Synovial Joint Biopsy Techniques: Arthroscopy vs Ultrasound-Guided Methods

knee biopsy
knee biopsy
Data support the integration of ultrasound-guided methods along with arthroscopy into clinical trial protocols requiring sequential joint sampling for subsequent histological and molecular analysis.

Ultrasound-guided methods along with arthroscopy can be used for clinical trial protocols requiring sequential large and small joint sampling for histological and molecular analysis, according to a retrospective study published in Arthritis & Rheumatology.

Arthroscopy is currently recommended for acquiring synovial tissue for assessment of rheumatoid arthritis in clinical trials. However, alternative techniques such as blind needle biopsy and ultrasound-guided procedures are often used because they are minimally invasive, can be used in both large and small joints, are relatively inexpensive to perform, and are technically simple.

Researchers evaluated 159 procedures from 5 academic rheumatology centers to determine whether significant differences in synovial sampling quality and quantity could be demonstrated between various biopsy procedures in patients with inflammatory arthritis. Of these, 84 baseline procedures were performed on large joints, 41 on small joints, and 34 sequential biopsy procedures were evaluated.

The investigators found that a lower percentage of small joint blind needle biopsies and a significantly smaller percentage of large joint blind needle biopsies produced graded synovial tissue compared with the other techniques evaluated. However, they observed no significant difference in the percentage of graded tissue samples or synovial tissue area between ultrasound-needle biopsy and arthroscopic large joint procedures. Of the sequential biopsies evaluated, including small joint ultrasound-needle biopsy, large joint arthroscopy, ultrasound-portal and forceps, and blind needle, no significant difference in the percentage of graded synovial tissue or total area of synovial tissue was demonstrated. In addition, all procedures generated RNA of significant quality and quantity for subsequent transcriptomic analysis.

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The authors concluded, “These data support the integration of [ultrasound]-guided methods along with arthroscopic biopsy for clinical trial protocols necessitating sequential sampling of synovium from large and small joints for both histological and molecular analysis. [Blind needle] biopsy may be considered if graded synovial tissue is not required for subsequent analyses.”

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Humby F, Romão V, Manzo A, et al. A multi centre retrospective analysis evaluating performance of synovial biopsy techniques: arthroscopic vs. ultrasound guided vs. blind needle biopsy [published online February 6, 2018]. Arthritis Rheumatol. doi:10.1002/art.40433