Ultrasound-Guided Synovial Needle Biopsy Shown to be Safe, Effective, and Tolerable

Ultrasound-guided synovial biopsy is safe, effective, and well tolerated by patients, and can be used to collect high-quality tissue samples for both clinical and research purposes, according to research results published in Arthritis Care and Research.  

Researchers sought to examine the safety, efficacy, and tolerability of ultrasound-guided synovial needle biopsies; they also assessed the sampling variation associated with these biopsies.

The study prospectively included patients of the Rheumatology Department of the Hospital de Santa Maria, Lisbon, Portugal, between November 2013 and January 2018. Synovial biopsies were performed in patients with either clinically unspecified forms of synovitis or in patients with an established diagnosis and unexplained monoarthritis that could not be confirmed by arthrocentesis or other routine imaging or laboratory methods.

A total of 64 ultrasound-guided synovial biopsies were performed in 58 patients (64% women; mean age, 59±16 years). The primary indication for synovial biopsy in the clinical setting was monoarthritis (66%), and biopsies were performed for either clinical reasons or research studies (52 and 12 biopsies, respectively).

Overall, synovial biopsies were well tolerated, and classified as “easy” or “very easy” by two-thirds of patients; 70% of patients indicated that they experienced either no or mild discomfort. Patient willingness to repeat an ultrasound-guided synovial biopsy was high; 74% of patients reported that they were “likely” or “very likely” to repeat the procedure. The visual analog score of pain, swelling, and stiffness of the biopsied joint decreased significantly after a median of 8 days following the procedure. Although 36% of patients reported an increase in analgesic use immediately after the procedure, there were no differences in tolerability outcomes by joint, degree of ultrasound synovitis, or operator.

In terms of safety, only 6 minor immediate adverse events and 7 postbiopsy adverse events were reported. All cases of local hematoma or mild local inflammation resolved in the days following the procedure. Two postbiopsy adverse events were moderately severe, with 2 patients reporting “mild limitation of digit extension, with no detectible tendinous rupture on [ultrasound] evaluation,” which persisted during follow-up.

Usefulness of ultrasound-guided synovial biopsy was high in clinical practice and research. Among the 37% of patients (n=19) who underwent biopsy for clinical reasons, biopsy findings affected diagnosis, prognosis, and therapeutic guidance. Although 31 biopsies were not associated with specific findings, the biopsies ruled out infection and allowed clinicians to safely adjust treatment.

Of the 12 patients who underwent a biopsy for research purposes, all but 1 (92.2%) provided a good quality tissue that allowed investigators to pursue their research goals.

Ultrasound-guided synovial biopsies were effective in collecting substantial amounts of synovial tissue, with a mean of 6±2 samples per procedure made available for analysis; a total of 386 samples were independently analyzed.

Study limitations included the retrospective retrieval of missing information, a lack of available follow-up in some patients, and the limited generalizability because of the heterogeneity of the study population.

“[S]ynovial biopsy is an important tool for clinical practice and research.…Considering the wide access to [ultrasound] in current rheumatology practice, this is an attractive mean to allow synovial tissue collection at a global scale for clinical and research efforts,” the researchers concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Romão VC, Polido-Pereira J, Barros R, et al. Efficacy, safety and sample quality of ultrasound-guided synovial needle biopsy in clinical practice and research: a prospective observational study [published online August 17, 2019]. Arthritis Care Res (Hoboken). doi:10.1002/acr.24050