Intensive training programme for ultrasound-guided minimally invasive synovial tissue biopsy on knees and wrists in different phases of inflammation

Coletto, L. A., Marino, V., Rizzo, C., Bruno, D., Caporali, R., Gremese, E., D'Agostino, M. A. and Alivernini, S. (2024) Intensive training programme for ultrasound-guided minimally invasive synovial tissue biopsy on knees and wrists in different phases of inflammation. RMD Open, 10(1), e003705. (doi: 10.1136/rmdopen-2023-003705) (PMID:38351051) (PMCID:PMC10868172)

Abstract

Objectives: To develop an intensive training programme for ultrasound (US)-guided synovial tissue (ST) biopsy on knees and wrists in inflammatory arthritis and to assess the learning curve, patient tolerability, sample quality and trainees’ expectations. Methods: Active or remission rheumatoid arthritis patients were enrolled. Nine trainees joined the 4-month programme in a centre experienced in performing US-guided ST biopsies consisting of four sequential phases: (1) observation, (2) performance of guided step-by-step phases, (3) execution of the whole procedure on paired joints (knees or wrists) of the same patient in parallel with the trainer and (4) performance of the procedure autonomously. Sample representativity was assessed by histology, and procedure-related adverse events were recorded. Before and after the programme, trainees’ expectations and perceptions were collected. Results: 328 ST biopsy procedures were included. The rate of trainees’ informative samples was: (1) comparable to the trainers in active and remission knees, but lower in active wrists (70% for trainees vs 100% for trainers, p=0.06) in phase 3; (2) excellent on active knees and wrists (91.9% and 90.9% respectively) but lower (77.6%, p=0.0089) on remission knees in phase 4. Procedures performed by trainees did not affect patient tolerability. Trainees’ expectations about procedure-related invasiveness and pain infliction decreased while the difficulty of procedure execution on active wrists and remission knees remained perceived as moderately difficult. Conclusions: This intensive training programme develops advanced skills in the performance of US-guided ST biopsy on knees and wrists, yielding high-quality specimens available for basic and translational studies on inflammatory joint diseases.

• Item Type: Articles
• Additional Information: Funding: This study was partially supported by Ricerca Finalizzata- GR- 2018- 12366992 and PARTNER Fellowship Programme.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Coletto, Ms Lavinia and Bruno, Dario and ALIVERNINI, Dr STEFANO
• Authors: Coletto, L. A., Marino, V., Rizzo, C., Bruno, D., Caporali, R., Gremese, E., D'Agostino, M. A., and Alivernini, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Journal Name: RMD Open
• Publisher: BMJ Publishing Group
• ISSN: 2056-5933
• ISSN (Online): 2056-5933
• Published Online: 13 February 2024
• Copyright Holders: Copyright © Author(s) (or their employer(s)) 2024
• First Published: First published in RMD Open 10:e003705
• Publisher Policy: Reproduced under a creative commons licence