Minimally invasive ultrasound-guided biopsy of the common extensor tendon enthesis: a cadaveric study to standardise the technique
Objective To develop and validate a minimally invasive ultrasound (US)-guided biopsy technique to collect entheseal tissue from the common extensor tendon (CET) enthesis at the lateral humeral epicondyle.Methods Seven sonographers performed a US examination of the CET on six human cadaveric upper li...
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BMJ Publishing Group
2025-04-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/11/2/e005328.full |
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| author | Ingrid Moller Georg Schett Andreas Ramming Giuliana Guggino Stefano Alivernini Pietro Rubortone Carlo Tur Enrico De Lorenzis Beatrice Belmonte Maria Antonietta D’Agostino Maria Gabriella Raimondo Chiara Rizzo Marco Maria Lizzio Luis Coronel Maribel Miguel Perez Valeria Cancila |
| author_facet | Ingrid Moller Georg Schett Andreas Ramming Giuliana Guggino Stefano Alivernini Pietro Rubortone Carlo Tur Enrico De Lorenzis Beatrice Belmonte Maria Antonietta D’Agostino Maria Gabriella Raimondo Chiara Rizzo Marco Maria Lizzio Luis Coronel Maribel Miguel Perez Valeria Cancila |
| author_sort | Ingrid Moller |
| collection | DOAJ |
| description | Objective To develop and validate a minimally invasive ultrasound (US)-guided biopsy technique to collect entheseal tissue from the common extensor tendon (CET) enthesis at the lateral humeral epicondyle.Methods Seven sonographers performed a US examination of the CET on six human cadaveric upper limbs to locate the enthesis using an anatomical landmark-based approach. An adapted mini-arthroscopic system was introduced under US guidance to the target site for sample collection. At the end of the procedure, a dye was injected through the guide needle, followed by dissection, to confirm the sampling location. Histology and immunohistochemistry analyses were performed to assess the quality and representativeness of the samples. The reliability of the procedure among operators was evaluated by analysing the rate of successful sampling.Results 24 samples were collected. The target site to be biopsied was identified as the insertion of the extensor carpi radialis brevis component of the CET. On dissection, the stain used to verify sampling accuracy was confirmed within the defined target area, with no damage to adjacent structures. Histology and immunohistochemistry indicated that most of the samples exhibited characteristics consistent with entheseal tissue (21 out of 24). All participants identified the CET and successfully completed the procedure, demonstrating reliable sample quality across operators.Conclusion We developed a landmark-based approach to perform a minimally invasive full controlled US-guided biopsy of the CET enthesis that showed to be feasible and reproducible. We believe that this standardised, minimally invasive technique will widespread a reliable collection of entheseal tissue for future clinical and translational studies. |
| format | Article |
| id | doaj-art-6c700bdb86254de3a3d7293a8564e41b |
| institution | Kabale University |
| issn | 2056-5933 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMJ Publishing Group |
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| series | RMD Open |
| spelling | doaj-art-6c700bdb86254de3a3d7293a8564e41b2025-08-20T03:59:36ZengBMJ Publishing GroupRMD Open2056-59332025-04-0111210.1136/rmdopen-2024-005328Minimally invasive ultrasound-guided biopsy of the common extensor tendon enthesis: a cadaveric study to standardise the techniqueIngrid Moller0Georg Schett1Andreas Ramming2Giuliana Guggino3Stefano Alivernini4Pietro Rubortone5Carlo Tur6Enrico De Lorenzis7Beatrice Belmonte8Maria Antonietta D’Agostino9Maria Gabriella Raimondo10Chiara Rizzo11Marco Maria Lizzio12Luis Coronel13Maribel Miguel Perez14Valeria Cancila15Instituto Poal de Reumatología, Barcelona, SpainDepartment of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, GermanyDepartment of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, GermanyDepartment of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology section - “P. Giaccone”, University of Palermo, Palermo, ItalyDepartment of Aging Diseases, Orthopedic and Rheumatology, Rheumatology Division, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, ItalyDepartment of Aging Diseases, Orthopedic and Rheumatology, Rheumatology