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Ariizumi T, Kawashima H, Yamagishi T, Oike N, Murayama Y, Umezu H, Endo N, Ogose A. Diagnostic accuracy of fine needle aspiration cytology and core needle biopsy in bone and soft tissue tumor: A comparative study of the image-guided and blindly performed procedure. Ann Diagn Pathol 2022; 59:151936. [DOI: 10.1016/j.anndiagpath.2022.151936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 02/05/2022] [Accepted: 03/15/2022] [Indexed: 11/27/2022]
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Pouedras M, Briand S, Crenn V, Cassagnau E, Gouin F. Non image-guided core needle biopsies can be used safely to improve diagnostic efficiency for soft tissue tumors. Surg Oncol 2021; 37:101518. [PMID: 33434767 DOI: 10.1016/j.suronc.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/11/2020] [Accepted: 12/27/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Front-line biopsy remains the rule in the management of soft tissue mass syndromes. Although open biopsy has long been considered the gold standard, it has recently been shown that a percutaneous biopsy is associated with a reduction in the rate of complications and cost, while maintaining high diagnostic accuracy. Though there is much literature regarding the diagnostic accuracy of image-guided and open biopsies for soft tissue tumors, the accuracy of percutaneous non image-guided biopsies has not been well documented. The objective of this study was to compare the failure rate of non image-guided biopsies, image-guided biopsies and open biopsies for the diagnosis of soft tissue tumors. We also attempted to identify the failure risk factors for non image-guided biopsies and we compared the diagnostic delay of the three types of biopsy. MATERIALS AND METHODS This was a continuous, single-center retrospective study. We reviewed the results from 337 patients managed with a biopsy (percutaneous or open) for a soft tissue tumor, all carried out in our center between January 2010 and December 2015. Biopsy technique was chosen by the treating orthopedic surgeon, according to the clinical and radiological characteristics of the mass. 141 patients (41.8%) had a non-image-guided biopsy as the first-line diagnostic procedure, 81 (24.0%) had an image-guided biopsy, and 115 (34.1%) an open biopsy. Diagnostic failure was defined either by a non-contributory biopsy, the need for repeat biopsy, or a major histological discordance obtained from the resected tumor piece. The risk factors studied were tumor characteristics, patient' characteristics and sampling modalities. Diagnostic delay was defined as the period between the day of the first external consultation at the hospital and the day of the notification of the diagnosis by the physician. RESULTS We obtained a failure rate of 9.9% (14 patients) for non image-guided biopsies. Eleven were non-contributive and three were considered as errors of diagnosis. The failure rate for image-guided biopsies was 18.5% (15 patients), with no significant difference compared with non image-guided biopsies. The open biopsies were associated with a failure rate of 6.9% (eight patients). We found no failure risk factors for non image-guided biopsies. Diagnostic delay was significantly shorter for non image-guided biopsies (p = 0.001). CONCLUSION When performed in a referral center by the patient's surgeon, a non-image-guided core needle biopsy is a safe procedure which ensures equivalent diagnostic accuracy for soft tissue tumors, while reducing the diagnostic delay.
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Affiliation(s)
- Marie Pouedras
- Orthopedics and Trauma Department, University Hospital of Nantes, 1, place Alexis Ricordeau, 44093, Nantes Cedex 1, France.
| | - Sylvain Briand
- Orthopedic and Traumatology Surgery Department, Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris, Paris-Sud University ORSAY, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France.
| | - Vincent Crenn
- Orthopedics and Trauma Department, University Hospital of Nantes, 1, place Alexis Ricordeau, 44093, Nantes Cedex 1, France; Inserm UMR 1238, Bone sarcomas and Remodeling of Calcified Tissues, France.
| | - Elisabeth Cassagnau
- Department of Pathology, University Hospital of Nantes, 1, place Alexis Ricordeau, 44093, Nantes Cedex 1, France.
| | - François Gouin
- Centre Léon Bérard, Department of Surgery, Lyon, France; Inserm U1238, Bone Sarcomas and Remodeling of Calcified Tissue, France.
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Bata BM, Martin A, Connolly D, Mudhar HS, Hersey N, Salvi SM. Computerized Tomography-Guided Core-Needle Biopsy of Orbital Space-Occupying Lesions: A Case Series. Ocul Oncol Pathol 2020; 7:54-61. [PMID: 33796518 DOI: 10.1159/000510867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/12/2020] [Indexed: 02/01/2023] Open
Abstract
Purpose To describe our experience in performing biopsy of post-septal orbital masses with core needle under computerized tomography guidance (CT-CNB). Methods The medical records of all patients who underwent this procedure were reviewed. The procedure was performed under local anesthesia on a day case basis under a peribulbar block. A planning non-contrast computerized tomography (CT) scan of the orbits was performed to localise the mass. A 6-cm 18-G Temno Evolution® semi-automated biopsy needle was inserted through the skin into the orbit. Prior to further advancement of the needle, a low-dose CT limited to the previously determined plane was performed to confirm its position. The needle was then advanced, and the cutting needle was deployed to obtain the biopsy. Results Five patients who underwent CT-CNB were identified. The CNB was successful in 4 patients and revealed a metastatic prostate adenocarcinoma, diffuse large B-cell lymphoma, a metastatic neuroendocrine tumour, and orbital inflammatory disease. The biopsy failed in the fifth patient when the needle failed to penetrate the tumour despite good localisation on CT. He was eventually diagnosed with fibrous meningioma of the greater wing of sphenoid on open biopsy. None of the patients had any complications other than peri-ocular bruising which was present in all of them. Conclusion CT-CNB of mass lesions located in the lateral aspect of the orbit can be an alternative to open biopsy in selected cases. It avoids major surgery and allows the use of radiotherapy, if required, without any delay.
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Affiliation(s)
- Bashar M Bata
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Andrew Martin
- Department of Radiology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Daniel Connolly
- Department of Radiology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS) Department of Histopathology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Naomi Hersey
- Department of Radiology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Sachin M Salvi
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom
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Tamvakopoulos GS, Rose B, Saifuddin A, Skinner JA, Pollock R. Managing NON-DIAGNOSTIC biopsies in musculoskeletal tumours in a specialist centre: Deciding on the algorithm. Eur J Surg Oncol 2020; 47:1207-1213. [PMID: 33077295 DOI: 10.1016/j.ejso.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Core needle biopsy is an effective method of obtaining tissue diagnosis. However, a diagnostic dilemma arises when lesional tissue is non-diagnostic which obviates considering radiological guided re-biopsy (RB) or an open surgical biopsy but the question raised is which serves as a better diagnostic tool. PATIENT AND METHODS We retrospectively reviewed data from a prospectively collected database of 4516 core needle biopsies performed in our specialist musculoskeletal tumour centre over a 6-year period. Our aim was to evaluate the management of non-diagnostic biopsies (NDB) and establish a safe and accurate diagnostic strategy in the presence of a NDB. RESULTS Two hundred fifteen (4.8%) NDB cases with complete follow-up were identified. Of these 157 (73%) were treated definitively on the basis of imaging and 58 (27%) had a RB, 48 (83%) of which led to a positive histological diagnosis. The remaining 10 were again non-diagnostic giving a total of 167 patients being treated definitively without a tissue diagnosis. The sensitivity and specificity for multidisciplinary team (MDT) assessment as a diagnostic tool was 0.75 and 0.88 respectively while that for RB was 0.91 and 0.9. CONCLUSION Re-biopsy after first non-diagnostic core needle biopsy offers high sensitivity and specificity, especially in the presence of malignancy. In the absence of tissue diagnosis, however, MDT assessment is also highly accurate and a safe strategy in managing this complex group of patients. LEVEL OF EVIDENCE Diagnostic Level III.
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Affiliation(s)
| | - Barry Rose
- Department of Orthopaedic Oncology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - John A Skinner
- Department of Orthopaedic Oncology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Robin Pollock
- Department of Orthopaedic Oncology, Royal National Orthopaedic Hospital, Stanmore, UK
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McKee TC, Belair JA, Sobol K, Brown SA, Abraham J, Morrison W. Efficacy of image-guided synovial biopsy. Skeletal Radiol 2020; 49:921-928. [PMID: 31912178 DOI: 10.1007/s00256-019-03370-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/17/2019] [Accepted: 12/29/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A variety of benign and neoplastic lesions can affect the synovium, including pigmented villonodular synovitis (PVNS) and synovial chondromatosis. Prior to surgical resection, accurate characterization of synovial lesions is necessary for appropriate treatment planning. Additionally, recent advances in potential medical therapies for PVNS could decrease or eliminate the need for surgery in some cases. Such treatment options demand accurate characterization of synovial lesions prior to treatment. METHODS AND MATERIALS Institutional IRB approval was obtained. We identified 54 synovial biopsies performed at our institution using a comprehensive database search under ultrasound (US) or computed tomography (CT) guidance. Cases were reviewed for pre-procedure imaging, location, biopsy approach, biopsy results, post-procedure complications, and surgical pathology if synovectomy was performed. RESULT A total of 54 image-guided synovial biopsies were performed, 36 using CT guidance and 18 using US guidance. Six different anatomic locations were biopsied (the hip, knee, shoulder, elbow, ankle, and temporomandibular joint). Synovial tissue was obtained in 89% of cases (48/54). CT-guided biopsies had a positive yield of 86% (31/36) and US-guided biopsies had a positive yield of 94% (17/18). Surgical pathology was obtained in 30 of the cases and image-guided biopsy concordance was 90% (27/30). Of the patients taken for synovectomy, biopsy concordance of suspected neoplastic lesions was 100% (23/23). In cases of suspected neoplasm, the concordance between image-guided biopsy and surgical pathology was 96% (22/23). There were no reported complications. CONCLUSION Image-guided biopsy of synovial lesions is safe and effective for establishing a definitive diagnosis prior to surgical or other intervention.
