Ultrasound-Guided Biopsies of Bone Lesions Without Cortical Disruption Using Fusion Imaging and Needle Tracking: Proof of Concept

Objective To assess the technical feasibility and safety of combined fusion imaging and needle tracking under ultrasound guidance to target bone lesions without cortical disruption. Materials and Methods Between January 2016 and March 2016, seven patients underwent US-guided biopsy of bone lesions without cortical disruption. Targeted bone lesions were measuring more than 1.5 cm with a thin cortex, a trans-osseous pathway not exceeding 2 cm and without any adjacent vulnerable structures. First three procedures were performed in the CT suite to aid the needle tracking where necessary (group 1), the remaining four procedures were performed in the US suite (group 2). In group 1, deviation from the real position of the bone trocar (estimated on CT) was compared to the virtual position (estimated on the fusion CT–US images). In both group, procedure data and histopathological results were collected, and compared to the suspected diagnosis and follow-up. Results Mean procedure duration was 44 min. Total number of synchronisation points for combined fusion imaging were 3.3 on average. In group 1, mean deviation between the virtual and real CT coordinates was 5.3 mm on average. All biopsies yielded adequate quality analysable bone sample. Histopathological analysis revealed malignancy in three cases, non-specific inflammation in two cases, and normal bone in two cases. The four benign results were confirmed as true negative results. There were no immediate or post-procedural complications. Conclusion The use of combined fusion imaging and needle tracking ultrasound guidance to target bone lesions without cortical disruption seems technically feasible, provided the patient and lesion selection is appropriate.