CT–Guided Bone Biopsies in Metastatic Castration-Resistant Prostate Cancer: Factors Predictive of Maximum Tumor Yield

Michael G. Holmes, Erik Foss, Gabby Joseph, Adam Foye, Brooke Beckett, Daria Motamedi, Jack Youngren, George V. Thomas, Jiaoti Huang, Rahul Aggarwal, Joshi J. Alumkal, Tomasz M. Beer, Eric J. Small, Thomas M. Link

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Purpose To evaluate the success rate of CT–guided bone biopsies in metastatic castration-resistant prostate cancer (mCRPC) and to investigate associated technical, imaging, and clinical parameters affecting diagnostic yields. Materials and Methods Eighty CT–guided bone biopsy specimens were obtained from 72 men (median age, 68 y; range, 49–89 y) enrolled in a multicenter trial to identify mechanisms of resistance in mCRPC. Successful biopsy was determined by histologic confirmation of tumor cells and successful isolation of RNA for molecular analysis. Results The overall success rate of CT–guided bone biopsies was 69% (55/80) based on histology and 64% (35/55) based on isolation of molecular material for RNA sequencing. Biopsies performed in lesions with areas of radiolucency had significantly higher diagnostic yields compared with lesions of predominantly dense sclerosis (95% vs 33%; P =.002) and lesions of predominantly subtle sclerosis (95% vs 65%; P =.04). Success rates increased in lesions with density ≤ 475 HU (79% for ≤ 475 HU vs 33% for > 475 HU; P =.001) and in lesions with ill-defined margins (76% for ill-defined margins vs 36% for well-circumscribed margins; P =.005). Alkaline phosphatase was the only clinical parameter to correlate significantly with diagnostic yield (83% for > 110 U/L vs 50% for ≤ 110 U/L; P =.001). Conclusions Image-guided bone tumor biopsies can be successfully used to acquire cellular and molecular material for analyses in patients with osteoblastic prostate cancer metastases. Diagnostic yields are significantly increased in lesions with areas of radiolucency, density ≤ 475 HU, ill-defined margins, and interval growth and in patients with alkaline phosphatase > 110 U/L.

Original languageEnglish (US)
Pages (from-to)1073-1081.e1
JournalJournal of Vascular and Interventional Radiology
Issue number8
StatePublished - Aug 2017

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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