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

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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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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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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Core needle biopsy versus incisional biopsy for differentiation of soft‐tissue sarcomas: A systematic review and meta‐analysis

Cancer ◽

10.1002/cncr.32735 ◽

2020 ◽

Vol 126 (9) ◽

pp. 1917-1928 ◽

Cited By ~ 5

Author(s):

Emrullah Birgin ◽

Cui Yang ◽

Svetlana Hetjens ◽

Christoph Reissfelder ◽

Peter Hohenberger ◽

...

Keyword(s):

Systematic Review ◽

Soft Tissue ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Meta Analysis ◽

Soft Tissue Sarcomas ◽

Incisional Biopsy ◽

Core Needle

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Outcome Prediction in Primary Resected Retroperitoneal Soft Tissue Sarcoma: Histology-Specific Overall Survival and Disease-Free Survival Nomograms Built on Major Sarcoma Center Data Sets

Journal of Clinical Oncology ◽

10.1200/jco.2012.44.3747 ◽

2013 ◽

Vol 31 (13) ◽

pp. 1649-1655 ◽

Cited By ~ 165

Author(s):

Alessandro Gronchi ◽

Rosalba Miceli ◽

Elizabeth Shurell ◽

Fritz C. Eilber ◽

Frederick R. Eilber ◽

...

Keyword(s):

Overall Survival ◽

Soft Tissue ◽

Cox Model ◽

External Validation ◽

Soft Tissue Sarcomas ◽

Disease Free Survival ◽

Histologic Subtype ◽

Free Survival ◽

Quality Of Surgery ◽

Disease Free

Purpose Integration of numerous prognostic variables not included in the conventional staging of retroperitoneal soft tissue sarcomas (RPS) is essential in providing effective treatment. The purpose of this study was to build a specific nomogram for predicting postoperative overall survival (OS) and disease-free survival (DFS) in patients with primary RPS. Patients and Methods Data registered in three institutional prospective sarcoma databases were used. We included patients with primary localized RPS resected between 1999 and 2009. Univariate (Kaplan and Meier plots) and multivariate (Cox model) analyses were carried out. The a priori chosen prognostic covariates were age, tumor size, grade, histologic subtype, multifocality, quality of surgery, and radiation therapy. External validation was performed by applying the nomograms to the patients of an external cohort. The model's discriminative ability was estimated by means of the bootstrap-corrected Harrell C statistic. Results In all, 523 patients were identified at the three institutions (developing set). At a median follow-up of 45 months (interquartile range, 22 to 72 months), 171 deaths were recorded. Five- and 7-year OS rates were 56.8% (95% CI, 51.4% to 62.6%) and 46.7% (95% CI, 39.9% to 54.6%. Two hundred twenty-one patients had disease recurrence. Five- and 7-year DFS rates were 39.4% (95% CI, 34.5% to 45.0%) and 35.7% (95% CI, 30.3% to 42.1%). The validation set consisted of 135 patients who were identified at the fourth institution for external validation. The bootstrap-corrected Harrell C statistics for OS and DFS were 0.74 and 0.71 in the developing set and 0.68 and 0.69 in the validating set. Conclusion These nomograms accurately predict OS and DFS. They should be used for patient counseling in clinical practice and stratification in clinical trials.

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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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Clinical Outcomes of Intraoperative Radiation Therapy for Extremity Sarcomas

Sarcoma ◽

10.1155/srcm/2006/91671 ◽

2006 ◽

Vol 2006 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Quy N. H. Tran ◽

Anne C. Kim ◽

Alexander R. Gottschalk ◽

William M. Wara ◽

Theodore L. Phillips ◽

...

Keyword(s):

Radiation Therapy ◽

Soft Tissue ◽

Soft Tissue Sarcomas ◽

Disease Free Survival ◽

Intraoperative Radiation Therapy ◽

Intraoperative Radiation ◽

Free Survival ◽

Control Disease ◽

Metastatic Sites ◽

Disease Free

Purpose.Radiation of extremity lesions, a key component of limb-sparing therapy, presents particular challenges, with significant risks of toxicities. We sought to explore the efficacy of intraoperative radiation therapy (IORT) in the treatment of soft tissue sarcomas of the extremities.Patients.Between 1995 and 2001, 17 patients received IORT for soft tissue sarcomas of the extremities. Indications for IORT included recurrent tumors in a previously radiated field or tumors adjacent to critical structures.Results. Gross total resections were achieved in all 17 patients. Two patients experienced locoregional relapses, six patients recurred at metastatic sites, and one patient died without recurrence. Thirty-six month estimates for locoregional control, disease free survival, and overall survival were 86%, 50%, and 78%, respectively. IORT was extremely well tolerated, with no toxicities referable to IORT.Conclusions. For patients with soft tissue sarcomas of the extremities, IORT used as a boost to EBRT provides excellent local control, with limited acute toxicities.

