Cytologic Evaluation of Primary Bone Lesions Sampled by Fine Needle Aspiration Biopsy: Diagnostic Utility
Valentina Robila, Gregory F Domson, William C Foster, Ema A Dragoescu. Virginia Commonwealth University, Richmond, VA
Background: Open biopsy is the traditional method for sampling bone lesions; however, this procedure puts the patients at risk for fracture and infection. A less traumatic approach is the image-guided needle biopsy technique, using either fine needle aspiration (FNA) or core needle biopsy (CNB) depending on the consistency of the lesion. These techniques yield less material and due to their rarity in clinical practice, pathologists have less experience interpreting these samples. This study analizes the diagnostic outcomes of FNA/CNB performed on bone lesions, with a special emphasis on primary bone tumors, in order to build evidence that a meaningful diagnosis can be rendered from these samples in most cases.
Design: All bone FNA/CNB (FNAB) performed with CT-guidance between 2006-2011 were reviewed. Site of involvement, method of collection, preliminary on-site interpretation, cytologic diagnosis, and follow-up were recorded.
Results: 220 bone FNABs were performed at our center during this interval. Biopsy sites were: pelvic bones (44.5%), long bones (23.1%), spine (20.4%), and other (12%). A useful interpretation was rendered in all but 2.7% nondiagnostic FNABs. 41 FNABs were from primary bone lesions: 73.1% CNB only, 24.4% CNB and FNA, and 2.5% FNA only. Touch imprints and smears provided useful diagnostic clues.
|Cytologic interpretation (case numbers)||Findings on touch imprints/smear slides|
|Cartilage-forming tumors (13)||Chondroid matrix|
|Osteoid-forming tumors (2)||Rare osteoclasts and osteoblasts; no matrix|
|Ewing sarcoma (4)||Diagnostic material|
|Langerhans cell histiocytosis (LGH) (3)||Mixed inflammation, Langerhans cells present|
|Giant cell lesions (5)||Giant cells single or in groups|
|Fibro-osseous lesions (3)||Rare spindle cells|
|Sarcomas (3)||Diagnostic material|
|Glomus tumor (1), nerve sheath tumor (1)||Blood|
|Descriptive (6)||Blood or bone marrow elements|