Synovium is a specialized mesenchymal tissue in which varied pathological lesions can occur, but most common are non neoplastic lesions. Aim of the Study: To determine histopathological spectrum of non-neoplastic lesions of synovium and to correlate the clinical and histopathological diagnosis in our tertiary care hospital. Materials & Methods: Prospective study of 65 synovial biopsy samples. Patient’s complete clinical data, radiological findings, biochemical and serological parameters were obtained. Synovial fluid analysis was done in available cases. Histopathological examination of synovial biopsy tissue was done with routine and special histochemical stains wherever necessary. Statistical analysis for sensitivity, specificity and diagnostic accuracy was done. Results: We observed arthritis was common in 5th decade with Male-Female ratio of 1.7: 1. Most were monoarticular disease with the knee joint commonly affected. The common clinical manifestation was joint pain and swelling. The most common lesion was chronic nonspecific synovitis followed by osteoarthritis, tuberculous arthritis, rheumatoid arthritis and septic arthritis. One case of pigmented villonodular synovitis [PVNS], gouty arthritis and ochronotic arthritis were observed in our study. In our study, the diagnostic accuracy of synovial biopsy in comparison with clinical impression was 85% with 73% sensitivity, 97% specificity, 96% positive predictive value and 78% negative predictive value, 27%false negative rate and 3% false positive rate. Conclusion: In our study, we observed that synovial biopsy is cost effective and offers immense help to clinicians in providing appropriate treatment for patients, especially in long standing and subtle inflammatory lesions.

Keywords: Synovial Biopsy; Synovitis; Histopathology; Correlation; Diagnostic Accuracy.