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Logo of annrheumdAnnals of the Rheumatic DiseasesCurrent TOCInstructions for authors
Ann Rheum Dis. Jun 2005; 64(6): 926–929.
Published online Nov 18, 2004. doi:  10.1136/ard.2004.027409
PMCID: PMC1755510
Ultrasound guided synovial biopsy using portal and forceps
J Koski and M Helle
Department of Internal Medicine, Mikkeli Central Hospital, Porrassalmenkatu 35-37, FIN-50100 Mikkeli, Finland. f.koski/at/
Objective: To describe a new method for taking a synovial biopsy specimen under ultrasound guidance using portal and forceps.
Methods: Percutaneous ultrasound guided biopsy was performed for 37 patients with mono- or polyarthritis as outpatients. A portal to a planned area was built using a needle, guiding wire, and dilators, through which forceps could be inserted and samples taken. Biopsy samples were taken from small and large joints, bursae, and tendon sheaths.
Results: Representative synovial tissue in adequate amounts for histopathological evaluation was obtained in 33/37 cases—a success rate of 89%. The biopsy procedures were well tolerated, but one complication of skin infection was encountered.
Conclusion: The new method of synovium biopsy under ultrasound guidance using sheath introducer set and flexible forceps can be performed on most joints and even bursae and tendon sheaths. The method gives sufficient samples for clinical work in most cases, but further work is needed before accepting this promising technique for scientific purposes.
Figure 1
Figure 1
 Synovium biopsy instruments. (A) 18 gauge needle, wire, and dilators; (B) optional metallic instruments; (C, D) Olympus FB-52C-1 forceps; and (E) rigid forceps.
Figure 2
Figure 2
 Synovium biopsy of the knee joint as seen with ultrasound. (A) Needle in the lateral compartment of the knee joint (longitudinal view) (S, synovium); (B) wire; (C) plastic dilator; and (D) the flexible forceps.
Figure 3
Figure 3
 Synovium biopsy of the tibialis posterior tendon sheath as seen with ultrasound. (A) Needle and wire in the tendon sheath; (B) metallic dilator on the tendon; and (C, D) open jaws of the forceps ready for a bite.
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