Background/Purpose: Ultrasound-guided synovial biopsy (USGSBx) is a well-established minimally-invasive alternative to arthroscopy for sampling synovial tissue.  Adverse event rates in published studies are favourable by comparison with arthroscopy, but a large-scale evaluation of the safety of these procedures is required.

Methods: A survey of USGSBx safety and practice was devised within the European Synovitis Study Group (ESSG). Respondents were asked to complete either an online web-form, or a spreadsheet data-collection tool encompassing centre-level information regarding facilities and training for USGSBx, anonymised information about USGSBx practitioners, and a comprehensive list of USGSBx procedures with any resultant complications. A systematic literature search was performed and email survey invitations sent to individuals featuring on publications reporting the use of USGSBx. ESSG members, and those known to be involved in USGSBx as part of a network or collaboration were also invited, and respondents asked to identify any other centres in their country believed to be performing USGSBx. One response was requested per centre.

Results: The first 15 responses from centres in 11 countries and encompassing 35 practitioners are presented. 10 centres reported performing USGSBx needle biopsies, and 7 using the portal & forceps technique.  8 centres arranged for routine patient follow-up face-to-face, with 5 centres following patients by telephone.  8 centres routinely issued patients with an alert card after their procedure.

1874 biopsies were reported, 1252 (67%) performed primarily for research, and 622 (33%) for a clinical indication. Intra-articular steroid was administered after 162 (8.6%) of the procedures. Procedures performed on 15 anatomical structures were reported, with the most commonly sampled being the knee (54%), wrist (29%), metacarpophalangeal (6%), ankle (5%), elbow (1%), shoulder (1%), metatarsophalangeal (1%), hip (1%) and proximal interphalangeal (1%) joints. Other structures sampled included tendon sheaths, subacromial and subdeltoid bursae, acromioclavicular, sternoclavicular, and naviculocuneiform joints (all < 1%).

210 complications were reported from 1874 USGSBx procedures (see Table 1). For 5 procedures, 2 complications were reported, and for one 1 further procedure, 3 complications were reported.  4 major complications (marked with asterisk) were reported (0.21%), with no report of joint infection, thrombophlebitis, or deep venous thrombosis. 8 complications (none major) were reported in 162 procedures (4.9%) during which intra-articular steroid was used, and 202 complications reported in 1517 procedures (11.8%) in which intra-articular steroid was not used.  Structures in which complications rates exceeded the average of 11.2% included the naviculocuneiform joint (1/1, 100%), elbow (8/27, 30%), MTP (4/16, 25%), and knee (123/1010, 12%) joints, although the sample size for some procedures is low.

Conclusion: Preliminary results of this survey of over 1,800 procedures, support the safety and tolerability of the minimally-invasive ultrasound-guided approach as an alternative to arthroscopy for synovial biopsy procedures.

Table 1: Complications arising from minimally-invasive ultrasound-guided synovial biopsy procedures (1881 reports from 1874 procedures); major complications marked with asterisk (*)

« Back to ACR Convergence 2020

ACR Meeting Abstracts - https://acrabstracts.org/abstract/survey-of-minimally-invasive-ultrasound-guided-synovial-biopsy-performed-at-rheumatology-centres/