Ultrasound-guided synovial biopsy

Abstract

Ultrasound-guided needle biopsy of synovium is an increasingly performed procedure with a high diagnostic yield. In this review, we discuss the normal synovium, as well as the indications, technique, tissue handling and clinical applications of ultrasound-guided synovial biopsy.

Figures

Figure 1.

Setup for ultrasound-guided synovial biopsy. Key components include a small (22 G) needle for local anaesthetic injection (arrow head), scalpel for skin incision (asterisk), coaxial needle (arrow) and tru-cut (e.g. Temno) biopsy needle (hollow arrow).

Figure 2.

Close up of coaxial needle which allows repeated biopsies via a single skin entry.

Figure 3.

A Temno needle can be used to perform tru-cut synovial biopsy.

Figure 4.

Close up of the Temno needle when opened. The empty specimen slot (hollow arrow) is clearly seen.

Figure 5.

Insertion of coaxial needle into the shoulder joint under ultrasound guidance. Following injection of local anaesthetic to the skin and pericapsular region (the latter under ultrasound guidance), a small stab-like skin incision is made with the scalpel prior to insertion of coaxial needle. A strict asepsis technique is used at all times.

Figure 6.

Insertion of the tru-cut (e.g. Temno) needle into the coaxial needle (with inner trocar removed). Several tissue cores can then be obtained by reinserting the tru-cut needle into the joint via the coaxial needle. The coaxial needle is realigned, under ultrasound guidance, after each biopsy to allow subsequent biopsies to be obtained from different parts of the joint.

Figure 7.

Transverse ultrasound of the shoulder joint showing a coaxial needle with its tip (arrow) within the joint effusion (arrowhead). The effusion was aspirated and sent for microbiology before tru-cut synovial biopsy. Culture of this specimen yielded tuberculosis.

Figure 8.

Transverse ultrasound of the shoulder joint showing the echogenic tip of the coaxial needle (arrow) just piercing the thickened synovium (arrowheads). The tip of the coaxial system should be left at the outer margin of the thickened synovium to facilitate subsequent repositioning.

Figure 9.

Transverse ultrasound of the shoulder joint (same patient as Figure 8) showing the open specimen slot of the tru-cut biopsy needle (arrow) during biopsy of the thickened synovium (arrowheads).

Figure 10.

Core of synovial tissue within specimen slot of 16-G tru-cut needle. Histological and microbiological analysis revealed tuberculous infection.

Figure 11.

Transverse ultrasound of the knee joint showing the biopsy needle (arrow) during biopsy of thickened synovium in the lateral patellar recess (arrowheads).