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Needle-in-Needle Technique for Percutaneous Retrieval of a Fractured Biopsy Needle Embedded in the Thoracic Spine During a CT-Guided Biopsy 2014

Category Interventional Hamza Shaikh
Jayesh Thawani
Bryan Pukenas
Purpose Common complications related to CT-guided percutaneous thoracic bone biopsy procedures include pneumothorax and muscular hematoma. Serious, but rare complications include paralysis, nerve injury, CSF leak, and aortic injury.  Device failure has not been well documented in the literature. We discuss our experience with biopsy needle breakage during retrieval of a core specimen and the technique used to help retrieve an embedded needle using a CT fluoroscopic-guided, needle-in-needle approach. FIGURE1.tif Materials & Methods A 43 year-old male with Stage IIIa NSCLC was found to have a T11 vertebral body lesion as seen on PET, CT, and MR imaging. The patient underwent a CT-guided biopsy in the prone position. The T11 vertebral body was localized and cannulated using the percutaneous BONEOPTY (Apriomed, Upsalla, Sweden) needle device. After fine needle aspiration samples were obtained, a core needle biopsy was attempted with a 16-gauge device. The needle fractured 4 cm deep to the skin during removal of a sclerotic lesion, leaving a retained portion within the pedicle and vertebral body. Results We present a case of needle fracture during removal of a Boneopty penetration needle after core biopsy. This case illustrates the importance of utilizing a larger bore needle when targeting sclerotic lesions and using a coaxial technique for more support when using the Boneopty set to prevent needle angulation and potential breakage.  In cases where needle breakage does occur, guiding a larger-bore biopsy needle (such as the Murphy) over and through the retained, fractured needle can help to remove it and ultimately obviate the need for an open surgical retrieval. FIGURE 3.tif Conclusion Using CT-guided fluoroscopy, a large diameter Murphy M2 needle was advanced over the distal portion of the fractured BONEOPTY needle. The Murphy M2 needle was advanced distal to the tip of the BONEOPTY needle and removed, capturing the broken BONEOPTY penetration needle along with a core specimen. Larger-bore biopsy needle systems and/or a coaxial system should be used to perform core biopsies in sclerotic lesions to prevent device fracture.  If there is device fracture, a larger-bore needle may be used to help capture the fractured needle and prevent open surgery. FIGURE 4.tif References 1. Babu NV, Titus VT, Chittaranjan S, Abraham G, Prem H, Korula RJ. Computed tomographically guided biopsy of the spine. Spine (Phila Pa 1976). Nov 1 1994;19(21):2436-2442. 2. Lis E, Bilsky MH, Pisinski L, et al. Percutaneous CT-guided biopsy of osseous lesion of the spine in patients with known or suspected malignancy. AJNR Am J Neuroradiol. Oct 2004;25(9):1583-1588. 3. Moller S, Kothe R, Wiesner L, Werner M, Ruther W, Delling G. Fluoroscopy-guided transpedicular trocar biopsy of the spine--results, review, and technical notes. Acta Orthop Belg. Dec 2001;67(5):488-499. 4. Nourbakhsh A, Grady JJ, Garges KJ. Percutaneous spine biopsy: a meta-analysis. J Bone Joint Surg Am. Aug 2008;90(8):1722-1725.