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Affiliation(s)
- T Conor McKee
- Department of Radiology, Thomas Jefferson University Hospital, 132 S. 10th Street, 10th Floor, Philadelphia, PA, 19107, USA.
| | - Jeffrey A Belair
- Department of Radiology, Thomas Jefferson University Hospital, 132 S. 10th Street, 10th Floor, Philadelphia, PA, 19107, USA
| | - Keenan Sobol
- Sidney Kimmel Medical College, 1025 Walnut St. #100, Philadelphia, PA, 19107, USA
| | - Scot A Brown
- Rothman Orthopedic Institute at Jefferson, 925 Chestnut St. 5th Floor, Philadelphia, PA, 19107, USA
| | - John Abraham
- Rothman Orthopedic Institute at Jefferson, 925 Chestnut St. 5th Floor, Philadelphia, PA, 19107, USA
| | - William Morrison
- Department of Radiology, Thomas Jefferson University Hospital, 132 S. 10th Street, 10th Floor, Philadelphia, PA, 19107, USA
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Biopsy Path Contamination in Primary Bone Sarcomas. Rev Bras Ortop 2019; 54:33-36. [PMID: 31363240 PMCID: PMC6424802 DOI: 10.1016/j.rbo.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/05/2017] [Indexed: 12/02/2022] Open
Abstract
Objective To determine the incidence of contamination of the biopsy pathway in patients with primary bone sarcomas, as well as the clinical characteristics that influenced this outcome. Materials and Methods The anatomopathological reports of the patients who were treated by the Orthopedic Oncology Sector of the Orthopedic and Traumatology Department of this institution were retrospectively evaluated. Results Of the 148 patients included for evaluation in the present study, only 1 presented contamination by neoplastic cells in his biopsy pathway. Conclusion The bone biopsy procedure in patients with primary bone sarcomas presents great safety regarding pathway contamination when performed in specialized centers that treat this type of pathology.
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Baad-Hansen T, Freund SS, Bech BH, Keller J. Is there consensus regarding surgical treatment of bone sarcomas? World J Orthop 2018; 9:173-179. [PMID: 30254974 PMCID: PMC6153138 DOI: 10.5312/wjo.v9.i9.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/20/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To perform an Internet based survey on the surgical management of bone sarcomas in the lower extremity amongst sarcoma surgeons.
METHODS All orthopedic surgical members of the Scandinavian Sarcoma Group were invited to participate in an online questionnaire. The questionnaire consisted of a clinical case involving resection of a malignant bone tumor. Several questions were asked, subdivided into categories. Among these, surgical/technical considerations, e.g., choice of implant; choice of antibiotics, dosage, and duration of treatment, choice of antithrombotic drug, initial start-up, dosage, and duration were included.
RESULTS In terms of choice of implant fixation, the majority of surgeons preferred an uncemented prosthesis in younger patients until the age of 50. All participants administer intravenous prophylactic antibiotics for endoprosthetic reconstructive surgery. First choice of antibiotics was cephalosporin. Less common used was glycopeptide, penicillin, or a combination. Duration of prophylactic antibiotics ranged from less than one day to more than four days. All participants used low molecular weight heparins as antithrombotic prophylaxis and 55% of the participants answered that initial treatment was started preoperatively, 3% perioperatively and 42% postoperatively. Duration of the antithrombotic treatment ranged from five days to more than twenty-eight days.
CONCLUSION The use of resection prosthesis in the treatment of bone sarcomas is a well-established procedure. However, therse is a significant discrepancy in the surgical treatment algorithm between the sarcoma centers. Still the treatment is mainly based on best clinical practice, due to the lack of evidence-based medicine in the surgical management of bone sarcomas.
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Affiliation(s)
- Thomas Baad-Hansen
- Department of Orthopaedic Oncology, Aarhus University Hospital, Aarhus C8000, Denmark
| | - Sarah Stammose Freund
- Department of Orthopaedic Oncology, Aarhus University Hospital, Aarhus C8000, Denmark
| | - Bodil Hammer Bech
- Department of Public Health, Aarhus University, Aarhus C8000, Denmark
| | - Johnny Keller
- Department of Orthopaedic Oncology, Aarhus University Hospital, Aarhus C8000, Denmark
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Sequeiros RB, Sinikumpu JJ, Ojala R, Järvinen J, Fritz J. Pediatric Musculoskeletal Interventional MRI. Top Magn Reson Imaging 2018; 27:39-44. [PMID: 29406414 DOI: 10.1097/rmr.0000000000000143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Minimally invasive procedures play a crucial role in the diagnosis and treatment of many pediatric musculoskeletal conditions. Although computed tomography and fluoroscopy are commonly used for image guidance, the associated exposure to ionizing radiation is especially concerning in pediatric patients. Ultrasonography may be used successfully in a subset of interventions, but it is often not useful for complex, deep, and osseous targets. Interventional magnetic resonance imaging (iMRI) facilitates targeting and treatment of musculoskeletal lesions at many locations with high accuracy due to its excellent tissue contrast. Furthermore, MRI provides imaging guidance without the use of ionizing radiation and as such complies with the ALARA practice mandate in a formidable fashion. MRI guidance is our method of choice for lesion that are not visible by other modalities or when other techniques and modalities failed. MRI guidance is especially useful for selective targeting of complex lesions, intra-articular lesions, cyst aspirations in difficult locations of the body, and lesions that are located adjacent to surgical hardware. Tumor-related diagnostic sampling is more frequently performed under MRI; however, MRI guidance is also exquisitely well suited for a variety of therapeutic percutaneous osseous or articular conditions, such as osteoid osteoma, epiphyseal bone bridging, osteochondritis dissecans lesions, and aneurysmal bone cysts. In this article, we will describe the technical aspects and clinical indications of a variety of MRI-guided pediatric procedures in the musculoskeletal system.
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Affiliation(s)
| | - Juha-Jaakko Sinikumpu
- Division of Paediatric Surgery and Orthopaedics, Department of Children and Adolescents, Oulu University Hospital
| | | | - Jyri Järvinen
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - Jan Fritz
- Russell H. Morgan Department of Radiology and Radiological Science, Musculoskeletal Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
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Patel K, Kinnear D, Quintanilla NM, Hicks J, Castro E, Curry C, Dormans J, Ashton DJ, Hernandez JA, Wu H. Optimal Diagnostic Yield Achieved With On-site Pathology Evaluation of Fine-Needle Aspiration–Assisted Core Biopsies for Pediatric Osseous Lesions: A Single-Center Experience. Arch Pathol Lab Med 2017; 141:678-683. [DOI: 10.5858/arpa.2016-0269-oa] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Image-guided, fine-needle aspiration–assisted core needle biopsy with an on-site evaluation by a pathologist (FNACBP) of osseous lesions is not a common practice in pediatric institutions.
Objectives.—
To evaluate the diagnostic adequacy and accuracy of FNACBP for pediatric osseous lesions and to compare the adequacy with procedures that do not use fine-needle aspiration.
Design.—
Six-year, retrospective review of 144 consecutive children biopsied for osseous lesions with and without fine-needle aspiration assistance.
Results.—
Pathologic diagnosis was achieved in 79% (57 of 72) of the core biopsies without an on-site evaluation, 78% (32 of 41) of the open biopsies (9 with intraoperative consultation), and 97% (30 of 31) of the FNACBPs as the initial diagnostic procedure. Three FNACBP cases were preceded by nondiagnostic open biopsies. Among 34 lesions sampled by FNACBP, 33 (97%) succeeded with diagnostic tissue, with most (30 of 33; 91%) being neoplasms, including 16 malignant (48%), 13 benign (39%), and 1 indeterminate (3%) lesions. The most-common diagnoses were osteosarcoma (9 of 33; 27%) and Langerhans cell histiocytosis (7 of 33; 21%). In cases with follow-up information available, 93% (28 of 30) of the FNACBP-rendered diagnoses were clinically useful, allowing initiation of appropriate therapy. The FNACBP procedure had 100% specificity, sensitivity, and positive predictive value for all 14 malignant lesions, with the sensitivity being 88% in benign lesions. Most FNACBP procedures (32 of 34; 94%) yielded adequate material for ancillary testing. A gradual upward trend was observed for the choice of FNACBP as an initial diagnostic procedure for osseous lesions.
Conclusions.—
The FNACBP procedure yields sufficient material for diagnosis and ancillary studies in pediatric, osseous lesions and may be considered an initial-diagnostic procedure of choice.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Hao Wu
- From the Departments of Pathology (Drs Patel, Quintanilla, Hicks, Castro, Curry, and Wu and Mr Kinnear), Surgery (Dr Dormans); and Radiology (Drs Ashton and Hernandez), Texas Children's Hospital and Baylor College of Medicine, Houston
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Rajwanshi A, Rohilla M, Singh P. Trans-oral fine needle aspiration cytology in cervical (C1 and C2) vertebral lesions: a novel diagnostic approach. Cytopathology 2016; 28:31-34. [PMID: 27489015 DOI: 10.1111/cyt.12361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fine needle aspiration (FNA) cytology is a relatively non-invasive method for diagnosing both superficial and deep-seated neoplastic and non-neoplastic lesions. In this study, we evaluated the diagnostic utility of trans-oral FNA in cervical (C1 and C2) vertebral and paravertebral lesions. MATERIAL AND METHODS Eighteen FNA cases of cervical vertebral and paravertebral lesions performed by a trans-oral route without any image-guidance between 1995 and 2014 were retrieved from the archives of the cytology department at PGIMER, Chandigarh and reviewed. RESULTS Out of 18 cases, a definite diagnosis was given in 15 cases (83.3%). The commonest diagnosis seen was granulomatous inflammation consistent with tuberculosis (33.3%). CONCLUSION Trans-oral FNA is a quick, inexpensive and relatively safe outpatient procedure for sampling C1 and C2 vertebral and paravertebral lesions, which are clinically and radiologically difficult to approach. It helps in the early diagnosis and management of these patients.
