Diagnostic Accuracy of CT-Guided Core Needle Biopsy for Solitary Bone Lesions in Pediatric Patients

Purpose: A prospective study was performed to assess the sensitivity, specificity, and diagnostic accuracy of computed tomography (CT)-guided core needle biopsy (CNB) in patients aged 1 to 18 years.

Methods and Materials: Between October 2016 and October 2019, 148 pediatric patients (65 females and 83 males; average age: 11 years) underwent CT-guided CNB for a solitary bone lesion. The procedure was performed by or under the direct supervision of a consultant musculoskeletal radiologist with 23 years of experience. Anatomical location, size and type of needle used, radiologic diagnosis, CT-guided CNB diagnosis, and final diagnosis were recorded as were postprocedural complications. Inclusion criteria were the presence of a final diagnosis obtained with the reference standard test for each entity (surgical excision, surgical biopsy, and laboratory test). Sensitivity, specificity, and diagnostic accuracy were reported according to the Standards for Reporting of Diagnostic Accuracy Studies 2015 guidelines.

Results: A total of 125 patients met the inclusion criteria (57 females and 68 males; average age: 11 years). Twenty-three patients were excluded because the final diagnosis and/or the medical follow-up was not available. The biopsies were performed using a Jamshidi 10G (n = 96), Jamshidi 13G (n = 8), Tru-Cut 14G (n = 18), or Temno 14G (n = 3). The most common anatomical locations were the femur (n = 40), tibia (n = 25), and sacrum (n = 22). Osteosarcoma (n = 35) and Ewing’s sarcoma (n = 20) were the most common diagnoses. No immediate postprocedural complications were recorded.

• True positive (TP), n = 99. Concordance between the CNB and the gold standard test.

• False positive (FP), n = 7. The CNB returned a different result compared with the gold standard.

• True negative (TN), n = 9. CNB and gold standard did not identify a neoplastic bone lesion.

• False negative (FN), n = 16. Negative CNB and lesion identified with the gold standard test.

Sensitivity, specificity, and diagnostic accuracy were 86%, 56%, and 82.5%, respectively.

Conclusion: CT-guided CNB represents a safe and effective tool for the diagnosis of solitary bone lesions in pediatric patients.

Fig. 1 Flow diagram of participants through the study. CT, computed tomography; F, female; M, male.

Fig. 2 Anatomical location of the solitary bone lesions.

Fig. 3 Most common final diagnoses. ABC, aneurysmal bone cyst; GCT, giant cell tumor; LCH, Langerhans cell histiocytosis; CRMO, chronic recurrent multifocal osteomyelitis.

Publication History

Article published online:
17 December 2020