Background Ultrasound-guided synovial biopsy is increasingly applied in rheumatology. Usually forceps- or needle-based techniques are used. So far there has been no direct comparison of different devices regarding their suitability in high resolution musculoskeletal ultrasound (hrMSUS)-guided synovial biopsy.
Objectives To compare different forceps and needle-based instruments in hrMSUS-guided synovial biopsy in a cadaver study.
Methods A core needle biopsy (A, Quickcore, Cook Medical, Bloomington, IN, USA), a retrograde forceps (B, Retroforce, Karl-Storz GmbH Tuttlingen, Germany), an anterograde arthroscopy forceps (C, Karl Storz GmbH, Tuttlingen, Germany) and an convexly shaped integrated core needle system (D, Synovex, Hipp Medical, Kolbingen, Germany) were tested for ultrasound-guided synovial biopsy of the suprapatellar recess in cadaver knee joints. Four senior rheumatologists scored each intervention from 0–5 regarding the following characteristics: visualization, handiness, accuracy, synovial tissue yield, invasiveness and overall suitability. Each intervention was recorded as static images and video clips.
Results In all devices, enough representative synovial tissue was obtained and the instruments were all well visualized by hrMSUS. Core needle biopsy and the integrated needle system were best visualized due to their horizontally shaped closing mechanism. The core needle obtained a high yield of superficial synovial tissue and was the least invasive procedure. Despite handiness and accuracy were higher in the forceps instruments, overall suitability for hrMSUS-guided synovial biopsy was rated highest for the core biopsy needle.
Conclusions Technically, all of the tested devices can be used for hrMSUS-guided synovial biopsy. Core needle biopsy seems to be most suitable for this intervention due to a low invasiveness, good visualisation and optimal yield of superficial synovial tissue.
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Hügle T et al. Development of a New Device for Synovial Biopsies. Surg Innov. 2015;22(5):496–9.
Disclosure of Interest T. Hügle Shareholder of: Prof. Hügle contributed to the development of the Retroforce and Synovex instruments and receives royalties from Karl-Storz GmbH and Hipp Medical AG., P. Urbaniak: None declared, M. Müller-Gerbl: None declared, C. Marx: None declared, G. Tamborrini: None declared