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Affiliation(s)
- A Rajwanshi
- Department of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - M Rohilla
- Department of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P Singh
- Department of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Taupin T, Decouvelaere AV, Vaz G, Thiesse P. Accuracy of core needle biopsy for the diagnosis of osteosarcoma: A retrospective analysis of 73 patients. Diagn Interv Imaging 2015; 97:327-31. [PMID: 26616843 DOI: 10.1016/j.diii.2015.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/07/2015] [Accepted: 09/09/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE The goals of this retrospective study were to evaluate the accuracy of core needle biopsy (CNB) for the diagnosis of osteosarcoma and to identify criteria that may predict failed CNB. MATERIALS AND METHODS From 2002 to 2012, 73patients with a total of 73osteosarcomas underwent CNB. Patients demographics and procedure details were recorded, including tumor size, tumor characteristics (hemorrhagic or not, lytic, sclerotic [>50% bone condensation], or mixed), the type of anesthesia, the number of tissue samples, the size of the biopsy needle and pathology report. Procedures were analyzed in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS A diagnosis was not made in 5/73patients (6.8%) with an overall sensitivity of 93.1%, a specificity of 100%, a PPV of 100% and a NPV of 99.9%. No complications due to CNB were observed. No criteria were identified as predictors of CNB failure. CONCLUSION Even in the presence of sclerotic tumors, CNB should be the first line diagnostic test for suspected osteosarcomas, pending performance by a well-trained radiologist and reading by a specialized pathologist. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- T Taupin
- Centre de lutte contre le cancer Léon-Bérard, service de radiologie, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France.
| | - A-V Decouvelaere
- Centre de lutte contre le cancer Léon-Bérard, service d'anatomie et de cytologie pathologiques, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - G Vaz
- Hôpital Édouard-Herriot, service de chirurgie orthopédique, place d'Arsonval, 69008 Lyon, France
| | - P Thiesse
- Centre de lutte contre le cancer Léon-Bérard, service de radiologie, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
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Oliveira MP, Lima PMDA, de Mello RJV. TUMOR CONTAMINATION IN THE BIOPSY PATH OF PRIMARY MALIGNANT BONE TUMORS. Rev Bras Ortop 2015; 47:631-7. [PMID: 27047877 PMCID: PMC4799461 DOI: 10.1016/s2255-4971(15)30015-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 01/13/2012] [Indexed: 02/08/2023] Open
Abstract
Objective: To study factors possibly associated with tumor contamination in the biopsy path of primary malignant bone tumors. Method: Thirty-five patients who underwent surgical treatment with diagnoses of osteosarcoma, Ewing's tumor and chondrosarcoma were studied retrospectively. The sample was analyzed to characterize the biopsy technique used, histological type of the tumor, neoadjuvant chemotherapy used, local recurrences and tumor contamination in the biopsy path. Results: Among the 35 patients studied, four cases of contamination occurred (11.43%): one from osteosarcoma, two from Ewing's tumor and one from chondrosarcoma. There was no association between the type of tumor and presence of tumor contamination in the biopsy path (p = 0.65). There was also no association between the presence of tumor contamination and the biopsy technique (p = 0.06). On the other hand, there were associations between the presence of tumor contamination and local recurrence (p = 0.01) and between tumor contamination and absence of neoadjuvant chemotherapy (p = 0.02). Conclusion: Tumor contamination in the biopsy path of primary malignant bone tumors was associated with local recurrence. On the other hand, the histological type of the tumor and the type of biopsy did not have an influence on tumor contamination. Neoadjuvant chemotherapy had a protective effect against this complication. Despite these findings, tumor contamination is a complication that should always be taken into consideration, and removal of the biopsy path is recommended in tumor resection surgery.
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Affiliation(s)
- Marcelo Parente Oliveira
- Orthopedist in the Orthopedics and Traumatology Clinic, HC-UFPE; Auxiliary Professor in the Cariri School of Medicine, Federal University of Ceará; Master's student in the Postgraduate Pathology Program, CCS-UFPE, Recife, PE, Brazil
| | - Pablo Moura de Andrade Lima
- MSc in Pathology from the Federal University of Pernambuco; Orthopedist responsible for the Orthopedic Oncology Group, Orthopedics and Traumatology Clinic, HC-UFPE, Recife, PE, Brazil
| | - Roberto José Vieira de Mello
- PhD in Pathology from the Federal University of Pernambuco; Associate Professor in the Department of Pathology, CCS-UFPE, Recife, PE, Brazil
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Oliveira MP, Lima PMDA, Silva HJD, Mello RJVD. Neoplasm seeding in biopsy tract of the musculoskeletal system. A systematic review. ACTA ORTOPEDICA BRASILEIRA 2014; 22:106-10. [PMID: 24899866 PMCID: PMC4031257 DOI: 10.1590/1413-78522014220200422] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 11/16/2011] [Indexed: 12/20/2022]
Abstract
To identify, through a systematic literature review, the characteristics of neoplasm seeding in biopsy performed on the musculoskeletal system. We performed a search on PubMed, MEDLINE, LILACS and SciELO from August to October 2010. We included articles that addressed the neoplasm seeding in biopsy performed on the musculoskeletal system. The search was limited to English, Spanish and Portuguese as publication languages, but it was not limited by year of publication. We retrieved 2858 articles, but only seven were selected based on inclusion and exclusion criteria. Other four papers were found in the references of selected articles, totalizing 11 articles that were used to perform this systematic review. Issues may be raised in the literature: age and gender don't seem to influence the occurrence of neoplasm seeding; without resection of the biopsy tract, the possibility of local recurrence is very real; the influence of the type of tumor in the occurrence of neoplasm seeding is uncertain; it is impossible to conclude whether the closed biopsy technique has a lower chance of neoplasm seeding; it is likely that adjuvant chemotherapy has a protective effect against neoplasm seeding; an unfavorable prognosis is expected according to neoplasm seeding results.
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14
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Henshaw RM. Surgical advances in bone and soft tissue sarcoma: 50 years of progress. Am Soc Clin Oncol Educ Book 2014:252-8. [PMID: 24857083 DOI: 10.14694/edbook_am.2014.34.252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
As the American Society of Clinical Oncology celebrates its 50th anniversary, physicians can appreciate the significant advances made in the treatment of patients with sarcoma. Historically, these rare tumors have garnered great interest in the medical profession, due to their ability to reach extraordinary size, resulting in substantial deformities and disabilities. Fortunately, advances in surgical management, which have occurred concurrently with advances in imaging, diagnostic techniques, and both local and systemic adjuvant treatments, offer patients diagnosed with sarcoma significant hope for successful treatment and the expectation of a meaningful quality of life.
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Affiliation(s)
- Robert M Henshaw
- From the Department of Orthopedic Oncology, Medstar Georgetown Orthopedic Institute, Washington, DC; and Department of Orthopedic Oncology, Children's National Medical Center, Washington, DC
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Abstract
Osteosarcoma is the most common primary osseous malignancy excluding malignant neoplasms of marrow origin (myeloma, lymphoma and leukemia) and accounts for approximately 20% of bone cancers. It predominantly affects patients younger than 20 years and mainly occurs in the long bones of the extremities, the most common being the metaphyseal area around the knee. These are classified as primary (central or surface) and secondary osteosarcomas arising in preexisting conditions. The conventional plain radiograph is the best for probable diagnosis as it describes features like sun burst appearance, Codman's triangle, new bone formation in soft tissues along with permeative pattern of destruction of the bone and other characteristics for specific subtypes of osteosarcomas. X-ray chest can detect metastasis in the lungs, but computerized tomography (CT) scan of the thorax is more helpful. Magnetic resonance imaging (MRI) of the lesion delineates its extent into the soft tissues, the medullary canal, the joint, skip lesions and the proximity of the tumor to the neurovascular structures. Tc99 bone scan detects the osseous metastases. Positron Emission Tomography (PET) is used for metastatic workup and/or local recurrence after resection. The role of biochemical markers like alkaline phosphatase and lactate dehydrogenase is pertinent for prognosis and treatment response. The biopsy confirms the diagnosis and reveals the grade of the tumor. Enneking system for staging malignant musculoskeletal tumors and American Joint Committee on Cancer (AJCC) staging systems are most commonly used for extremity sarcomas.