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Assessment of cyclin D1 overexpression as a prognostic factor in soft tissue sarcomas: role of laparoscopy and core needle biopsy

Surgical Endoscopy ◽

10.1007/s00464-004-2094-6 ◽

2005 ◽

Vol 19 (8) ◽

pp. 1120-1124 ◽

Cited By ~ 1

Author(s):

M. Musella ◽

F. Fazioli ◽

S. Lombardi ◽

C. I. Servodio ◽

C. De Martino ◽

...

Keyword(s):

Prognostic Factor ◽

Soft Tissue ◽

Cyclin D1 ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Soft Tissue Sarcomas ◽

Core Needle

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Adjuvant Treatment of High-risk Adult Soft Tissue Sarcomas: A Survey by the Italian Sarcoma Group

Tumori Journal ◽

10.1177/030089160609200202 ◽

2006 ◽

Vol 92 (2) ◽

pp. 92-97 ◽

Cited By ~ 5

Author(s):

Sergio Frustaci ◽

Massimiliano Berretta ◽

Alessandro Comandone ◽

Ettore Bidoli ◽

Antonino De Paoli ◽

...

Keyword(s):

Overall Survival ◽

High Risk ◽

Soft Tissue ◽

Survival Rates ◽

Soft Tissue Sarcomas ◽

Disease Free Survival ◽

Free Survival ◽

Disease Free ◽

Overall Survival Rates

Aims and Background After the first adjuvant study on adult soft tissue sarcomas was concluded, the participating institutions continued to select and treat patients according to that protocol. The aim of this study was to test the protocol reproducibility when applied as a standard practice. Methods A call for retrospective data was launched in June 1999 (self-referral of consecutive unregistered patients); thereafter, a prospective follow-up was performed. The treatment regimen consisted of epirubicin (60 mg/m2 days 1 and 2), ifosfamide (3 g/m2/die for 3 days) and equimolar doses of 6-mercapto-ethansulfonate (MESNA), with 300 μg G-CSF administered subcutaneously from day +8 until recovery, every 3 weeks for a total of 5 cycles. Results From November 1996 to June 1999, 55 high-risk, adult patients were treated. The average median dose intensity was 89% of the planned program. Grade 3-4 toxicities were leukopenia (49%), thrombocytopenia (14%), transfusion requiring anemia in 7 patients (16%), and alopecia in all patients (100%). After a median follow-up of 70 months, 23 patients (41.8%) relapsed and 19 died. Median disease-free, local disease-free and overall survival rates have not yet been reached. The disease-free survival rates at 2 and 4 years were 73% and 57%, respectively; the corresponding overall survival rates were 91% and 70%, respectively. Conclusions The feasibility and reproducibility of the original protocol were confirmed, since disease-specific overall survival and disease-free survival rates at the same period of observation and with the same prolonged follow-up did not differ.

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Surgical Management of Retroperitoneal Soft Tissue Sarcomas: Role of Curative Resection

The American Surgeon ◽

10.1177/000313481608200215 ◽

2016 ◽

Vol 82 (2) ◽

pp. 128-133

Author(s):

Fausto Rosa ◽

Claudio Fiorillo ◽

Antonio Pio Tortorelli ◽

Alejandro Martin SÁNchez ◽

Guido Costamagna ◽

...

Keyword(s):

Soft Tissue ◽

Surgical Management ◽

Soft Tissue Sarcomas ◽

Disease Free Survival ◽

Tumor Grade ◽

Term Survival ◽

Free Survival ◽

Factors Affecting ◽

Retroperitoneal Sarcomas ◽

Disease Free

Retroperitoneal sarcomas are a rare group of malignant soft tissue tumors with a generally poor prognosis. However, factors affecting the recurrence and long-term survival are not well understood. The aim of this study was to assess clinical, pathological, and treatment-related factors affecting prognosis in patients with retroperitoneal sarcomas. The hospital records of 107 patients who underwent surgical exploration at our unit for primary or recurrent retroperitoneal sarcomas between 1984 and 2013 were reviewed. Of these patients, 92 had a primary tumor and 15 had a recurrent neoplasm. Study end points included factors affecting overall and recurrence-free survival for the 92 patients with primary disease. Mean follow-up was 79.7 ± 56.3 months. Only the patients undergoing surgery for primary sarcoma were included in this study. Overall 5-year survival was 71 per cent. Disease-free 5-year survival was 65 per cent. Only tumor grade affects overall and disease-free survival. This study confirmed the importance of an aggressive surgical management for retroperitoneal sarcomas to offer these patients the best chance of cure. In our series, only the tumor grade seems to be associated with worse outcome and higher rate of recurrence, regardless of the size of the tumor.

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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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