Optimizing ultrasound-guided biopsy of musculoskeletal masses by application of an ultrasound contrast agent.

PURPOSE: We report on a novel approach to the work-up of musculoskeletal lesions with addition of an ultrasound contrast agent followed by focal ultrasound-guided biopsy. MATERIALS AND METHODS: In this pilot study 25 patients (age: 12-75) with unclear musculoskeletal tumors underwent grayscale ultrasound, color Doppler, contrast-enhanced ultrasound and subsequent ultrasound-guided biopsy. Grayscale and color Doppler ultrasound were performed with a 12-5 MHz broadband linear transducer and contrast-enhanced ultrasound with a 9-3 MHz broadband linear transducer (iU22®, Philips, USA) using a second-generation contrast agent (SonoVue®, Bracco, Italy). After the definition of the target area by contrast-enhanced ultrasound, guided biopsies were performed with a spring-loaded tru-cut™ biopsy needle using the coaxial technique. RESULTS: The definition of enhancing and viable tumor regions resulted in a diagnostic yield of the subsequent biopsy of 100%. Seventeen tumors were classified as malignant and eight as benign, which was finally confirmed by histological work-up or the further clinical follow-up. CONCLUSION: This pilot study with a limited series of patients improved the diagnostic yield of ultrasound-guided biopsy to 100%, which is at least rather promising. Our easy-to-use algorithm should reduce the rate of inconclusive histology results mainly caused by sampling errors to an unrivaled minimum.