AB1637-HPR HISTOLOGICAL AND SAFETY EVALUATION OF A TRAINING PROGRAMME FOR HEALTH PROFESSIONALS IN ULTRASOUND GUIDED SYNOVIAL BIOPSIES
Authors: M. C. Maybury, H. R. Adams, E. Powell, A. Filer
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Obtaining synovial tissue has become a cornerstone of rheumatology research, but throughput of synovial biopsies can be limited by availability of suitably qualified staff. Performing ultrasound guided synovial biopsies (USBx) requires diagnostic and advanced interventional ultrasound skills. To increase capacity, a health professional (HP) with existing diagnostic and interventional musculoskeletal ultrasound skills was recruited to train in needle (nUSBx) and portal and forceps (pfUSBx) ultrasound guided synovial biopsy. <h3>Objectives:</h3> We report the training of a HP performing pfUSBx for the knee joint, success of the programme determined by the percentage of retrieved tissue containing synovium/lining layer, and safety profile. <h3>Methods:</h3> A physiotherapist/sonographer with 18-years diagnostic and 15-years interventional ultrasound experience was recruited. Theoretical components of the programme included local competencies, regional ultrasound, and watching videos of ultrasound guided synovial biopsies. Practical component required the trainee observe 10, assist an experienced practitioner in 10, and then perform 10 pfUSBx autonomously under supervision before being deemed competent in the procedure, and allowed to practice independently. Tissue biopsy fragments were fixed, paraffin embedded, sectioned and H&amp;E stained before being assessed at two levels for the presence of synovium by two trained, blinded independent assessors. The minimum threshold for gradable tissue was agreed a priori to be identifiable synovial tissue in 50% of the analysed tissue fragments. Results were compared to synovial tissue obtained by an established practitioner with 15-years' experience in synovial biopsies to assess proficiency and competency. <h3>Results:</h3> All samples were above acceptable synovium/fragment threshold (Table 1.): 92.08% (range 50-100) and 98.75% (range 87.5-100) for supervised and independent phase respectively, compared to experienced operator 98.75% (range 87.5-100). Lining layer was identified in 66.19% (range 25-65.7) and 87.89% (range 43-100) for supervised and independent phases respectively when compared to an experienced operator at 76.44% (range 25-100). Safety: of 20-biopsies undertaken in training and independent phases, no participant experienced any complications either immediately or during the 3-months that followed. <h3>Conclusion:</h3> We report competency and safety outcomes for a HP training programme in knee pfUSBx using synovial tissue and safety profile as the outcome metrics. Previous studies have reported rheumatology trainee doctors performing nUSBx. Tissue histology results demonstrate that a HP with interventional ultrasound experience can competently and safely achieve a high standard of tissue retrieval using the pfUSBx technique during a supervised training programme and subsequent independent practice. After the supervised period, the quality of the retrieved tissue appeared to improve with practitioner experience. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Mark C. Maybury: None declared, Holly R. Adams: None declared, Emily Powell: None declared, Andrew Filer Janssen, Sonoma, BMS, Roche, UCB, Nascient, Mestag, GSK, Janssen.