Presentation
CT suggests metastatic lung cancer, Request for liver biopsy for histology.
Patient Data
3.5cm expansile rib metastasis with cortical breech.
16G core biopsy undertaken.
Radiologist suggests to the clinician a safer, easier method of tissue diagnosis would be from an ultrasound-guided rib biopsy.
This could be done as an outpatient rather than requiring admission for post-procedural monitoring.
Case Discussion
A few learning points here.
1. Even if asked to biopsy a specific site, review the prior imaging to see if an easier, safer more convenient site if available as an alternative.
2. If a bone metastasis has a soft tissue component a standard biopsy needle can be used (no need for a bone biopsy needle).
3. Deeper 'subcutaneous' masses are often easier to biopsy with the curvilinear probe than a linear probe, although initially counterintuitive (see different in diagnosis images here and the biopsy throw image)
4. A biopsy without admission is nearly always more popular with the patient and cheaper for the healthcare system. But only do if safe to do so. Safety must come first.
Histology: Metastasis from a hepatocellular carcinoma
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