{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T22:01:27Z","timestamp":1779400887579,"version":"3.53.1"},"reference-count":28,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T00:00:00Z","timestamp":1745366400000},"content-version":"unspecified","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Piano Nazionale di Ripresa e Resilienza (PNRR) Program","award":["PNRR-MAD-2022-12376876"],"award-info":[{"award-number":["PNRR-MAD-2022-12376876"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2025,4,1]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2024-005328","type":"journal-article","created":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T23:50:22Z","timestamp":1745452222000},"page":"e005328","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Minimally invasive ultrasound-guided biopsy of the common extensor tendon enthesis: a cadaveric study to standardise the technique"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4838-5854","authenticated-orcid":false,"given":"Chiara","family":"Rizzo","sequence":"first","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology section - \u201cP. Giaccone\u201d, University of Palermo, Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5460-864X","authenticated-orcid":false,"given":"Luis","family":"Coronel","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Vall d\u2019Hebron University Hospital, Barcelona, Spain"},{"name":"Department of Pathology and Experimental Therapeutics, Unit of Human Anatomy and Embriology, University of Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9819-105X","authenticated-orcid":false,"given":"Enrico","family":"De Lorenzis","sequence":"additional","affiliation":[{"name":"Department of Aging Diseases, Orthopedic and Rheumatology, Rheumatology Division, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Rubortone","sequence":"additional","affiliation":[{"name":"Department of Aging Diseases, Orthopedic and Rheumatology, Rheumatology Division, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"M\u00f6ller","sequence":"additional","affiliation":[{"name":"Department of Pathology and Experimental Therapeutics, Unit of Human Anatomy and Embriology, University of Barcelona, Barcelona, Spain"},{"name":"Instituto Poal de Reumatologia, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maribel","family":"Miguel Perez","sequence":"additional","affiliation":[{"name":"Department of Pathology and Experimental Therapeutics, Unit of Human Anatomy and Embriology, University of Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Tur","sequence":"additional","affiliation":[{"name":"Department of Aging Diseases, Orthopedic and Rheumatology, Rheumatology Division, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"},{"name":"Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum Erlangen, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Gabriella","family":"Raimondo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum Erlangen, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Belmonte","sequence":"additional","affiliation":[{"name":"Department of Health Science, Tumor Immunology Unit, University of Palermo, Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Cancila","sequence":"additional","affiliation":[{"name":"Department of Health Science, Tumor Immunology Unit, University of Palermo, Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Ramming","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum Erlangen, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Schett","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum Erlangen, Erlangen, Germany"},{"name":"Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco Maria","family":"Lizzio","sequence":"additional","affiliation":[{"name":"Department of Aging Diseases, Orthopedic and Rheumatology, Rheumatology Division, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7383-4212","authenticated-orcid":false,"given":"Stefano","family":"Alivernini","sequence":"additional","affiliation":[{"name":"Department of Aging Diseases, Orthopedic and Rheumatology, Rheumatology Division, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"},{"name":"Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2479-6958","authenticated-orcid":false,"given":"Giuliana","family":"Guggino","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology section - \u201cP. 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