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Rheumatology (Oxford). 2015 Oct;54(10):1867-75. doi: 10.1093/rheumatology/kev128. Epub 2015 May 28.

Ultrasound-guided synovial biopsy: a systematic review according to the OMERACT filter and recommendations for minimal reporting standards in clinical studies.

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Queen Mary University of London, Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK.
Université Versailles Saint Quentin en Yvelines, Service de Rhumatologie Hôpital Ambroise Paré, Boulogne-Billancourt, France.
Rheumatology Department, Hospital General Universitario Gregorio Marañón and Universidad Complutense, Madrid, Spain.
University of Birmingham, Division of Immunity and Infection, Birmingham, UK and.
Rheumatology Department, Mile End Hospital, Barts Health NHS Trust, London, UK



To describe existing techniques of US-guided synovial biopsy (USG-SB) and critically appraise the literature on this technology through the OMERACT filter.


USG-SB techniques are described and compared. A systematic literature search of PubMed and Embase was performed for original research reports including US and SB. The subjects, procedure protocols and reported results were analysed. A future research agenda is proposed.


USG-SB can be performed using a portal-and-forceps or a dedicated semi-automatic guillotine-type biopsy needle approach. Of 50 reports identified, 7 were included in the review. Large, intermediate and small joints were all amenable to USG-SB. We found great heterogeneity with regard to indications for and definition of a successful procedure and of synovitis. Adverse events were assessed in most papers with an overall major complication rate of 0.4%. However, there was a lack of construct validity using a histological comparator. Relatively few papers reported details on the technique used, tissue processing, synovitis scoring and blinding for tissue analysis.


USG-SB can be regarded as a valuable tool for large-scale synovial tissue sampling. Standardization of the techniques of USG-SB and tissue processing is needed. Future research should focus on the reliability, responsiveness and feasibility of this procedure in prospective studies.


histology; joint; procedure; synovial biopsy; ultrasound

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