Diagnostic accuracy of ultrasound-guided core needle biopsy versus incisional biopsy in soft tissue sarcoma: an institutional experience

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

Skeletal Radiology ◽

10.1007/s00256-020-03496-8 ◽

2020 ◽

Vol 50 (1) ◽

pp. 43-50 ◽

Cited By ~ 1

Author(s):

A. Tan ◽

R. Rajakulasingam ◽

A. Saifuddin

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Surgical Resection ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Histological Grading ◽

Ultrasound Guided ◽

Core Needle ◽

Diagnostic Concordance

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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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Sarcomas of the extremities and the pelvis: comparing local recurrence after incisional and after core-needle biopsy

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02481-2 ◽

2022 ◽

Vol 20 (1) ◽

Author(s):

Alexander Klein ◽

Christof Birkenmaier ◽

Julian Fromm ◽

Thomas Knösel ◽

Dorit Di Gioia ◽

...

Keyword(s):

Soft Tissue ◽

Local Recurrence ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Tumor Resection ◽

Soft Tissue Sarcomas ◽

Wide Resection ◽

Incisional Biopsy ◽

Core Needle

Abstract Background The degree of contamination of healthy tissue with tumor cells during a biopsy in bone or soft tissue sarcomas is clearly dependant on the type of biopsy. Some studies have confirmed a clinically relevant contamination of the biopsy tract after incisional biopsies, as opposed to core-needle biopsies. The aim of our prospective study was to evaluate the risk of local recurrence depending on the biopsy type in extremity and pelvis sarcomas. Methods We included 162 patients with a minimum follow-up of 6 months after wide resection of extremity sarcomas. All diagnostic and therapeutic procedures were performed at a single, dedicated sarcoma center. The excision of the biopsy tract after an incisional biopsy was performed as a standard with all tumor resections. All patients received their follow-up after the conclusion of therapy at our center by means of regional MRI studies and, at a minimum, CT of the thorax to rule out pulmonary metastatic disease. The aim of the study was the evaluation of the influence of the biopsy type and of several other clinical factors on the rate of local recurrence and on the time of local recurrence-free survival. Results One hundred sixty-two patients with bone or soft tissue tumors of the extremities and the pelvis underwent either an incisional or a core-needle biopsy of their tumor, with 70 sarcomas (43.2%) being located in the bone. 84.6% of all biopsies were performed as core-needle biopsies. The median follow-up time was 55.6 months, and 22 patients (13.6%) developed a local recurrence after a median time of 22.4 months. There were no significant differences between incisional and core-needle biopsy regarding the risk of local recurrence in our subgroup analysis with differentiation by kind of tissue, grading of the sarcoma, and perioperative multimodal therapy. Conclusions In a large and homogenous cohort of extremity and pelvic sarcomas, we did not find significant differences between the groups of incisional and core-needle biopsy regarding the risk of local recurrence. The excision of the biopsy tract after incisional biopsy in the context of the definitive tumor resection seems to be the decisive factor for this result.

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Sampling Modality Influences the Predictive Value of Grading in Adult Soft Tissue Extremity Sarcomas

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2012-0427-oa ◽

2013 ◽

Vol 137 (12) ◽

pp. 1774-1779 ◽

Cited By ~ 11

Author(s):

Hatim Khoja ◽

Anthony Griffin ◽

Brendan Dickson ◽

Jay Wunder ◽

Peter Ferguson ◽

...

Keyword(s):

Soft Tissue ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Spindle Cell ◽

Soft Tissue Sarcomas ◽

Disease Free Survival ◽

Incisional Biopsy ◽

Free Survival ◽

Core Needle ◽

Disease Free

Context.—Histologic grade is one of the best predictors of outcome in adult soft tissue sarcomas. Current grading systems were validated on resection specimens; however, there has been a trend toward the use of biopsies to diagnosis these tumors. Objectives.—To determine whether the grade of an extremity soft tissue sarcoma determined on tissue obtained by either core needle biopsy or incisional biopsy is predictive of metastasis- or disease-free survival, and whether either sampling modality is superior. Design.—One hundred three core needle biopsies and 107 incisional biopsies of nonmetastatic spindle cell sarcomas of the extremities were retrieved from the archives. All cases had a minimum 2-year follow-up. Patient data and outcome and tumor characteristics were recorded. Tumors were reviewed and evaluated using the French Federation of Cancer Centers Sarcoma Group grading system. Kaplan-Meier survival curves were generated to correlate tumor grade with metastasis- and disease-free survival for both groups. Results.—Patient and tumor characteristics were similar between groups except that more tumors were grade 3 and superficial in the incisional biopsy group. Grade determined on core needle biopsy was not predictive of either metastasis-free survival (P = .59) or disease-free survival (P = .50). In contrast, grade determined on incisional biopsy was predictive of both metastasis-free survival (P < .001) and disease-free survival (P = .001). Conclusions.—Biopsy, particularly core needle biopsy, represents a convenient diagnostic tool, particularly in the context of neoadjuvant therapy. However, based on these results incisional biopsy is recommended if grading is to be used to predict prognosis in spindle cell soft tissue sarcomas of the extremities.

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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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Relative Sensitivity of Core-Needle Biopsy and Incisional Biopsy in the Diagnosis of Musculoskeletal Sarcomas

Cancers ◽

10.3390/cancers13061393 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1393

Author(s):

Alexander Klein ◽

Theresa Fell ◽

Christof Birkenmaier ◽

Julian Fromm ◽

Volkmar Jansson ◽

...

Keyword(s):

Soft Tissue ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Histopathological Examination ◽

Statistical Significance ◽

Soft Tissue Sarcomas ◽

Incisional Biopsy ◽

Tissue Samples ◽

Core Needle ◽

Significant Difference

Background: There is no evidence as to the diagnostic value of the two most frequently used methods of biopsies in sarcomas: Incisional or core needle biopsy. The aim of our study was to evaluate the diagnostic sensitivity of the incisional and the core needle biopsy techniques in the diagnosis of bone and soft tissue sarcomas. Methods: We included 417 patients with a definitive diagnosis of bone or soft tissue sarcoma in whom a total of 472 biopsies had been performed. We correlated the results of the biopsies with the result of the definitive histopathological examination of the resected tumor. Dignity, entity, and grading (whenever possible) of the tissue samples were evaluated. Results: A total of 258 biopsies (55%) were performed in order to diagnose a soft tissue tumor and 351 biopsies (74.4%) were core needle biopsies. The number of repeat core needle biopsies, necessitated because of inconclusive histopathological results, was significantly higher (50 vs. 5; p = 0.003). We observed no significant difference regarding dignity, entity, and grading between the 2 different types of biopsies. Only with regards to the determination of dignity and entity of chondroid tumors, incisional biopsy was superior with statistical significance (p = 0.024). Conclusions: This study represents the largest study on biopsies for bone and soft tissue sarcomas. Based only on our results, we are unable to favor one method of biopsy and found high accuracy with both methods. Considering the potential complications, the added oncological risks of incisional biopsies and the ready availability of core needle biopsies, the latter, in our assessment, represents a valid and favourable method for bone and soft tissue sarcomas.

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