RESUMEN
OBJECTIVE: To investigate the diagnostic performance of ultrasound-guided synovial biopsy. METHODS: Clinical notes, pathology and microbiology reports, ultrasound and other imaging studies of 100 patients who underwent 111 ultrasound-guided synovial biopsies were reviewed. Biopsies were compared with the final clinical diagnosis established after synovectomy (n = 43) or clinical/imaging follow-up (n = 57) (mean 30 months). RESULTS: Other than a single vasovagal episode, no complication of synovial biopsy was encountered. One hundred and seven (96 %) of the 111 biopsies yielded synovium histologically. Pathology ± microbiology findings for these 107 conclusive biopsies comprised synovial tumour (n = 30, 28 %), synovial infection (n = 18, 17 %), synovial inflammation (n = 45, 42 %), including gouty arthritis (n = 3), and no abnormality (n = 14, 13 %). The accuracy, sensitivity, and specificity of synovial biopsy was 99 %, 97 %, and 100 % for synovial tumour; 100 %, 100 %, and 100 % for native joint infection; and 78 %, 45 %, and 100 % for prosthetic joint infection. False-negative synovial biopsy did not seem to be related to antibiotic therapy. CONCLUSION: Ultrasound-guided Tru-cut synovial biopsy is a safe and reliable technique with a high diagnostic yield for diagnosing synovial tumour and also, most likely, for joint infection. Regarding joint infection, synovial biopsy of native joints seems to have a higher diagnostic yield than that for infected prosthetic joints. KEY POINTS: ⢠Ultrasound-guided Tru-cut synovial biopsy has high accuracy (99 %) for diagnosing synovial tumour. ⢠It has good accuracy, sensitivity, and high specificity for diagnosis of joint infection. ⢠Synovial biopsy of native joints works better than biopsy of prosthetic joints. ⢠A negative synovial biopsy culture from a native joint largely excludes septic arthritis. ⢠Ultrasound-guided Tru-cut synovial biopsy is a safe and well-tolerated procedure.
Asunto(s)
Condromatosis Sinovial/patología , Condrosarcoma/patología , Biopsia Guiada por Imagen/métodos , Linfoma de Células B Grandes Difuso/patología , Neoplasias de los Tejidos Blandos/patología , Membrana Sinovial/patología , Sinovitis/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Artritis Gotosa/diagnóstico por imagen , Artritis Gotosa/patología , Artritis Gotosa/terapia , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/terapia , Condrosarcoma/diagnóstico por imagen , Condrosarcoma/terapia , Femenino , Ganglión/diagnóstico por imagen , Ganglión/patología , Ganglión/terapia , Humanos , Linfoma de Células B Grandes Difuso/diagnóstico por imagen , Linfoma de Células B Grandes Difuso/terapia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/terapia , Infecciones Estafilocócicas/diagnóstico por imagen , Infecciones Estafilocócicas/patología , Infecciones Estafilocócicas/terapia , Sinovectomía , Membrana Sinovial/diagnóstico por imagen , Sinovitis/diagnóstico por imagen , Sinovitis/terapia , Sinovitis Pigmentada Vellonodular/diagnóstico por imagen , Sinovitis Pigmentada Vellonodular/patología , Sinovitis Pigmentada Vellonodular/terapia , Ultrasonografía , Adulto JovenRESUMEN
Ultrasound-guided needle biopsy of synovium is an increasingly performed procedure with a high diagnostic yield. In this review, we discuss the normal synovium, as well as the indications, technique, tissue handling and clinical applications of ultrasound-guided synovial biopsy.