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Affiliation(s)
- Zile Singh Kundu
- Department of Orthopaedics, Pt B D Sharma PGIMS, Rohtak, Haryana, India,Address for correspondence: Prof. Zile Singh Kundu, 1393, Sector-3, Rohtak, Haryana - 124 001, India. E-mail:
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Abstract
PURPOSE To evaluate the sensitivity and specificity of core needle biopsy in determining musculoskeletal tumours in our hospital. METHODS Records of 134 patients who underwent core needle biopsy followed by definitive surgery were retrospectively reviewed. Results of the core needle biopsy were compared with those of the final histology. Histology was classified into benign versus malignant, and bony versus soft-tissue lesions. The sensitivity and specificity of core needle biopsy were calculated. RESULTS Based on final histology, there were 33 bone tumours (3 benign and 30 malignant), 74 soft-tissue tumours (6 benign and 68 malignant), 11 schwannomas (7 benign and 4 malignant), and 16 inflammatory/necrotic (benign) lesions. For 118 (88%) tumours, the biopsy results matched the final histological results. For 7 tumours, biopsy results were non-diagnostic, as the amount of tissue obtained was insufficient. For 9 tumours, biopsy results did not match the final histological results; 5 considered benign but turned out to be malignant, one considered malignant but turned out to be benign, and 3 were correctly identified as malignant but incorrectly subtyped. The sensitivity and specificity of core needle biopsy were 95% (97/102) and 97% (31/32), respectively, assuming that the 7 non-diagnostic tumours were correctly diagnosed. CONCLUSION Core needle biopsy is an accurate and reliable diagnostic tool for musculoskeletal tumours if performed by skilled persons and adequate tissue is obtained.
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Affiliation(s)
- Chusheng Seng
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
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Mohr Z, Hirche C, Klein T, Kneif S, Hünerbein M. Vacuum-assisted minimally invasive biopsy of soft-tissue tumors. J Bone Joint Surg Am 2012; 94:103-9. [PMID: 22257995 DOI: 10.2106/jbjs.j.00764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although exact histological characterization of soft-tissue tumors is essential for determining the appropriate therapy, the quality of the histological assessment is often limited by the size of the tissue samples. Incisional biopsy and core needle biopsy have been the most effective techniques for obtaining tissue samples from soft-tissue tumors. This study was performed to investigate whether vacuum-assisted biopsy can serve as a new diagnostic tool for soft-tissue neoplasms. METHODS This retrospective study compared the characterization made with use of vacuum-assisted biopsy of soft-tissue tumors in seventy-five patients between 2004 and 2006 and the characterization made with use of incisional biopsy of tumors in a comparison group of seventy-four patients between 2000 and 2005 with the final characterization made after radical tumor excision. All vacuum-assisted and incisional biopsies were performed by the same experienced surgeons and evaluated by the same experienced pathologists at a single tumor center. The sensitivity, specificity, positive and negative predictive values, and accuracy of the preliminary characterization made with use of each method were calculated on the basis of the final characterization made after excision. RESULTS The vacuum-assisted biopsy procedure was performed successfully in seventy-four (99%) of the seventy-five patients. The accuracy of vacuum-assisted biopsy (96%) was comparable with that of incisional biopsy (99%). Vacuum-assisted biopsy correctly characterized the tumor as benign or malignant in 96% (95% confidence interval [CI], 92% to 100%) of the seventy-five patients compared with 99% (95% CI, 96% to 100%) of the seventy-four patients who underwent incisional biopsy. Vacuum-assisted biopsy correctly characterized the tumor diagnosis in 95% (95% CI, 90% to 100%) of the patients compared with 95% (95% CI, 89% to 100%) for incisional biopsy. Vacuum-assisted biopsy correctly characterized the tumor grade in 89% (95% CI, 82% to 96%) of the patients compared with 88% (95% CI, 80% to 95%) for incisional biopsy. The sensitivity of vacuum-assisted biopsy was 93% (95% CI, 71% to 100%), the specificity and the positive predictive value were both 100%, and the negative predictive value was 91% (95% CI, 85% to 98%). The overall accuracy of vacuum-assisted biopsy was 96% (95% CI, 92% to 100%). CONCLUSIONS Vacuum-assisted biopsy appears to be safe and provides a new tool for the diagnosis of soft-tissue tumors. One advantage of vacuum-assisted biopsy is that it can be performed with use of local anesthesia in an outpatient setting.
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Affiliation(s)
- Zarah Mohr
- Department of General Surgery and Surgical Oncology, HELIOS Hospital Berlin-Buch, Berlin, Germany.
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Virayavanich W, Ringler MD, Chin CT, Baum T, Giaconi JC, O'Donnell RJ, Horvai AE, Jones KD, Link TM. CT-Guided Biopsy of Bone and Soft-Tissue Lesions: Role of On-Site Immediate Cytologic Evaluation. J Vasc Interv Radiol 2011; 22:1024-30. [PMID: 21570872 DOI: 10.1016/j.jvir.2011.03.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 03/06/2011] [Accepted: 03/20/2011] [Indexed: 11/28/2022] Open
Affiliation(s)
- Warapat Virayavanich
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 400 Parnassus Ave, A 367, Box 0628, San Francisco, CA 94143-0628, USA
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Rougraff BT, Aboulafia A, Biermann JS, Healey J. Biopsy of soft tissue masses: evidence-based medicine for the musculoskeletal tumor society. Clin Orthop Relat Res 2009; 467:2783-91. [PMID: 19597901 PMCID: PMC2758991 DOI: 10.1007/s11999-009-0965-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 06/17/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED The literature contains a number of controversies regarding key questions: (1) When is a biopsy indicated? (2) How should the biopsy be placed? (3) How should the biopsy be performed and which has the greatest diagnostic accuracy? (4) Who should perform the biopsy? (5) What clinical parameters present the greatest diagnostic difficulty? Using PubMed and Google Scholar we performed English-language literature searches of clinical studies reporting biopsy of soft tissue masses. Thirty-two studies met the inclusion criteria but were only able to address three of the five questions the authors had hoped to evaluate. Available evidence suggests open biopsy has the highest diagnostic accuracy over core needle biopsy, which was higher than fine needle aspiration. There was no evidence to address who is best suited to perform the biopsy (general surgeon, orthopaedic surgeon, radiologist, pathologist) in terms of accuracy of diagnosis. Frozen section at the time of biopsy may improve diagnostic accuracy. Diagnostic difficulty was associated with myxoid and round cell neoplasms, infections, and tumors located in the paraspinal region. The limited number of references addressing these issues demonstrated the need for more Level I research in the area of biopsy of soft tissue masses. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bruce T. Rougraff
- Indiana Orthopaedic Hospital, 8450 Northwest Boulevard, Indianapolis, IN 46278 USA
| | | | | | - John Healey
- Memorial Sloan Kettering Cancer Center, New York, NY USA
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21
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Abstract
BACKGROUND Percutaneous spine biopsy has widely replaced open biopsy. We conducted a meta-analysis to evaluate the effect of the inner diameter of the biopsy needle and the method of imaging guidance on the adequacy and accuracy of tissue samples and to evaluate the complication rates associated with the different needle diameters and imaging guidance methods. METHODS We searched MEDLINE for studies that evaluated either the adequacy (whether or not a diagnosis could be made on the basis of pathologic examination) or the accuracy (whether or not the primary diagnosis was correct) of samples obtained by means of percutaneous spine biopsy. These articles and their relevant references subsequently were reviewed twice and were evaluated against the inclusion criteria, yielding twenty-five studies. The inclusion criterion was the use of a biopsy instrument (a fine needle or trephine with an identifiable inner diameter) under the guidance of imaging (fluoroscopy or computed tomography) for the evaluation of an identified spine lesion, with the report of either adequacy or accuracy. Meta-analysis with use of the random-effects model was used to analyze the data. RESULTS The adequacy, accuracy, and complication rates increased with the inner diameter of the needles, but, with the numbers available, only the complication rate increased significantly (p = 0.01). Although the use of a computed tomography scan slightly increased the adequacy and accuracy of the samples, these increases were not significant. The complication rate associated with the use of computed tomography was 3.3%, compared with 5.3% for fluoroscopy. CONCLUSIONS As the outcomes associated with computed tomography were not significantly different from those associated with fluoroscopy, the decision to use one or the other requires the consideration of other factors, such as the type, level, and vertebral location of the lesion as well as the expertise of the physician. In situations in which the use of a needle with a small inner diameter is highly effective (for example, in cases of metastatic lesions), the clinician should first consider using a needle with a smaller inner diameter to obtain the biopsy specimen because of the higher complication rate associated with large-bore needles. However, in cases of sclerotic lesions, in which obtaining an adequate sample can be difficult, the use of a needle with a larger inner diameter is desirable.
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Affiliation(s)
- Ali Nourbakhsh
- Division of Spine Surgery, Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX 77555, USA.
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Shin HJ, Amaral JG, Armstrong D, Chait PG, Temple MJ, John P, Smith CR, Taylor G, Connolly BL. Image-guided percutaneous biopsy of musculoskeletal lesions in children. Pediatr Radiol 2007; 37:362-9. [PMID: 17340168 DOI: 10.1007/s00247-007-0421-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Revised: 12/27/2006] [Accepted: 01/18/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Percutaneous core needle biopsy (PCNB) of musculoskeletal lesions can provide early and definitive diagnosis and guide decisions on management. The technique is less invasive than open biopsy and has a low complication rate. OBJECTIVES The purpose of this study was to assess the diagnostic accuracy and safety of image-guided PCNB of musculoskeletal lesions in children. MATERIALS AND METHODS Retrospective review of the medical records of patients referred for PCNB of musculoskeletal lesions was performed. Data collected included tumor type and complication rates. Lesion "hit" or "missed", and core adequacy and ability to reach a definitive pathological diagnosis were reviewed and used to determine whether the biopsy was overall successful or unsuccessful. RESULTS A total of 127 biopsies were performed in 111 patients. Of the 127 PCNB procedures, 114 "hit" the lesion and 13 "missed," and 120 of the cores provided for analysis were deemed adequate for pathological interpretation and 7 were deemed inadequate. A definitive pathological diagnosis was possible in 97 of the 127 PCNB preocedures and not possible in 30. Overall 76% of the PCNB procedures were successful. The diagnostic success of biopsy in primary malignant tumors was significantly higher (92%) than in primary benign tumors (65%; P=0.008). Six minor complications resulted from PCNB. CONCLUSION This study showed that PCNB is accurate and safe for the diagnosis of musculoskeletal lesions in pediatric patients, and its results are comparable to those in adult studies.
