The Annals of Thoracic Surgery, Vol 38, 59-62, Copyright © 1984 by The Society of Thoracic Surgeons
Open rib biopsy guided by radionuclide technique
WJ Shih, FH DeLand, PA Domstad, S Magoun and ML Dillon
When abnormally increased radioactivity is seen in a rib or ribs by bone
imaging in a patient with suspected or known malignancy, it frequently is
difficult to differentiate fracture from metastatic disease. Histological
examination of the lesion is crucial for diagnosis, staging, and planning
of therapy. To assess the value of external localization of the site or
sites of abnormal uptake in a rib as a guide for open rib biopsy, 10
patients (7 men, 3 women; age range, 34 to 68 years) with known or
suspected malignancy were studied. With reference to the oscilloscope
image, a cobalt 57 marker was placed on the skin overlying the focus of
increased uptake, and the area of increased activity was marked on the skin
as a guide to surgical resection. Of ten resected ribs, four showed
metastatic disease and five had fractures. (One patient underwent two
external marking procedures and two surgical procedures.) Rib biopsy was
not performed in 1 patient because prior to the surgical procedure, a small
subcutaneous nodule adjacent to the skin marker was excised and confirmed
to be carcinoma. Appropriate courses of management (operation, irradiation,
chemotherapy) were taken after the biopsies. The surgeon responsible for
the biopsy should be present during the skin-marking procedure, and the
area beneath the scapula and the region adjacent to the spine should be
avoided. Our results indicate that the technique is a very useful aid for
approaching open rib biopsies more precisely.
