Punch biopsy of synovial membrane.

An instrument has been devised which makes biopsy of the synovial membrane a relatively easy procedure. With this instrument the usual operative incision is unnecessary and the disability incident to operation is avoided. It has been used on 130 occasions to remove specimens from 135 joints of 108 patients, ranging in age from 3 to 71 years. Single procedures were performed on 93 patients, on the right knee 54 times, on the left knee 37 times, and on the elbow and shoulder once each. Multiple (two to six) procedures involving 42 joints were performed on fifteen patients; these entailed removal of specimens from the knees of ten patients on 32 occasions, and from both knees at one time of each of five patients (five occasions).t In the presence of sufficient distention by synovial effusion to permit safe introduction of the instrument it might also be used on the ankle or wrist joint. With added experience other applications have been found, including biopsy of bursae, diseased bone, and soft tissue masses (Bickel and Barber, 1951). Techniques for aspiration or punch biopsy (usually for the purpose of making an early diagnosis of tumours) have been reported since about 1900, but the synovial membrane was apparently not considered among the many tissues easily accessible by such means (Franseen, 1941). A conspicuous if not isolated exception is a report by Forestier (1932), who commented on the potential value of synovial biopsy and described a modified barbed dental broach which could be inserted through the bore of a needle " to explore lymph nodes, synovia, etc.". Specimens were generally unsatisfactory however, and the procedure was abandoned (Forestier, 1951). In July, 1948, while synovial fluid was being aspirated for inoculation into guinea-pigs because of suspected articular tuberculosis, enough synovial tissue was obtained in the tip of the needle to permit histologic diagnosis of tuberculosis. This experience led to more intensive efforts to devise an instrument whereby adequate specimens of synovial membrane could be consistently obtained. The principle of a punch technique has been utilized and in this respect the instrument resembles those used in transurethral prostatic resection. Results obtained to date justify the inclusion of synovial membrane among the tissues readily accessible to punch-biopsy procedure.