Ultrasound guided biopsy of rib metastasis

Case contributed by Dr Ian Bickle

Presentation

CT suggests metastatic lung cancer, Request for liver biopsy for histology.

Patient Data

Age: 70 years
Gender: Male

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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