Diagnostic concordance between ultrasound-guided core needle biopsy and surgical resection specimens for histological grading of extremity and trunk soft tissue sarcoma

AbstractCore needle biopsy (CNB) is gaining in importance due to its advantages in the matter of patient morbidity, time and cost. Nevertheless, controversies still exist regarding the biopsy technique of choice for the accurate diagnosis of soft tissue sarcoma (STS). This retrospective cohort study compared the diagnostic performance between ultrasound-guided CNB and incisional biopsy (IB), both performed by orthopedic surgeons. The aims of the study were to answer the following questions: (1) Is ultrasound-guided CNB a highly reliable modality for diagnosing STSs? (2) Is CNB equally useful to IB for identifying histologic subtype? (3) Had patients who underwent CNB a reduced risk of complications? One-hundred and fifty-three patients who underwent resection of soft tissue sarcoma were classified into two groups according to biopsy technique prior to surgery; CNB group (n = 95) and IB group (n = 58). The final surgical specimens were in 40 patients liposarcoma (myxoid, pleomorphic and dedifferentiated), 39 undifferentiated pleomorphic sarcoma (UPS), 33 myxofibrosarcoma, 10 synovial sarcoma, 10 leiomyosarcoma and in the remaining 21 patients different soft tissue sarcoma entities. Sarcoma location of 71 patients was in the thigh, 19 in the lower leg, 22 in the upper arm and shoulder area; 10 in the knee and gluteal region, 9 in the thoracic region, the residual 12 in other body areas. Malignancy was correctly diagnosed in 87% (83 of 95) for the CNB group and 93% (54/58) for the IB group. Correct identification rate of histologic subtype was 80% (76 of 95) in the CNB group and 83% (48 of 58) in the IB group. There were no significant differences in the correct diagnosis rates of malignancy and subtype between the two techniques. No complications were seen in the CNB group, whereas 2 patients in whom IB was performed developed pulmonary embolism and 1 patient surgical site infection. Ultrasound-guided CNB is highly accurate and not inferior to IB in diagnosing the dignity of lesions and histologic subtype in patients with suspected STSs.

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Diagnostic Accuracy of Ultrasound-Guided Core Needle Biopsy Versus Incisional Biopsy in Soft Tissue Sarcoma: An Institutional Experience.

10.21203/rs.3.rs-442014/v1 ◽

2021 ◽

Author(s):

Miroslava Cernakova ◽

Gerhard Martin Hobusch ◽

Gabriele Amann ◽

Philipp Theodor Funovics ◽

Reinhard Windhager ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Correct Identification ◽

Incisional Biopsy ◽

Ultrasound Guided ◽

Histologic Subtype ◽

Core Needle ◽

Biopsy Technique

Abstract Background Core needle biopsy (CNB) is gaining in importance due to its advantages in the matter of patient morbidity, time and cost. Nevertheless, controversies still exist regarding the biopsy technique of choice for the accurate diagnosis of soft tissue sarcoma (STS). This study compared the diagnostic performance between ultrasound-guided CNB and incisional biopsy (IB), both performed by orthopedic surgeons. Questions/purposesThe aims of the study were to answer the following questions: (1) Is ultrasound-guided CNB a highly reliable modality for diagnosing STSs? (2) Is CNB equally useful to IB for identifying histologic subtype? (3) Had patients who underwent CNB a reduced risk of complications? MethodsOne-hundred and seventy-five patients who underwent resection of soft tissue sarcoma were classified into two groups according to biopsy technique prior to surgery; CNB group (n=109) and IB group (n=66). The final surgical specimens were in 62 patients liposarcoma, 39 undifferentiated pleomorphic sarcoma (UPS), 33 myxofibrosarcoma, 10 synovial sarcoma, 10 leiomyosarcoma and in the remaining 21 patients different soft tissue sarcoma entities. Sarcoma location of 90 patients was in the thigh, 21 in the lower leg, 22 in the upper arm and shoulder area; 10 in each the knee, gluteal and thoracic region, the residual 12 in other body areas. Results Malignancy was correctly diagnosed in 86% (94 of 109) for the CNB group and 91% (60/66) for the IB group. Correct identification rate of histologic subtype was 80% (87 of 109) in the CNB group and 82% (54 of 66) in the IB group. There were no significant differences in the correct diagnosis rates of malignancy and subtype between the two techniques. No complications were seen in the CNB group, whereas 2 patients in whom IB was performed developed pulmonary embolism and 1 patient surgical site infection. Conclusions Ultrasound-guided CNB is highly accurate and not inferior to IB in diagnosing the dignity of lesions and histologic subtype in patients with suspected STSs.

