Diagnostic value and related factors of ultrasound-guided percutaneous needle biopsy in bone lesions suspicious for tumor.
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BACKGROUND: Accurate pathological diagnosis is essential for managing bone lesions suspicious for tumor, including primary tumors and metastases. While CT-guided biopsy is standard, it involves radiation and operational limitations. Ultrasound (US) guidance offers a radiation-free, real-time alternative but is underutilized due to signal attenuation by cortical bone. This study aims to evaluate the diagnostic value of US-guided percutaneous needle biopsy for bone lesions suspicious for tumor and identify key factors influencing its efficacy. METHODS: A retrospective analysis was conducted on 345 patients with bone lesions suspicious for tumor who underwent US-guided biopsy. Parameters including soft tissue mass visibility and thickness, needle gauge (16-gauge large-bore or 21-gauge fine needle), and number of samples were recorded. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of diagnostic efficacy. RESULTS: The overall diagnostic efficacy rate was 83.48%, with 79.55% for primary and 84.82% for metastatic lesions. Multivariate analysis confirmed that visible soft tissue mass (OR = 5.391), mass thickness > 15 mm (OR = 5.391), large-bore needle use (OR = 3.287), and ≥ 3 samples (OR = 0.322) were independent predictors of successful diagnosis. ROC analysis showed an AUC of 0.756. Subgroup analysis revealed optimal sampling strategies: ≥4 samples for primary and 3 for metastatic lesions. CONCLUSION: US-guided percutaneous needle biopsy is an effective alternative to CT guidance for bone lesions suspicious for tumor with visible soft tissue masses. Key factors improving diagnostic yield include mass thickness > 15 mm, large-bore needles, and adequate sampling. Tailored strategies based on lesion type are recommended to enhance diagnostic accuracy.