Division, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, ItalyDepartment of Aging Diseases, Orthopedic and Rheumatology, Rheumatology Division, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, ItalyRheumatology and Clinical Immunology, Catholic University of the Sacred Heart, Roma, ItalyDepartment of Health Science, Tumor Immunology Unit, University of Palermo, Palermo, ItalyDepartment of Aging Diseases, Orthopedic and Rheumatology, Rheumatology Division, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Rome, ItalyDepartment of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, GermanyDepartment of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Section - `P. Giaccone`, University of Palermo, Palermo, ItalyDepartment of Aging Diseases, Orthopedic and Rheumatology, Rheumatology Division, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, ItalyRheumatology Unit, Vall d’Hebron University Hospital, Barcelona, SpainDepartment of Pathology and Experimental Therapeutics, Unit of Human Anatomy and Embriology, University of Barcelona, Barcelona, SpainDepartment of Health Science, Tumor Immunology Unit, University of Palermo, Palermo, ItalyObjective To develop and validate a minimally invasive ultrasound (US)-guided biopsy technique to collect entheseal tissue from the common extensor tendon (CET) enthesis at the lateral humeral epicondyle.Methods Seven sonographers performed a US examination of the CET on six human cadaveric upper limbs to locate the enthesis using an anatomical landmark-based approach. An adapted mini-arthroscopic system was introduced under US guidance to the target site for sample collection. At the end of the procedure, a dye was injected through the guide needle, followed by dissection, to confirm the sampling location. Histology and immunohistochemistry analyses were performed to assess the quality and representativeness of the samples. The reliability of the procedure among operators was evaluated by analysing the rate of successful sampling.Results 24 samples were collected. The target site to be biopsied was identified as the insertion of the extensor carpi radialis brevis component of the CET. On dissection, the stain used to verify sampling accuracy was confirmed within the defined target area, with no damage to adjacent structures. Histology and immunohistochemistry indicated that most of the samples exhibited characteristics consistent with entheseal tissue (21 out of 24). All participants identified the CET and successfully completed the procedure, demonstrating reliable sample quality across operators.Conclusion We developed a landmark-based approach to perform a minimally invasive full controlled US-guided biopsy of the CET enthesis that showed to be feasible and reproducible. We believe that this standardised, minimally invasive technique will widespread a reliable collection of entheseal tissue for future clinical and translational studies.https://rmdopen.bmj.com/content/11/2/e005328.full |
| spellingShingle | Ingrid Moller Georg Schett Andreas Ramming Giuliana Guggino Stefano Alivernini Pietro Rubortone Carlo Tur Enrico De Lorenzis Beatrice Belmonte Maria Antonietta D’Agostino Maria Gabriella Raimondo Chiara Rizzo Marco Maria Lizzio Luis Coronel Maribel Miguel Perez Valeria Cancila Minimally invasive ultrasound-guided biopsy of the common extensor tendon enthesis: a cadaveric study to standardise the technique RMD Open |
| title | Minimally invasive ultrasound-guided biopsy of the common extensor tendon enthesis: a cadaveric study to standardise the technique |
| title_full | Minimally invasive ultrasound-guided biopsy of the common extensor tendon enthesis: a cadaveric study to standardise the technique |
| title_fullStr | Minimally invasive ultrasound-guided biopsy of the common extensor tendon enthesis: a cadaveric study to standardise the technique |
| title_full_unstemmed | Minimally invasive ultrasound-guided biopsy of the common extensor tendon enthesis: a cadaveric study to standardise the technique |
| title_short | Minimally invasive ultrasound-guided biopsy of the common extensor tendon enthesis: a cadaveric study to standardise the technique |
| title_sort | minimally invasive ultrasound guided biopsy of the common extensor tendon enthesis a cadaveric study to standardise the technique |
| url | https://rmdopen.bmj.com/content/11/2/e005328.full |
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