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Evaluation of a Soft Tissue Mass in the Extremity or Trunk

10.2310/cgso.16095 ◽

2018 ◽

Author(s):

Daniel C Thomas ◽

Dale Han

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Physical Examination ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Malignant Tumors ◽

Soft Tissue Mass ◽

Tissue Mass ◽

Core Needle ◽

Needle Tract

Soft tissue sarcoma (STS) represents a diverse group of malignant tumors derived from mesenchymal elements. Evaluation of a soft tissue mass of the trunk or extremity starts with a detailed history and physical examination, which will help guide further diagnostic evaluation. Imaging should then be obtained for an STS, with MRI being the preferred modality for the trunk or extremities. Imaging can assist with diagnosis and delineate the extent of the primary lesion, including the relationship to contiguous structures, for treatment planning and assessing resectability. Pathology diagnosis is most commonly performed via examination of a specimen obtained through image-guided percutaneous core-needle biopsy. This requires multidisciplinary planning between Surgery and Radiology to place the needle within the anticipated definitive surgical incision to allow for en bloc resection of the needle tract. Once the diagnosis of an STS is made, appropriate staging studies should be performed based on the history and physical examination and tumor histology, grade, and size. Clinical and pathology data are used to stage STS patients using the American Joint Committee on Cancer staging system, which incorporates the STS site, size and grade of the primary tumor, and absence or presence of nodal and distant metastatic disease. This review contains 6 figures, 6 tables and 50 references Key words: core-needle biopsy, extremity, histology, imaging, risk factors, soft tissue mass, soft tissue sarcoma, staging evaluation, trunk, tumor grade

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Accuracy and Safety of Ultrasound-Guided Core Needle Biopsy of Soft Tissue Tumors in an Outpatient Setting: A Sarcoma Center Analysis of 392 Consecutive Patients

Cancers ◽

10.3390/cancers13225659 ◽

2021 ◽

Vol 13 (22) ◽

pp. 5659

Author(s):

Helene Weigl ◽

Peter Hohenberger ◽

Alexander Marx ◽

Nikolaos Vassos ◽

Jens Jakob ◽

...

Keyword(s):

Soft Tissue ◽

Diagnostic Accuracy ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Outpatient Service ◽

Outpatient Setting ◽

Safe Procedure ◽

Ultrasound Guided ◽

Core Needle ◽

Tertiary Referral Center

Background: The aim of this study was to investigate diagnostic accuracy, safety and histologic results of ultrasound guided core needle biopsy (CNB) in patients with soft tissue lesions (STL) at a tertiary referral center. Methods: A retrospective analysis of all consecutive patients undergoing ultrasound guided CNB for STL at our sarcoma outpatient service between January 2015 and August 2020 was performed. Results: A total of 392 patients were identified. Main histologic entities were sarcomas, lipomas and desmoid tumors. Biopsy was performed in an outpatient setting in 87.6% of the cases. Conclusive biopsies were obtained in 88.5% of the cases. In patients who underwent surgical resection after CNB, the concordance of dignity, tumor entity and histopathological grading between biopsy and resection specimen were 97.2%, 92.7% and 92.5% respectively. The risk of inconclusive CNB was highest in intraabdominal or retroperitoneal tumors (19.5%) and lowest in lesions at the lower extremity (4.4%). Major complications after CNB occurred in three cases (0.8%). No case of biopsy tract seeding was observed during the study period. Conclusions: Ultrasound guided CNB for STL at first presentation in a dedicated surgical outpatient setting is a safe procedure and yields a high diagnostic accuracy.

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Percutaneous core needle biopsy versus open biopsy in diagnostics of bone and soft tissue sarcoma: a retrospective study

European Journal of Medical Research ◽

10.1186/2047-783x-17-29 ◽

2012 ◽

Vol 17 (1) ◽

Cited By ~ 61

Author(s):

Florian Pohlig ◽

Chlodwig Kirchhoff ◽

Ulrich Lenze ◽

Johannes Schauwecker ◽

Rainer Burgkart ◽

...

Keyword(s):

Retrospective Study ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Open Biopsy ◽

Core Needle ◽

Percutaneous Core Needle Biopsy

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Evaluation of a Soft Tissue Mass in the Extremity or Trunk

10.2310/7800.16095 ◽

2018 ◽

Author(s):

Daniel C Thomas ◽

Dale Han

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Physical Examination ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Malignant Tumors ◽

Soft Tissue Mass ◽

Tissue Mass ◽

Core Needle ◽

Needle Tract

Soft tissue sarcoma (STS) represents a diverse group of malignant tumors derived from mesenchymal elements. Evaluation of a soft tissue mass of the trunk or extremity starts with a detailed history and physical examination, which will help guide further diagnostic evaluation. Imaging should then be obtained for an STS, with MRI being the preferred modality for the trunk or extremities. Imaging can assist with diagnosis and delineate the extent of the primary lesion, including the relationship to contiguous structures, for treatment planning and assessing resectability. Pathology diagnosis is most commonly performed via examination of a specimen obtained through image-guided percutaneous core-needle biopsy. This requires multidisciplinary planning between Surgery and Radiology to place the needle within the anticipated definitive surgical incision to allow for en bloc resection of the needle tract. Once the diagnosis of an STS is made, appropriate staging studies should be performed based on the history and physical examination and tumor histology, grade, and size. Clinical and pathology data are used to stage STS patients using the American Joint Committee on Cancer staging system, which incorporates the STS site, size and grade of the primary tumor, and absence or presence of nodal and distant metastatic disease. This review contains 6 figures, 6 tables and 50 references Key words: core-needle biopsy, extremity, histology, imaging, risk factors, soft tissue mass, soft tissue sarcoma, staging evaluation, trunk, tumor grade

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