Effectiveness and Safety of Percutaneous CT-Guided Rib Biopsy

Purpose: To retrospectively evaluate effectiveness and safety of percutaneous CT-guided rib biopsy. Materials and Methods: CT-guided core rib biopsies were performed in 249 consecutive patients between January 2002 and June 2016. Mean patient age was 64.8 years +/- 13.8. Additional patient demographics, rib lesion characteristics, and procedural techniques were reviewed. Diagnostic yield was assessed, and complications were classified using SIR criteria. Results: Mean maximal diameter of 249 rib lesions was 2.7 cm +/- 1.8, and 107 (43%) rib lesions had an associated extraosseous soft tissue component. Of rib lesions, 172 (69%) were lytic, 75 (30%) were sclerotic, and 2 (1%) were identifiable only with positron emission tomography/CT correlation. Specimens from 241 (96.8%) biopsies were adequate for pathologic diagnosis, whereas 8 (3.2%) were nondiagnostic. Of diagnostic biopsies, 168 (69.7%) were positive for malignancy; 73 (30.3%) revealed benign etiologies. There was a significant difference in diagnostic biopsy rate depending on size of the rib lesion (mean 2.8 cm +/- 1.8 for diagnostic biopsies vs mean 1.3 cm +/- 0.5 for nondiagnostic biopsies; P =.007). Of rib lesions, 170 (99%) lytic lesions and 69 (92%) sclerotic lesions yielded diagnostic biopsies; diagnostic biopsy rate was significantly higher for lytic lesions than sclerotic lesions (P =.01). There were 14 (5.6%) minor complications and no major complications. Conclusions: Percutaneous CT-guided core rib biopsy resulted in high diagnostic yield and low complications. Diagnostic biopsy rates were higher with larger lesion size and lytic rib lesions.