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Affiliation(s)
- Hyun-Joon Shin
- Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
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Kavanagh EC, Roberts CC, Frangos A, Parker L, Gopez A, Deely D, Morrison WB. Musculoskeletal biopsy: utilization and provider distribution in the United States Medicare population. Acad Radiol 2007; 14:371-5. [PMID: 17307671 DOI: 10.1016/j.acra.2006.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Revised: 12/11/2006] [Accepted: 12/11/2006] [Indexed: 11/27/2022]
Abstract
RATIONALE AND OBJECTIVES Physicians from many specialties perform musculoskeletal biopsy. Using the Medicare database, we sought to determine which specialties represent the physicians who are performing the majority. MATERIALS AND METHODS Using the CMS physician supplier procedure summary master file for 1996-2003, we extracted all claims for biopsy procedure codes (including marrow aspiration, muscle biopsy, percutaneous bone biopsy, and open surgical biopsy) categorized by provider specialty, and we analyzed procedure volumes. RESULTS Since 1996, the rate of utilization of percutaneous bone biopsy has remained stable. In 2003, marrow aspiration was most commonly performed by hematology/oncology (80,038, 57%), followed by medical oncology (23,428, 17%); radiologists performed 755 (0.5%). Muscle biopsies were predominantly performed by radiologists (4,761, 40%), followed by neurosurgery (591, 5%). Percutaneous bone biopsy was mostly performed by radiologists (14,830, 53%), but orthopedic surgeons, neurosurgeons, and hematology/oncology specialists performed a large minority (6,879, 2,296, and 1,048 respectively; in aggregate, 37%). From 1996 to 2003, radiologists performed 71% more muscle biopsies (2,788 to 4,761) and 60% more percutaneous bone biopsies (9,259 to 14,830). Although most specialties are performing fewer percutaneous bone biopsies (e.g., oncologists: 7,217 to 1,048, -85%), orthopedic surgeons are performing 247% more (1,983 to 6,879) and neurosurgeons are performing 2,343% more (94 to 2,296). CONCLUSION Excluding marrow aspiration, radiologists perform the majority of percutaneous bone biopsies, and the volume is increasing in the U.S. Medicare population. The overall volume has remained relatively stable from 1996 to 2003; although medical specialties are performing fewer, the volume performed by surgeons is increasing rapidly.
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Mitsuyoshi G, Naito N, Kawai A, Kunisada T, Yoshida A, Yanai H, Dendo S, Yoshino T, Kanazawa S, Ozaki T. Accurate diagnosis of musculoskeletal lesions by core needle biopsy. J Surg Oncol 2006; 94:21-7. [PMID: 16788939 DOI: 10.1002/jso.20504] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Percutaneous needle biopsy has many advantages over open biopsy in the treatment of neoplasms. However, the accuracy of needle biopsy in the diagnosis of musculoskeletal lesions has not yet been established. Here, we evaluate the accuracy and limitations of the procedure for musculoskeletal lesions. METHODS The diagnoses of 163 needle biopsies (bone, 91; soft tissue, 72) performed on 157 consecutive patients using a Jamshidi needle or an Ostycut needle for bone lesions, or a Tru-cut needle for soft tissue lesions were compared with the final diagnoses made by open biopsy and/or a definitive operation. RESULTS One hundred forty-three specimens (88%) were determined to be adequate for histological examination. Obtaining undamaged cores from very hard bony lesions or sclerotic cyst walls proved difficult. A pathologist with experience in musculoskeletal lesions was able to differentiate malignant tumors from benign lesions in 97% of the cases (bone, 100%; soft tissue, 94%) and arrive at a specific diagnosis in 88% (bone, 96%; soft tissue, 78%) when adequate cores were obtained. Differentiating a well-differentiated liposarcoma from a benign lipoma and inflammatory lesions from benign tumorous conditions, was difficult. The overall accuracy was 77% (bone, 85%; soft tissue, 68%). There was no morbidity related to the procedure. CONCLUSION The results indicate that needle biopsy is safe and accurate for diagnosing musculoskeletal lesions.
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Affiliation(s)
- Goro Mitsuyoshi
- Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Hospital, Okayama, Japan
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Puri A, Shingade VU, Agarwal MG, Anchan C, Juvekar S, Desai S, Jambhekar NA. CT-guided percutaneous core needle biopsy in deep seated musculoskeletal lesions: a prospective study of 128 cases. Skeletal Radiol 2006; 35:138-43. [PMID: 16391943 DOI: 10.1007/s00256-005-0038-4] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2005] [Revised: 05/12/2005] [Accepted: 09/05/2005] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Although large lesions of the limbs can easily be biopsied without image guidance, lesions in the spine, paraspinal area and pelvis are difficult to target, and benefit from CT guidance to improve the accuracy of targeting the lesion for biopsy purposes. A prospective study of CT-guided core needle biopsies for deep-seated musculoskeletal lesions was conducted at a referral cancer institute over a 4-year period with the aim of assessing the safety and efficacy of the procedure. PATIENTS & METHODS From January 2000 to December 2003, 136 consecutive CT-guided biopsy sessions were undertaken for musculoskeletal lesions in 128 patients comprising 73 males and 55 females. The following data was recorded in all patients: demographic data, suspected clinicoradiological diagnosis, data related to core biopsy session (date, site, approach, total time required in minutes, number of cores, surgeon satisfaction with adequacy of cores), patient discomfort, complications, histopathology report and number of further sessions if material obtained during the first biopsy session was not confirmatory. The sample obtained during the biopsy session was considered inconclusive if, in the opinion of the pathologist, inadequate or non-representative tissue had been obtained. The diagnosis was considered inaccurate if the final histopathological diagnosis did not match with the biopsy diagnosis, or if subsequent clinicoradiological evaluation at follow up did not correlate with the biopsy diagnosis in those patients who were treated with modalities other than surgery. RESULTS In 121 patients, a single session was sufficient to obtain representative material, whilst for six patients two sessions, and for one patient three sessions were necessary. The time taken for biopsy, including the pre-biopsy CT examination time, varied from 15 min to 60 min (median 30 min). For 110 bony lesions 116 sessions were required, and for 18 soft-tissue lesions 20 sessions were required. 108 biopsy sessions yielded a diagnosis, whilst 28 were inconclusive (diagnostic yield of 79.41%). Of 108 diagnostic biopsies, five were considered inaccurate (accuracy rate of 95.37%). The overall diagnostic yield and accuracy rate for bony lesions were 81.03% and 95.74%; and those for soft-tissue lesions were 70% and 92.85%. There were two complications with no permanent sequelae. CONCLUSION CT-guided core needle biopsy is a safe, easy, and effective technique for the evaluation of deep-seated musculoskeletal lesions, with a high rate of diagnostic yield and accuracy. It facilitates definitive therapy without the patient having to undergo a major surgical procedure for diagnosis.
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Affiliation(s)
- A Puri
- Orthopaedic Oncology Service, Tata Memorial Hospital, E Borges Marg, Parel, Mumbai, India.
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Altuntas AO, Slavin J, Smith PJ, Schlict SM, Powell GJ, Ngan S, Toner G, Choong PFM. Accuracy of computed tomography guided core needle biopsy of musculoskeletal tumours. ANZ J Surg 2005; 75:187-91. [PMID: 15839962 DOI: 10.1111/j.1445-2197.2005.03332.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The accurate diagnosis of musculoskeletal tumours is important for successful treatment. Image guided biopsy is gaining increasing acceptance for obtaining tissue for diagnosis. The aim of the present study is to assess the accuracy of computed tomography (CT)-guided core needle biopsy of musculoskeletal tumours. METHODS This is a retrospective study on a series of 127 patients with a musculoskeletal tumour. The biopsies were performed over a 4-year period from 1998 to 2001. The accuracy of the CT-guided core needle biopsy was determined by comparing the histology of the biopsy with the final histology of the specimen obtained at open biopsy or surgical resection of the tumour. The effective accuracy was determined by the accuracy of the biopsy to distinguish between a benign and malignant tumour. RESULTS Computed tomography guided core needle biopsy in the present series has an overall accuracy of 80.3%. The effective accuracy as determined by a malignant versus benign lesion was 89%. There were 86 malignant tumours with a biopsy accuracy of 81.4% and there were 41 benign tumours with a biopsy accuracy of 78%. The positive predictive value (PPV) of a malignant tumour is 98.9% and the PPV of benign tumour 90.2%. The most common site of biopsy was from the femur and thigh, together accounting for 39.4% of the tumours. The most common tumours in this series were liposarcoma (n = 12), osteosarcoma (n = 11) and giant cell tumour (n = 11). There were no reported complications arising from the biopsy. CONCLUSION Computed tomography guided core needle biopsy is a safe and effective procedure that is important in the diagnosis and management of musculoskeletal tumours. It should be performed in a specialized institution with a multidisciplinary musculoskeletal tumour team.
