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

AbstractBone and soft tissue tumors are a largely heterogeneous group of tumors. Biopsy of musculoskeletal (MSK) tumors is sometimes a challenging procedure. Although the open biopsy is still considered the gold standard for the biopsy of MSK lesions, core needle biopsy can replace it in most cases, with similar accuracy and a low complication rate. The biopsy should be performed in a tertiary sarcoma center where the multidisciplinary team consists of at minimum a tumor surgeon, an MSK pathologist, and an MSK radiologist who can assess all steps of the procedure. Several factors can influence the success of the biopsy including the lesion characteristics, the equipment, and the method used for the procedure. This review highlights some of the important aspects regarding the biopsy of the MSK tumors, with special attention to imaging a guided core needle biopsy and highlighting some of the recent advancements and controversies in the field.

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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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Image-guided percutaneous core needle biopsy of soft-tissue masses in the pediatric population

Pediatric Radiology ◽

10.1007/s00247-016-3571-5 ◽

2016 ◽

Vol 46 (8) ◽

pp. 1173-1178 ◽

Cited By ~ 10

Author(s):

Terrence Metz ◽

Amer Heider ◽

Ranjith Vellody ◽

Marcus D. Jarboe ◽

Joseph J. Gemmete ◽

...

Keyword(s):

Soft Tissue ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Pediatric Population ◽

Core Needle ◽

Image Guided ◽

Percutaneous Core Needle Biopsy ◽

Soft Tissue Masses

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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 core needle biopsy as a substitute to open biopsy in the diagnosis of soft-tissue masses

European Journal of Cancer ◽

10.1016/s0959-8049(03)00430-1 ◽

2003 ◽

Vol 39 (14) ◽

pp. 2021-2025 ◽

Cited By ~ 73

Author(s):

I. Ray-Coquard ◽

D. Ranchère-Vince ◽

P. Thiesse ◽

H. Ghesquières ◽

P. Biron ◽

...

Keyword(s):

Soft Tissue ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Open Biopsy ◽

Core Needle ◽

Soft Tissue Masses

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Diagnostic yield of percutaneous core needle biopsy in suspected soft tissue lesions of extremities

Journal of International Medical Research ◽

10.1177/0300060519849294 ◽

2019 ◽

Vol 47 (6) ◽

pp. 2598-2606 ◽

Cited By ~ 1

Author(s):

Dianwen Qi ◽

Ming Zhao ◽

Tongyu Hu ◽

Guochuan Zhang

Keyword(s):

Soft Tissue ◽

Core Needle Biopsy ◽

Predictive Value ◽

Needle Biopsy ◽

Diagnostic Yield ◽

Benign Lesions ◽

Core Needle ◽

Soft Tissue Lesions ◽

Percutaneous Core Needle Biopsy ◽

Sensitivity Specificity

Objective This retrospective study was performed to investigate the diagnostic yield of percutaneous core needle biopsy (CNB) for suspected soft tissue lesions of the extremities. Methods The medical records of 139 consecutive patients who underwent percutaneous CNB for suspected soft tissue lesions of the extremities from January 2014 to December 2016 at a single institution were reviewed. The pathologic findings or clinical follow-ups were used to evaluate the performance of CNB. Alterations in the treatment regimen from pre- to post-biopsy were also analyzed. Complications, when present, were documented. Results In total, 141 biopsy procedures were performed in 139 patients. In total, 136 (96%) biopsies were successful, among which 5 were false-negative and 131 were diagnosed accurately. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CNB in the differentiation of malignant from benign lesions were 94%, 100%, 96%, 100%, and 90%, respectively. The treatment regimen was altered based on the biopsy findings in 25 cases. Two patients developed mild nerve injury but fully recovered during follow-up. Conclusions CNB is effective and safe, with high sensitivity, specificity, and accuracy for the diagnosis of soft tissue lesions, especially for differentiating malignant from benign lesions.

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

Scientific Reports ◽

10.1038/s41598-021-96953-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Miroslava Cernakova ◽

Gerhard M. Hobusch ◽

Gabriele Amann ◽

Philipp T. 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

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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Safety and Accuracy of Core Needle Biopsy for Soft Tissue Masses in an Ambulatory Setting

Sarcoma ◽

10.1155/2018/1657864 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

J. Brock Walker ◽

Erin Stockwell ◽

Kellen Worhacz ◽

Paul Kang ◽

Amalia Decomas

Keyword(s):

Soft Tissue ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Financial Burden ◽

Fellowship Training ◽

Ambulatory Setting ◽

Core Needle ◽

Percutaneous Core Needle Biopsy ◽

Soft Tissue Masses ◽

Musculoskeletal Oncology

Background. Percutaneous needle biopsy has been found to be a safe and accurate method for the initial investigation of soft tissue masses. The notion exists that needle biopsies should be performed in specialized sarcoma centers, which can place a financial burden on patients without a sarcoma center near their place of residence. There is no consensus in the current literature regarding the diagnostic accuracy and clinical utility of clinic-based percutaneous core needle biopsy performed by community orthopedic surgeons with fellowship training in musculoskeletal oncology. Questions/Purposes. Our primary goal was to determine if office-based core needle biopsy of soft tissue masses could safely yield accurate diagnoses when performed by a community orthopedic surgeon with fellowship training in musculoskeletal oncology. Patients and Methods. We retrospectively reviewed the charts of 105 patients who underwent percutaneous core needle biopsy of soft tissue masses in a community clinic. All procedures were performed by one fellowship-trained musculoskeletal oncologist. Accuracy of the initial clinic-based needle biopsy was determined through comparison to the results of pathological analysis of the surgically excised masses. Final data analysis included 69 patients who underwent both clinic-based biopsy and subsequent surgical excision of their masses. Results. We found clinic-based biopsies to be 87.0% accurate for exact diagnosis and 94.2% accurate in determining whether the mass was benign or malignant (p<0.0001). Minor complications related to the clinic-based biopsy occurred in 5.80% of cases, with no documentation of major complications. Conclusions. Our results provide evidence that office-based percutaneous biopsy can be administered safely and yield accurate, clinically useful results when performed by a fellowship-trained musculoskeletal oncologist.

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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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