (1.5 days) compared to open biopsy (4 days). Cost analysis revealed a compelling advantage for CNB, with an average cost per case of PKR 825,000, contrasting with PKR 1,200,000 for open biopsy.

Conclusion: Percutaneous CNB emerges as a preferred option for musculoskeletal malignancy diagnosis, offering enhanced diagnostic accuracy, lower complication rates, shorter hospitalization, and cost-effectiveness. Economic considerations play a pivotal role in healthcare decision-making, emphasizing the need for a balanced approach considering both clinical and financial dimensions.

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1. Veltri A, Bargellini I, Giorgi L, Almeida PAMS, Akhan O. CIRSE Guidelines on Percutaneous Needle Biopsy (PNB). Cardiovasc Intervent Radiol 2017;40:1501–13.
2. Gogna A, Peh WCG, Munk PL. Image-Guided Musculoskeletal Biopsy. Radiol Clin North Am 2008; 46:455–73.
3. Liu B, Limback J, Kendall M, Valente M, Armaly J, Grekoski V, et al. Safety of CT-Guided Bone Marrow Biopsy in Thrombocytopenic Patients: A Retrospective Review. Journal of Vascular and Interventional Radiology 2017;28:1727–31.
4. Holmes MG, Foss E, Joseph G, Foye A, Beckett B, Motamedi D, et al. CT–Guided Bone Biopsies in Metastatic Castration-Resistant Prostate Cancer: Factors Predictive of Maximum Tumor Yield. Journal of Vascular and Interventional Radiology 2017;28:1073-1081.e1.
5. Tam AL, Lim HJ, Wistuba II, Tamrazi A, Kuo MD, Ziv E, et al. Image-Guided Biopsy in the Era of Personalized Cancer Care: Proceedings from the Society of Interventional Radiology Research Consensus Panel. Journal of Vascular and Interventional Radiology 2016;27:8–19.
6. Heare TC, Enneking WF, Heare MM. Staging techniques and biopsy of bone tumors. Orthop Clin North Am 1989;20:273–85.
7. Gerrand CH, Rankin K. The Hazards of Biopsy in Patients with Malignant Primary Bone and Soft-Tissue Tumors. Classic Papers in Orthopaedics, London: Springer London; 2014, p. 491–3.
8. Boriani S, Ruggieri P, Sudanese A. Biopsy: considerations on surgical technique derived from a study of 749 cases of bone tumour. Ital J Orthop Traumatol 1984;10:489–99.
9. SKRZYNSKI MC, BIERMANN JS, MONTAG A, SIMON MA. Diagnostic Accuracy and Charge-Savings of Outpatient Core Needle Biopsy Compared with Open Biopsy of Musculoskeletal Tumors*. J Bone Joint Surg 1996;78:644–9.
10. Ball ABS, Fisher C, Pittam M, Watkins RM, Westbury G. Diagnosis of soft tissue tumours by Tru-Cut® biopsy. British Journal of Surgery 2005;77:756–8.
11. Ray-Coquard I, Ranchère-Vince D, Thiesse P, Ghesquières H, Biron P, Sunyach M-P, et al. Evaluation of core needle biopsy as a substitute to open biopsy in the diagnosis of soft-tissue masses. Eur J Cancer 2003;39:2021–5.
12. Welker JA, Henshaw RM, Jelinek J, Shmookler BM, Malawer MM. The percutaneous needle biopsy is safe and recommended in the diagnosis of musculoskeletal masses. Cancer 2000;89:2677–86.<2677::AID-CNCR22>3.0.CO;2-L.
13. Thomas JM. Surgical Biopsy Techniques and Differential Diagnosis of Soft Tissue Tumours, 1995, p. 25–9.
14. Ayala AG, Ro JY, Fanning C V., Flores JP, Yasko AW. Core Needle Biopsy and Fine-Needle Aspiration in the Diagnosis of Bone and Soft-Tissue Lesions. Hematol Oncol Clin North Am 1995;9:633–52.
15. Carrino JA, Khurana B, Ready JE, Silverman SG, Winalski CS. Magnetic Resonance Imaging-Guided Percutaneous Biopsy of Musculoskeletal Lesions. J Bone Joint Surg 2007;89:2179–87.