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Affiliation(s)
- Altay O Altuntas
- Department of Orthopeadics, St Vincent's Hospital, Melbourne, Victoria, Australia
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Kelekis AD, Somon T, Yilmaz H, Bize P, Brountzos EN, Lovblad K, Ruefenacht D, Martin JB. Interventional spine procedures. Eur J Radiol 2005; 55:362-83. [PMID: 16129245 DOI: 10.1016/j.ejrad.2005.03.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Revised: 03/07/2005] [Accepted: 03/10/2005] [Indexed: 10/25/2022]
Abstract
Minimally invasive techniques for the treatment of some spinal diseases are percutaneous treatments, proposed before classic surgery. By using imaging guidance, one can significantly increase accuracy and decrease complication rates. This review report physiopathology and discusses indications, methods, complications and results of performing these techniques on the spine, including different level (cervical, thoracic, lumbar and sacroiliac) and different kind of treatments (nerve block, disc treatment and bone treatment). Finally the present article also reviews current literature on the controversial issues involved.
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Affiliation(s)
- A D Kelekis
- Attikon University Hospital, 2nd Radiology Department, University of Athens, Rimini 1, 12461 Athens, Greece.
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Vieillard MH, Boutry N, Chastanet P, Duquesnoy B, Cotten A, Cortet B. Contribution of percutaneous biopsy to the definite diagnosis in patients with suspected bone tumor. Joint Bone Spine 2005; 72:53-60. [PMID: 15681249 DOI: 10.1016/j.jbspin.2004.03.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2003] [Accepted: 03/08/2004] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Percutaneous biopsy is widely used for the diagnosis of primary and secondary bone malignancies. The primary objective of this study was to evaluate the contribution of percutaneous biopsy to the definite diagnosis in patients with suspected bone tumor. The secondary objective was to assess the potential diagnostic benefits of a second percutaneous biopsy when the first failed to provide the diagnosis. METHODS We retrospectively reviewed 108 percutaneous biopsies of bone lesions in 89 patients admitted to our rheumatology department from January 1994 to December 2001. There were 61 men and 28 women with a mean age of 59 years. The biopsies were done under computed tomography guidance in 68 patients and fluoroscopy in 21 patients. RESULTS The diagnostic yield of percutaneous biopsies was 68.5% overall and was significantly higher in patients with metastatic bone disease (100%) than in patients with primary tumors (83%) or hematological malignancies (58%) (P = 0.0004 and P < 0.0001, respectively). Yields were higher for peripheral lesions (85%) than for vertebral (65%) and pelvic (60%) lesions. Yields were 87% for lytic lesions, 66% for sclerotic lesions, and 50% for mixed lesions. When soft tissues were sampled, the yield was 100%, as compared to 86% for biopsies composed only of bone. CONCLUSION Percutaneous biopsy of suspected bone tumors is a safe and inexpensive procedure that consistently ensures the diagnosis of bone metastases. The diagnostic yield is lowest in patients with bone lesions caused by hematological malignancies. When two biopsies fail to provide the diagnosis, further biopsies are unlikely to be helpful.
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Affiliation(s)
- Marie-Hélène Vieillard
- Service de Rhumatologie, Hôpital Roger Salengro, CHRU de LILLE, rue Emile Laine, 59 047 Lille cedex, France.
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Affiliation(s)
- James J Choi
- University of Wisconsin Medical School, Department of Radiology, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-3252, USA
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Ray-Coquard I, Ranchère-Vince D, Thiesse P, Ghesquières H, Biron P, Sunyach MP, Rivoire M, Lancry L, Méeus P, Sebban C, Blay JY. Evaluation of core needle biopsy as a substitute to open biopsy in the diagnosis of soft-tissue masses. Eur J Cancer 2003; 39:2021-5. [PMID: 12957456 DOI: 10.1016/s0959-8049(03)00430-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Open biopsy is recommended for a soft-tissue sarcoma (s-t-S) diagnosis. Core needle biopsy (CNB) was recently associated with minimal morbidity, cost and time-consumption, but also potential inaccuracy. Its diagnostic utility was investigated retrospectively in 110 patients with soft-tissue masses (s-t-M) undergoing CNB between September 1994 and September 2000. Sensitivity (Se), specificity (Sp), positive (PPV) and negative (NPV) predictive values were determined for malignancy (benign/malign), soft-tissue tumour (yes/no), and sarcoma diagnosis (yes/no), comparing CNB and the best standard test available; concordance was evaluated. 103/110 CNB were suitable for analysis. Final diagnosis was 23 benign tumours (19%), 65 s-t-S (59%), 9 lymphomas (8%), 6 fibromatoses (desmoid) (5%) and 7 carcinomas (6%). CNB Sp and PPV were 100%, Se was 95, 99 and 92%, and NPV 85, 95 and 88% for diagnosing malignancy, soft-tissue tumour and sarcoma. CNB Se and NPV were 100% for malignancy, connective tumour and sarcoma in lymphomas, high-grade sarcomas and desmoid tumours. In low grade sarcomas, Se was 94 and 85%, and NPV 84 and 77% for malignancy and sarcoma. Histological grade on CNB seems uneasy, except for grade-III tumours. CNB is accurate, not misleading for s-t-M diagnosis, avoids open biopsy complications, and allows one-surgery or neo-adjuvant chemotherapy planning when combined with appropriate imaging.
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Affiliation(s)
- I Ray-Coquard
- Centre Léon Bérard, 28 rue Laënnec, Lyon 69008, France.
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Nomikos GC, Murphey MD, Kransdorf MJ, Bancroft LW, Peterson JJ. Primary bone tumors of the lower extremities. Radiol Clin North Am 2002; 40:971-90. [PMID: 12462464 DOI: 10.1016/s0033-8389(02)00038-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The key to adequate and accurate evaluation, diagnosis, and treatment of bone tumors is an organized and integrated approach involving the surgeon, radiologist, and pathologist. The radiologist plays not only a valuable role in the diagnosis and preoperative staging of bone tumors but may also play a role in biopsy and treatment. Despite the wide variety of imaging modalities available today, radiographs remain the mainstay in the evaluation of osseous neoplasms. Advanced imaging is. however. very useful for staging purposes and for characterization of the internal characteristics of tumors and may aid significantly in limiting the differential diagnosis. Although a detailed discussion of all ofthe various bone tumors of the lower extremities is beyond the scope of this article, an attempt is made to provide a framework for a rational and comprehensive approach to these complicated but relatively uncommon lesions. Certain lesions with unique characteristics are discussed to facilitate the diagnostic process.
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Affiliation(s)
- George C Nomikos
- Department of Radiology, New York University Medical Center, 550 First Avenue, New York NY 10016, USA.
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Jelinek JS, Murphey MD, Welker JA, Henshaw RM, Kransdorf MJ, Shmookler BM, Malawer MM. Diagnosis of primary bone tumors with image-guided percutaneous biopsy: experience with 110 tumors. Radiology 2002; 223:731-7. [PMID: 12034942 DOI: 10.1148/radiol.2233011050] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the diagnostic accuracy of image-guided percutaneous biopsy in 110 primary bone tumors of varying internal compositions. MATERIALS AND METHODS One hundred ten consecutive patients with primary bone tumors underwent biopsy with computed tomography (CT) or fluoroscopy. Ninety-one patients underwent surgical follow-up and 19 received medical treatment and underwent subsequent imaging studies. Final analysis of bone biopsy results included tumor type, malignancy, final tumor grade, biopsy complications, and effect on eventual treatment outcome. RESULTS Seventy-seven tumors were malignant and 33 were benign. Most common tumors at biopsy were osteosarcoma (n = 20), lymphoma (n = 18), chondrosarcoma (n = 16), and giant cell tumor (n = 16). Correct final diagnosis was attained in 97 (88%) patients. Sixty-three lesions were solid nonsclerotic; 26, sclerotic; and 21, lytic with cystic centers containing internal areas of fluid, hemorrhage, or necrosis. In six of 21 lesions with a predominant cystic internal composition, problems occurred in determining a final diagnosis. In 13 patients, definite correct diagnosis was not obtained with initial percutaneous bone biopsy. Of these patients, benign bone tumors were better defined with surgical specimens in seven, a diagnosis of malignancy was changed to that of another malignancy in four, and the diagnosis was changed from benign to malignant in two. Nine patients underwent open surgical biopsy. Seven of the difficult cases were of cystic tumors with hemorrhagic fluid levels visible at CT or magnetic resonance imaging. The only complication was a small hematoma. CONCLUSION Percutaneous biopsy of primary bone tumors is safe and accurate for diagnosis and grade of specific tumor. In cases with nondiagnostic biopsy, open-procedure biopsy is likely to be associated with similar diagnostic difficulties.
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Affiliation(s)
- James S Jelinek
- Department of Radiology, Washington Hospital Center, 110 Irving St NW, Washington, DC 20010, USA.
