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Ultrasound-guided biopsy of musculoskeletal soft-tissue tumors: basic principles, usefulness and limitations

Violeta Vasilevska Nikodinovska
Violeta Vasilevska Nikodinovska
, 
Slavcho Ivanoski
Slavcho Ivanoski
, 
Slavica Kostadinova-Kunovska
Slavica Kostadinova-Kunovska
 e 
Milan Samardziski
Milan Samardziski
   | 27 apr 2022
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Article Category: Review paper
Pubblicato online: 27 apr 2022
Pagine: 109 - 116
Ricevuto: 02 gen 2021
Accettato: 15 mar 2021
DOI: https://doi.org/10.15557/JoU.2022.0018
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© 2022 Violeta Vasilevska Nikodinovska, Slavcho Ivanoski, Slavica Kostadinova-Kunovska, Milan Samardziski, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1

Giant cell tumor of finger flexor tendon sheath. The lesion (arrows) is visible superficially to the tendons. Flexor tendons – arrowheads; intermediate phalanx – asterisk
Giant cell tumor of finger flexor tendon sheath. The lesion (arrows) is visible superficially to the tendons. Flexor tendons – arrowheads; intermediate phalanx – asterisk

Fig. 2

A. Typical subcutaneous lipoma (arrows). Poorly demarcated from the surrounding adipose tissue, iso/hyperechoic lesion in the subcutaneous tissue. B. Ganglion cyst of the dorsal wrist. Clearly demarcated fluid collection is depicted (arrow) arising from the dorsal radiocarpal joint space. Radius – asterisk. C. Peripheral nerve sheath tumor. Oval, hypoechoic lesion with posterior acoustic enhancement is observed (arrow), in continuity with the nerve (arrowheads)
A. Typical subcutaneous lipoma (arrows). Poorly demarcated from the surrounding adipose tissue, iso/hyperechoic lesion in the subcutaneous tissue. B. Ganglion cyst of the dorsal wrist. Clearly demarcated fluid collection is depicted (arrow) arising from the dorsal radiocarpal joint space. Radius – asterisk. C. Peripheral nerve sheath tumor. Oval, hypoechoic lesion with posterior acoustic enhancement is observed (arrow), in continuity with the nerve (arrowheads)

Fig. 3

A. Paravertebral lesion with indeterminate sonographic appearance. Patient with a palpable, large, paravertebral mass sent for diagnostic ultrasound with clinical suspicion of soft-tissue tumor. Large lesion with multiple fluid-fluid levels was visualized on ultrasound (arrows), in contact with the nearby vertebra. The subsequent MRI and biopsy result (not shown) confirmed the diagnosis of aneurismal bone cyst arising from the adjacent vertebral lamina. B. Soft-tissue lesion with aggressive appearance (arrows). Solid, hypoechoic, large, intramuscular lesion located superficially to the scapula (asterisk). The biopsy result confirmed the diagnosis of high-grade rhabdomyosarcoma
A. Paravertebral lesion with indeterminate sonographic appearance. Patient with a palpable, large, paravertebral mass sent for diagnostic ultrasound with clinical suspicion of soft-tissue tumor. Large lesion with multiple fluid-fluid levels was visualized on ultrasound (arrows), in contact with the nearby vertebra. The subsequent MRI and biopsy result (not shown) confirmed the diagnosis of aneurismal bone cyst arising from the adjacent vertebral lamina. B. Soft-tissue lesion with aggressive appearance (arrows). Solid, hypoechoic, large, intramuscular lesion located superficially to the scapula (asterisk). The biopsy result confirmed the diagnosis of high-grade rhabdomyosarcoma

Fig. 4

Minor complication of core needle biopsy. Discrete intratumoral hemorrhage (arrowhead) immediately after needle pass (arrows) through the peripheral vascularized tumor part (A). Mild hemorrhage (arrows) in the same spot a few minutes later (B). The hemorrhage has increased slightly (arrowhead) during the second pass through the central tumor part (arrows) (C). The biopsy site should be checked for significant bleeding immediately after the procedure. Routinely, minimum 5-minute local compression or compression until the bleeding ends is suggested after each core needle procedure. The patient should remain resting (sitting or lying down depending on biopsy site) in the center for observation for at least 30 minutes after the procedure
Minor complication of core needle biopsy. Discrete intratumoral hemorrhage (arrowhead) immediately after needle pass (arrows) through the peripheral vascularized tumor part (A). Mild hemorrhage (arrows) in the same spot a few minutes later (B). The hemorrhage has increased slightly (arrowhead) during the second pass through the central tumor part (arrows) (C). The biopsy site should be checked for significant bleeding immediately after the procedure. Routinely, minimum 5-minute local compression or compression until the bleeding ends is suggested after each core needle procedure. The patient should remain resting (sitting or lying down depending on biopsy site) in the center for observation for at least 30 minutes after the procedure

Fig. 5

Positioning of biopsy needle and transducer. The needle should be in the same plane, as perpendicular to the transducer as possible. The needle advancement (arrows) should be followed during the entire procedure (A, B). There is no perfect presentation of the needle (arrows); the needle tip (arrowhead) is not clearly visible (C). Corrective movement – gentle rotation of the transducer can improve needle visualization (D). The needle is in the same longitudinal plane with the transducer, the total length of the needle is visualized (arrows), and the tip is clearly visible (arrowhead)
Positioning of biopsy needle and transducer. The needle should be in the same plane, as perpendicular to the transducer as possible. The needle advancement (arrows) should be followed during the entire procedure (A, B). There is no perfect presentation of the needle (arrows); the needle tip (arrowhead) is not clearly visible (C). Corrective movement – gentle rotation of the transducer can improve needle visualization (D). The needle is in the same longitudinal plane with the transducer, the total length of the needle is visualized (arrows), and the tip is clearly visible (arrowhead)

Fig. 6

Positioning of biopsy needle for better visualization. Gentle forward and backward movement of the needle during the procedure (arrows) with the transducer remaining in the same position can help in optimizing the view of the needle and needle tip (arrowhead)
Positioning of biopsy needle for better visualization. Gentle forward and backward movement of the needle during the procedure (arrows) with the transducer remaining in the same position can help in optimizing the view of the needle and needle tip (arrowhead)

Fig. 7

Heterogeneous, large, poorly demarcated, intramuscular soft-tissue lesion is visible. Color Doppler ultrasound is useful in discriminating between necrotic and vascularized parts, and helps to successfully target the viable part of the lesion
Heterogeneous, large, poorly demarcated, intramuscular soft-tissue lesion is visible. Color Doppler ultrasound is useful in discriminating between necrotic and vascularized parts, and helps to successfully target the viable part of the lesion
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Medicine, Basic Medical Science, other
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