16. Puri A, Shingade VU, Agarwal MG, Anchan C, Juvekar S, Desai S, et al. CT–guided percutaneous core needle biopsy in deep seated musculoskeletal lesions: a prospective study of 128 cases. Skeletal Radiol 2006;35:138–43.
17. Shin H-J, Amaral JG, Armstrong D, Chait PG, Temple MJ, John P, et al. Image-guided percutaneous biopsy of musculoskeletal lesions in children. Pediatr Radiol 2007;37:362–9.
18. van der Bijl AE, Taminiau AH, Hermans J, Beerman H, Hogendoorn PC. Accuracy of the Jamshidi trocar biopsy in the diagnosis of bone tumors. Clin Orthop Relat Res 1997:233–43.
19. Wu JS, Goldsmith JD, Horwich PJ, Shetty SK, Hochman MG. Bone and Soft-Tissue Lesions: What Factors Affect Diagnostic Yield of Image-guided Core-Needle Biopsy? Radiology 2008; 248:962–70.
20. Zornoza J, Bernardino ME, Ordonez NG, Thomas JL, Cohen MA. Percutaneous needle biopsy of soft tissue tumors guided by ultrasound and computed tomography. Skeletal Radiol 1982;9:33–6.
22. Ward WG, Kilpatrick S. Fine Needle Aspiration Biopsy of Primary Bone Tumors. Clin Orthop Relat Res 2000;373:80–7.
23. Serpell JW, Pitcher ME. PRE‐OPERATIVE CORE BIOPSY OF SOFT‐TISSUE TUMOURS FACILITATES THEIR SURGICAL MANAGEMENT. Australian and New Zealand Journal of Surgery 1998;68:345–9.
24. Stoker D, Cobb J, Pringle J. Needle biopsy of musculoskeletal lesions. A review of 208 procedures. J Bone Joint Surg Br 1991;73-B:498–500.
25. Heslin MJ, Lewis JJ, Woodruff JM, Brennan MF. Core needle biopsy for diagnosis of extremity soft tissue sarcoma. Ann Surg Oncol 1997;4:425–31.
26. Sung K-S, Seo S-W, Shon M-S. The diagnostic value of needle biopsy for musculoskeletal lesions. Int Orthop 2009;33:1701–6.
27. Le H, Lee S, Munk P. Image-Guided Musculoskeletal Biopsies. Semin Intervent Radiol 2010;27:191–8.
28. Filippiadis D, Charalampopoulos G, Mazioti A, Keramida K, Kelekis A. Bone and Soft-Tissue Biopsies: What You Need to Know. Semin Intervent Radiol 2018;35:215–20.
29. Ceraulo A, Ouziel A, Lavergne E, Perrier L, Decouvelaere A-V, Chotel F, et al. Percutaneous guided biopsy for diagnosing suspected primary malignant bone tumors in pediatric patients: a safe, accurate, and cost-saving procedure. Pediatr Radiol 2017;47:235–44.
30. Pouedras M, Briand S, Crenn V, Cassagnau E, Gouin F. Non image-guided core needle biopsies can be used safely to improve diagnostic efficiency for soft tissue tumors. Surg Oncol 2021;37:101518.
31. Kasraeian S, Allison DC, Ahlmann ER, Fedenko AN, Menendez LR. A Comparison of Fine-needle Aspiration, Core Biopsy, and Surgical Biopsy in the Diagnosis of Extremity Soft Tissue Masses. Clin Orthop Relat Res 2010; 468:2992–3002.
32. Seng C, Png W, Tan MH. Accuracy of Core Needle Biopsy for Musculoskeletal Tumours. Journal of Orthopaedic Surgery 2013; 21:92–5.
33. Crenn V, Vezole L, Bouhamama A, Meurgey A, Karanian M, Marec-Bérard P, et al. Percutaneous Core Needle Biopsy Can Efficiently and Safely Diagnose Most Primary Bone Tumors. Diagnostics 2021; 11:1552.
34. Adams SC, Potter BK, Pitcher DJ, Temple TH. Office-based Core Needle Biopsy of Bone and Soft Tissue Malignancies: An Accurate Alternative to Open Biopsy with Infrequent Complications. Clin Orthop Relat Res 2010; 468:2774–80.

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