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Joines JD, McNutt RA, Carey TS, Deyo RA, Rouhani R. Finding cancer in primary care outpatients with low back pain: a comparison of diagnostic strategies. J Gen Intern Med 2001; 16:14-23. [PMID: 11251746 PMCID: PMC1495160 DOI: 10.1111/j.1525-1497.2001.00249.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare strategies for diagnosing cancer in primary care patients with low back pain. Strategies differed in their use of clinical findings, erythrocyte sedimentation rate (ESR), and plain x-rays prior to imaging and biopsy. DESIGN Decision analysis and cost effectiveness analysis with sensitivity analyses. Strategies were compared in terms of sensitivity, specificity, and diagnostic cost effectiveness ratios. SETTING Hypothetical MEASUREMENTS Estimates of disease prevalence and test characteristics were taken from the literature. Costs were represented by the Medicare reimbursement for the tests and procedures employed. MAIN RESULTS In the baseline analysis, using magnetic resonance imaging (MRI) as the imaging procedure prior to a single biopsy, strategies ranged in sensitivity from 0.40 to 0.73, with corresponding diagnostic costs of $14 to $241 per patient and average cost effectiveness ratios of $5,283 to $49,814 per case of cancer found. Incremental cost effectiveness ratios varied from $8,397 to $624,781; 5 strategies were dominant in the baseline analysis. Use of a higher ESR cutoff point (50 mm/hr) improved specificity and cost effectiveness for certain strategies. Imaging with MRI, or bone scan followed in series by MRI, resulted in a fewer unnecessary biopsies than imaging with bone scan alone. Cancer prevalence was an important determinant of cost effectiveness. CONCLUSIONS We recommend a strategy of imaging patients who have a clinical finding (history of cancer, age > or = 50 years, weight loss, or failure to improve with conservative therapy) in combination with either an elevated ESR (> 50 mm/hr) or a positive x-ray, or using the same approach but imaging directly those patients with a history of cancer.
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Affiliation(s)
- J D Joines
- Internal Medicine Training Program, Moses H. Cone Memorial Hospital, Greensboro, NC 27401-1020, USA
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Welker JA, Henshaw RM, Jelinek J, Shmookler BM, Malawer MM. The percutaneous needle biopsy is safe and recommended in the diagnosis of musculoskeletal masses. Cancer 2000; 89:2677-86. [PMID: 11135231 DOI: 10.1002/1097-0142(20001215)89:12<2677::aid-cncr22>3.0.co;2-l] [Citation(s) in RCA: 181] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The purpose of this study was to analyze the role of percutaneous core needle biopsy in the diagnosis of musculoskeletal sarcomas. METHODS One hundred eighty-five biopsy procedures were performed on 161 musculoskeletal tissue masses suspected of being a sarcoma in 155 patients who underwent subsequent tumor resection. A percutaneous core needle biopsy was performed on all masses either in the clinic or under radiologic guidance. If an adequate diagnosis could not be made on the basis of this biopsy specimen, an open incisional biopsy was performed. RESULTS One hundred seventy-three core needle biopsy procedures were performed: 90 without radiologic guidance, 55 computed tomography guided, and 28 fluoroscopically guided. Twelve open incisional biopsies were performed. Eighty-three sarcomas, 67 benign mesenchymal tumors, and 11 metastatic epithelial tumors were identified. Analysis of the data reveals that only 7.4% of the masses required open biopsy. In 88.2% of the masses, a single percutaneous biopsy procedure was adequate, and no additional biopsy was necessary. There was a 1.1% rate of complications; none caused a change in the patient's treatment plan. There was a 1.1% rate of major diagnostic errors, none of which ultimately impacted on the patient's outcome. There were no unnecessary amputations. Percutaneous needle biopsy showed a positive predictive value of 100%, a negative predictive value of 82%, a sensitivity of 81.8%, and a specificity of 100%. The accuracy of a single-needle biopsy procedure to identify benign versus malignant lesions, exact grade, and exact pathology was 92.4%, 88.6%, and 72.7%, respectively. CONCLUSIONS The percutaneous needle biopsy was found to be extremely effective and safe for the diagnosis of musculoskeletal masses. This method allowed 88% of patients with suspected sarcomas to undergo a single-needle biopsy procedure before the initiation of definitive treatment. Patients undergoing percutaneous needle biopsy had lower rates of major diagnostic errors and complications than previously described for open biopsy. Open biopsy offered limited additional information when preceded by a needle biopsy, given that these tumors were difficult to identify even after final resection.
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Affiliation(s)
- J A Welker
- Washington Cancer Institute, Washington, District of Columbia 20010, USA.
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Abstract
Primary tumors of the bone and soft tissue of the pelvis are rare. Proper surgical treatment requires a fundamental knowledge of the biology of malignant musculoskeletal neoplasms. This understanding allows stratification of sarcomas into a staging system. In addition to prognostic value, the careful staging of the neoplasms dictates the type of surgical margins necessary and guides in the use of adjuvant therapy. Limb salvage techniques developed for the reconstruction of major extremity structural deficits can be used for reconstruction of the pelvis. This review first addresses the biologic behavior and staging of malignant musculoskeletal neoplasms. The surgical techniques employed for the resection and the reconstruction of the pelvis are then discussed.
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Affiliation(s)
- R E Wolf
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
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Fleuriau Chateau PB, Commons AS, O'Neil DJ. Fine-needle aspiration biopsy of chondroblastic osteosarcoma of the vertebral column complicated by Corynebacterium infection: a case report. Diagn Cytopathol 1999; 20:38-43. [PMID: 9884826 DOI: 10.1002/(sici)1097-0339(199901)20:1<38::aid-dc9>3.0.co;2-a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe a case of chondroblastic osteosarcoma of the vertebral column in a 67-yr-old male in whom the preoperative diagnosis was made by fine-needle aspiration biopsy (FNAB). This diagnosis was subsequently confirmed in the T8 corpectomy specimen. Although the smears of the aspirate revealed only occasional markedly atypical spindle-shaped nuclei, the cell block was diagnostic of malignancy. It showed a well-preserved fragment of neoplastic cartilage populated by markedly atypical hyperchromatic cells and a crushed fragment of anaplastic spindle-shaped cells surrounded by opaque collagenous matrix reminiscent of osteoid. The surgically resected specimen exhibited comparable histological features as well as colonies of gram-positive bacilli within the necrotic tumor. Culture confirmed the presence of Corynebacterium species. It is likely that these skin organisms were introduced at the time of FNAB. This case demonstrates the value of FNAB in the diagnosis of primary bone tumors and reports a rare complication of this procedure.
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Abstract
Percutaneous biopsies of musculoskeletal lesions are a safe, economical, and reliable method of obtaining a diagnosis. Most of these biopsies are done under CT guidance, but fluoroscopy is an alternative. Conditions that can be discovered through percutaneous biopsies include metastases, primary benign tumors, infection, and metabolic disease. Experience with invasive procedures and with imaging equipment are the requirements for a physician interested in performing these biopsies.
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Affiliation(s)
- B Ghelman
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY 10021, USA
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Heslin MJ, Lewis JJ, Woodruff JM, Brennan MF. Core needle biopsy for diagnosis of extremity soft tissue sarcoma. Ann Surg Oncol 1997; 4:425-31. [PMID: 9259971 DOI: 10.1007/bf02305557] [Citation(s) in RCA: 156] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Classic teaching has advocated the use of open biopsy to diagnose and grade extremity soft-tissue sarcoma. Reported advantages of core needle biopsy include the minimal morbidity, cost, and time. The perceived disadvantage has been diagnostic inaccuracy. The objective of this study was to compare the diagnostic accuracy of core needle biopsy to incisional or frozen section biopsy for primary extremity masses suspicious for soft-tissue sarcoma. METHODS Patients presenting with extremity masses were identified from our prospective soft-tissue sarcoma database (malignant) and from the clinical information center (benign) between January 1, 1990, and December 31, 1995. Biopsy and subsequent resection data were collected from the pathologic records. RESULTS During this time, 164 primary extremity soft-tissue masses were evaluated before any biopsy. As the initial diagnostic approach, there were 60 core needle, 44 incisional, 36 frozen section, and 26 excisional biopsies. Two patients underwent two biopsy procedures. Ninety-three percent of the specimens obtained at core needle biopsy were adequate to make a diagnosis. Of the adequate core needle biopsy specimens, 95%, 88% and 75% correlated with the final resection diagnosis for malignancy, grade, and histologic subtype, respectively. Of the frozen section biopsy specimens, 94% were adequate, and accurate diagnostic results of malignancy were obtained with 88%. However, only 62% and 47% were correct for grade and histologic subtype, respectively, which was significantly different than the results obtained with incisional biopsy. The false-negative and false-positive rates for core needle biopsy were 5% and 0% for malignancy. Two core needle biopsy specimens graded low were found to be high, and one core needle biopsy specimen graded high was subsequently found to be low on final resection. CONCLUSIONS When read by an experienced pathologist, the results of core needle biopsy provide accurate diagnostic information for malignancy and grade. Adequate core needle biopsy obviates the need for open biopsy and can be used for rational treatment planning. In the absence of adequate tissue, open biopsy is required.
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Affiliation(s)
- M J Heslin
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Althaus SJ, Matsuo R. Use of a large-diameter coring needle to remove a foreign body. J Vasc Interv Radiol 1997; 8:481-2. [PMID: 9152928 DOI: 10.1016/s1051-0443(97)70596-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Stevens KJ, Gregson RH, Kerslake RW. False aneurysm of a lumbar artery following vertebral biopsy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 1997; 6:205-7. [PMID: 9258641 PMCID: PMC3454612 DOI: 10.1007/bf01301438] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Vertebral body biopsy is regarded as a simple and relatively safe technique, with a low complication rate. We report the case of an 80-year-old man who developed a false aneurysm of a lumbar artery following biopsy of the fourth lumbar vertebra.
