Image-guided percutaneous biopsy of intramedullary lytic bone lesions: utility of aspirated blood clots.

The diagnostic value of aspirating blood clots while performing percutaneous biopsy of intramedullary lytic bone lesions was assessed. This was a retrospective analysis of 400 patients with intramedullary lytic bone lesions who underwent image-guided needle biopsy. The nature of the specimens obtained was noted from the histopathology records. In 83 (20.8%) of the 400 patients, the specimen obtained was either blood clot only or essentially blood clot with only tiny fragments of bone or soft tissue. Lesional tissue was present on needle biopsy specimens in 65 (78.3%) of the 83 cases, while in 18 (21.7%) cases no lesional tissue was obtained. In 24 of the 83 cases, there was no surgical histological diagnosis available. In the 59 cases where surgical histological diagnosis was available for comparison, the diagnostic accuracy for needle biopsy was 73%. Percutaneous biopsy provided the diagnosis allowing appropriate further management in 62 cases, for an overall diagnostic yield of 75%. The results of our study show a sufficiently good diagnostic value in obtaining blood clots as to necessitate routine attempts at obtaining such material while performing percutaneous biopsy of intramedullary lytic bone lesions.