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FRI0678 Ultrasound-guided synovial needle biopsy: single center experience of an emerging, minimally invasive technique in clinical practice and research
  1. VC Romao1,2,
  2. J Polido-Pereira1,2,
  3. R Barros1,
  4. E Vieira-Sousa1,2,
  5. R Luís3,
  6. E Vitorino3,
  7. F Saraiva1,
  8. JE Fonseca1,2
  1. 1Rheumatology Department, Hospital de Santa Maria, CHLN
  2. 2Rheumatology Research Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon
  3. 3Pathology Department, Hospital de Santa Maria, CHLN, Lisbon, Portugal

Abstract

Background Synovial biopsy remains an important tool in clinical practice and research for the study of synovitis. Ultrasound-guided needle biopsy (USNB) has recently emerged as a minimally invasive technique, which enables collection of high quality synovial tissue with very good patient tolerance.

Objectives To report the experience with USNB in our department, since its introduction in late 2013.

Methods We reviewed the clinical files of all patients who had an USNB in our department. Degree of US joint synovitis was evaluated on a semi-quantitative scale (0–3) in terms of synovial thickness (ST) and power Doppler (PD). Since 2015, we assessed patient tolerance and acceptance of the procedure using a standardized questionnaire, which includes visual analogue scales (VAS) of pain, stiffness and swelling of the biopsied joint. Changes in US and VAS scores were assessed using the Wilcoxon signed-rank test.

Results Forty-eight patients had 53 USNB, mostly for diagnostic purposes (79%), performed by 4 different operators - Figure 1. All types of joints were biopsied, mostly medium sized (26 wrists, 7 ankles), but also large (3 knees, 4 shoulders, 6 elbows, 3 hips) and small (1 sternoclavicular, 1 naviculocuneiform, 1 metacarpophalangeal and 1 proximal interphalangeal) joints, 2 bursae (subacromial) and 1 tendon sheath. USNB was repeated in the same joint (wrist) twice in 3 patients and three times in one patient. Procedures were well tolerated, with 67% of patients classifying it as easy or very easy, 78% reporting no or only mild discomfort and 77% considering likely/very likely to accept to repeat the biopsy. An increase in analgesic medication in the days following the biopsy was reported by 13 out of 44 questioned patients. After a median of 8 days following the procedure, a significant decrease was observed in VAS scores of pain, stiffness and swelling of the biopsied joint, although 23%, 23% and 31% of the patients reported small increases in these scores (median 9.5, 11 and 10mm, respectively). There was no significant change in US scores pre- and post-biopsy, with only 3 and 2 patients having an increase in ST or PD scores, respectively. Biopsies were overall safe, with 6 minor immediate adverse events (11%). There were no cases of haemartrosis, joint/periarticular infection or neurovascular damage. Two patients reported transient limitation of the 5th and 1st digit extension following a biopsy of the wrist and 1st extensor compartment tendon sheath, respectively, with no detectable tendinous ruptures on US; 1 patient had a muscular hematoma of the extensor muscles of the forearm following an elbow biopsy.

Conclusions In our center, USNB has proved to be an effective technique for collection of synovial membrane that can be used for diagnostic and research purposes. The vast majority of the procedures were well tolerated, without significant worsening of local joint symptoms or synovitis, and safe, without major adverse events. Importantly, patients' concordance to repeat a USNB was mostly high.

Disclosure of Interest None declared

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