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Affiliation(s)
- K J Stevens
- Department of Radiology, Queen's Medical Centre, University Hospital, Nottingham, UK
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Schwartz HS, Spengler DM. Needle tract recurrences after closed biopsy for sarcoma: three cases and review of the literature. Ann Surg Oncol 1997; 4:228-36. [PMID: 9142384 DOI: 10.1007/bf02306615] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Percutaneous closed needle biopsy of musculoskeletal neoplasms has gained in popularity. However, it remains controversial whether or not to resect the needle tract for fear of a local recurrence. A single published case report exists, noting the lone tract recurrence of an extremity skeletal osteosarcoma. METHODS We report on three additional individuals who demonstrated that tract local recurrences may occur after a closed needle biopsy for nonosteosarcoma, nonextremity sarcomas. For perspective, the world literature is reviewed to identify tract recurrences for other malignancies and the results of needle biopsy in musculoskeletal neoplasms. RESULTS Eighty-nine percent of needle tract local recurrences occur when carcinomas are subjected to biopsy, as reported in the literature. Forty-seven cases since 1950 are described representing essentially all tumor types. The nature of musculoskeletal neoplasms makes closed biopsy more difficult than for softer, more homogeneous, and easier to access neoplasms. CONCLUSIONS Local recurrences of sarcoma may occur in closed needle biopsy tracts. Strong consideration should be given to open biopsy and tract resection.
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Affiliation(s)
- H S Schwartz
- Department of Orthopaedics and Rehabilitation, Vanderbilt University, Nashville, Tennesse 37232-2550, USA
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Ward JC, Jeanneret B, Oehlschlegel C, Magerl F. The value of percutaneous transpedicular vertebral bone biopsies for histologic examination. Results of an experimental histopathologic study comparing two biopsy needles. Spine (Phila Pa 1976) 1996; 21:2484-90. [PMID: 8923636 DOI: 10.1097/00007632-199611010-00015] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A 3.5-mm trephine was designed to overcome difficulties encountered in the histologic evaluation of vertebral bone samples obtained with a 2-mm trephine. OBJECTIVES To compare the 3.5-mm trephine with the 2-mm trephine. SUMMARY OF BACKGROUND DATA A review of results obtained with a 2-mm trephine showed that histologic examination of vertebral bone cores was disturbed by artifacts in 32 of 70 cases (46%). Although tissue diagnosis was possible from 61 samples, only 36 (51%) bone cores yielded a secure diagnosis. METHODS Transpedicular bone cores were obtained from the bodies of 54 fresh cadaver vertebrae with both trephines. In each vertebra, the 2-mm trephine was used on one side, and the 3.5-mm trephine was used on the other side. Longitudinal sections were prepared and examined macroscopically for length and breakages and microscopically for trabeculae, marrow, and artifacts. Each sample was graded for its value for histologic examination. RESULTS Significant differences were found between the two trephines for all criteria evaluated. Of 54 samples taken with the 2-mm trephine, 13 (24%) were graded "good," compared with 45 (83%) from the 3.5-mm trephine. Twelve (22%) "bad" samples were taken from the 2-mm trephine compared with three (6%) "bad" samples taken from the 3.5-mm trephine. CONCLUSIONS The 2-mm trephine does not provide suitable bone cores for histologic examination, whereas samples obtained with the 3.5-mm trephine are suitable.
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Affiliation(s)
- J C Ward
- Klinik für Orthopädische Chirurgie, Kantonsspital St. Gallen, Switzerland
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Kawai A, Taguchi K, Sugihara S, Kunisada T, Inoue H. The value of needle biopsy in the diagnosis of musculoskeletal tumors. Int J Clin Oncol 1996. [DOI: 10.1007/bf02347266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Skrzynski MC, Biermann JS, Montag A, Simon MA. Diagnostic accuracy and charge-savings of outpatient core needle biopsy compared with open biopsy of musculoskeletal tumors. J Bone Joint Surg Am 1996; 78:644-9. [PMID: 8642019 DOI: 10.2106/00004623-199605000-00002] [Citation(s) in RCA: 180] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We performed a prospective study of sixty-two patients who were managed with a closed core needle biopsy in an outpatient clinic for a soft-tissue mass or a bone tumor with soft-tissue extension between August 1, 1992, and June 1, 1994. Eight (13 percent) of the closed core needle biopsies yielded no neoplastic tissue. Two needle biopsies (3 percent), which were of myxomatous masses, did not allow distinction between a benign and a malignant neoplasm; both masses were extraskeletal myxoid chondrosarcomas. Additionally, the histological grade of four resected specimens (6 percent) differed from that determined with the closed needle biopsy. The diagnostic accuracy of the closed needle biopsies was 84 percent (fifty-two of sixty-two). All ten diagnostic errors involved soft-tissue tumors. A retrospective study of a similar cohort of patients who had open biopsy in an outpatient operating room by the same surgeon in a contemporary period in the same institution and with analysis by the same pathologist, revealed a diagnostic accuracy of 96 percent (forty-eight of fifty). The hospital charges for the closed core needle biopsy were $1106, compared with $7234 for the open biopsy. We concluded that core needle biopsy can be performed in an outpatient clinic with use of local anesthesia and that it is substantially less expensive and more convenient than open biopsy. This technique has an acceptable but definitely lower rate of accuracy compared with open biopsy, especially for soft-tissue tumors, and it should be used only in a small subset of patients (those who have a large soft-tissue mass or a bone tumor with palpable soft-tissue extension). However, given the small size of the tissue sample, the clinician must recognize possible disadvantages, including a non-diagnostic biopsy, an indeterminate biopsy, or a potential error in the histological grade. These problems are much more likely to occur after core needle biopsy of soft-tissue masses. Because of the potential for errors in diagnosis when core needle biopsy is used, the musculoskeletal oncologist must rely on his or her clinical acumen. When a diagnosis is in reasonable doubt, there is no radiographic confirmation, the biopsy shows no tumor cells, or there is a combination of these findings, operative decisions should be made as if no biopsy had been performed. The management of patients who, after core needle biopsy, have a diagnosis of a bone or soft-tissue tumor, is best carried out by an experienced musculoskeletal oncologist working in close collaboration with an experienced musculoskeletal pathologist.
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Lise M, Rossi CR, Alessio S, Foletto M. Multimodality treatment of extra-visceral soft tissue sarcomas M0: state of the art and trends. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1995; 21:125-35. [PMID: 7720882 DOI: 10.1016/s0748-7983(95)90039-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We here outline principles and trends in the treatment of soft tissue sarcomas without distant metastases (M0). Over the last 15 years significant advances have been made in the diagnostic imaging and histological classification of these tumors as well as in their treatment. Magnetic resonance imaging (MRI) has essentially replaced computerized tomography (CT) for the evaluation of the local growth pattern, although the latter is still preferred for the detection of pulmonary metastases. Immunohistochemistry techniques and electron microscopy have improved the histological diagnosis, although the results obtained should always be interpreted in the context of routine light microscopy. Adequate surgical resection and radiotherapy can reduce the incidence of local recurrence, which is still high for head-neck and retroperitoneal sarcomas. Limb-sparing surgery in combination with irradiation and/or intra-arterial or perfusion chemotherapy is considered the treatment of choice in 90% of limb sarcomas, with a local recurrence rate of less than 20%. New radiotherapeutical techniques and anti-neoplastic agents are now under investigation in an attempt to improve local control. There is also a need for a more effective adjuvant chemotherapy. Randomized clinical trials using doxorubicin/ifosfamide and growth factors are now underway.
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Affiliation(s)
- M Lise
- Istituto di Clinica Chirurgica II, Università di Padova, Italy
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Area MJ, Biermann JS, Johnson TM, Chang AE. Biopsy Techniques for Skin, Soft-Tissue, and Bone Neoplasms. Surg Oncol Clin N Am 1995. [DOI: 10.1016/s1055-3207(18)30473-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Interventional musculoskeletal radiology. Curr Probl Diagn Radiol 1994. [DOI: 10.1016/0363-0188(94)90018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Between 60-80% of all patients with osteosarcomas of the pelvis and the extremities can now be safely treated with limb-sparing surgery. Results (as defined by rates of local recurrence, overall survival, and function) are equal to or better than those associated with amputation. Successful use of limb-sparing procedures, however, depends on a well-developed surgical plan. An understanding of the biologic behavior and growth patterns of these lesions is fundamental. Staging of the primary tumor must involve a full complement of imaging modalities, including plain radiography, bone scintigraphy, computerized axial tomography (CAT), magnetic resonance imaging (MRI), and angiography. The biopsy must be well placed to reduce the possibility of tissue contamination, which is a common reason for amputation. Restaging is necessary before surgery for patients who have undergone neoadjuvant therapy; there is recent evidence that preoperative therapy may make limb-sparing surgery possible in more than 50% of patients who otherwise would have required amputation. Relative contraindications to limb-sparing surgery include major involvement of the neurovascular bundle, pathologic fracture, inappropriate biopsy site, infection, immature skeletal age, and extensive muscle involvement. Each of these factors is relative, and patient selection decisions must be made on an individual basis. Limb-sparing surgery consists of the following three phases: tumor resection, skeletal reconstruction, and soft tissue and muscle transfers. The range of reconstruction techniques has been broadened by developments in bioengineering. Among the more commonly used techniques are custom endoprostheses and allograft replacements. Future progress in induction regimens and reconstructive techniques will undoubtedly enable limb-sparing surgery to be a satisfactory alternative to amputation in even more patients.
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Affiliation(s)
- A J Aboulafia
- Department of Orthopedics, Washington Hospital Center, Washington, DC 20010
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