Background/Purpose: Histological and bacteriological analysis of synovial tissue (ST) can be useful in the diagnosis of arthritis of undetermined origin. Ultrasound can assist this biopsy in directing the needle to relevant sites within the joint as well as allowing an evaluation of synovial inflammation and thickness.

The aims of this study were to describe the indications for US guided synovial biopsies in clinical practice, to determine the rate of success in acquiring ST using this approach and to determine how frequently the synovial biopsy can lead to a definite diagnosis.

Methods: Synovial biopsies of small and large joints were performed under US guidance (Philips HD11 XE) between January 2007 and December 2014 using a semi-automatic core biopsy needle (Tru-cut^R).

The patient cohort was characterized clinically. Crystal microscopy, bacteriological (with PCR for Whipple or Lyme disease), mycobacteriological and fungal analysis were performed according to the clinical presentation. Histological features of biopsies were described.

The biopsy procedure was considered as successful if synovial tissue was found at histological examination.

Results: Seventy-two patients underwent 74 synovial biopsies. Fifty-three percent were men and average age was 58,7 years (+/- 16,97).

Biopsies were performed in the following joints: knee (n=42; 56%), ankle (n=7; 10%), wrist (n=7; 10%), shoulder (n=6; 8%), hip (n=4), sterno-clavicular (n=3), elbow (n=3), pubic symphysis (n=1), acromio-clavicular (n=1), first metatarsophalangeal (n=1).

Patients presented with a chronic (> 3 months) monoarthritis in 42 cases (56%), an acute monoarthritis in 17 cases (23%), a chronic polyarthritis in 13 cases (18%), an acute polyarthritis, a chronic tenosynovitis and a chronic bursitis in 1 case respectively.

Biopsies were performed to rule out the diagnosis of septic arthritis in 64 cases (85%) or of villonodular synovitis in 11 cases (15%).

US guided biopsy attempt succeeded in 85% of cases (63 on 74 biopsies performed). Failed biopsies retrieved fibrin deposition or adipose tissue.There was no difference on success rate between small and large joints.

Ten of the 63 biopsies (17,5% of patients) leaded to a definitive diagnosis: 2 septic arthritis (no bacteria found on cultures, but a typical histological aspect), 2 villonodular synovitis, 1 case of amyloid arthritis on a patient having no known myeloma, 1 joint localization of a mantle cell lymphoma, 1 gouty arthritis, 1 osteochondromatosis, 1 Whipple disease (positive PCR on synovial tissue, with negative PCR on synovial fluid) and 1 Lyme arthritis (positive PCR on synovial tissue). The histological analysis of the 54 other biopsies showed a non-specific cell infiltrate with lymphocytes and/or macrophages.

One patient presented a knee hemarthrosis 48 hours after the US guided biopsy.

Conclusion: Ultrasound guided synovial biopsies in clinical practice are performed on patients with heterogeneous features. The rate of success in acquiring synovial tissue is high.  The procedure, when successful, leads to a definite diagnosis in more than 1 on 6 patients with an arthritis of undetermined origin.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/success-rate-and-utility-of-ultrasound-guided-synovial-biopsies-in-clinical-practice/