Trephine Or Aspiration Biopsy

For most authors, trephine biopsy is more efficient than aspiration biopsy in establishing a pathologic diagnosis (9,10). Moreover, in infectious diseases, bacteriological examinations may remain negative despite the aspiration of pus, whereas trephine biopsy allows both histopatho-logic and bacteriologic evalution. Thus, in bone tuberculosis, histopathologic results are obtained much more rapidly than those of bacteriologic cultures, allowing rapid set up of specific treatment. In bone tumors, Logan et al. proposed an algorithm for the selection of the

FIGURE 24 Biopsy of a lytic metastatic lesion of an anterior rib.

FIGURE 24 Biopsy of a lytic metastatic lesion of an anterior rib.

FIGURE 25 Percutaneous biopsy under computed tomography scan control of a myeloma located at the neural arch of L5. (A) Preoperative measurements; (B) biopsy with a soft tissue, side-notch, cutting needle.

biopsy technique. They used fine-needle aspiration to sample small (less than 3 cm) soft-tissue masses, a bone-cutting core biopsy needle to sample sclerotic bone tumors, and a combination technique to sample lytic bone tumors with an intact bony shell. With this algorithm, they achieved an overall diagnostic accuracy rate of 96% in musculoskeletal tumors (11). In a series of 138 patients from whom percutaneous skeletal aspiration and core biopsy were both obtained, Schweitzer et al. found that core biopsy had more procedural utility than aspiration in 28 patients, while conversely, aspiration was more useful than core biopsy in 18 (12). These authors concluded that aspiration and core skeletal biopsy have a complementary role and should be both routinely performed.

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