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Mavrogenis AF, Altsitzioglou P, Tsukamoto S, Errani C. Biopsy Techniques for Musculoskeletal Tumors: Basic Principles and Specialized Techniques. Curr Oncol 2024; 31:900-917. [PMID: 38392061 PMCID: PMC10888002 DOI: 10.3390/curroncol31020067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Biopsy is a pivotal component in the diagnostic process of bone and soft tissue tumors. The objective is to obtain adequate tissue without compromising local tumor dissemination and the patient's survival. This review explores contemporary principles and practices in musculoskeletal biopsies, emphasizing the critical role of diagnostic accuracy while also delving into the evolving landscape of liquid biopsies as a promising alternative in the field. A thorough literature search was done in PubMed and Google Scholar as well as in physical books in libraries to summarize the available biopsy techniques for musculoskeletal tumors, discuss the available methods, risk factors, and complications, and to emphasize the challenges related to biopsies in oncology. Research articles that studied the basic principles and specialized techniques of biopsy techniques in tumor patients were deemed eligible. Their advantages and disadvantages, technical and pathophysiological mechanisms, and possible risks and complications were reviewed, summarized, and discussed. An inadequately executed biopsy may hinder diagnosis and subsequently impact treatment outcomes. All lesions should be approached with a presumption of malignancy until proven otherwise. Liquid biopsies have emerged as a potent non-invasive tool for analyzing tumor phenotype, progression, and drug resistance and guiding treatment decisions in bone sarcomas and metastases. Despite advancements, several barriers remain in biopsies, including challenges related to costs, scalability, reproducibility, and isolation methods. It is paramount that orthopedic oncologists work together with radiologists and pathologists to enhance diagnosis, patient outcomes, and healthcare costs.
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Affiliation(s)
- Andreas F. Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini, 157 72 Athens, Greece;
| | - Pavlos Altsitzioglou
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini, 157 72 Athens, Greece;
| | - Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara 634-8521, Japan;
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy;
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Iida K, Matsumoto Y, Nabeshima A, Fujiwara T, Setsu N, Endo M, Nakashima Y. The Difference in Clinical Features between Small-Sized Soft Tissue Sarcomas and Benign Tumors. Kurume Med J 2023; 69:65-73. [PMID: 37793890 DOI: 10.2739/kurumemedj.ms69120015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Small-sized tumors tend to be resected without thorough assessment and are often managed in a sarcoma center after a malignancy is diagnosed. The lack of knowledge about the features of smallsized sarcomas may lead to unplanned resection. The features of small-sized soft tissue sarcomas were investigated by comparing them with those of small benign soft tissue tumors. METHODS We included 17 soft tissue sarcoma cases (7 on the hands and feet and 10 on the limbs and trunk) with a diameter of under 2 cm. The features of small-sized sarcomas were compared to those of 39 benign soft tissue tumors with a diameter of under 2 cm and non-specific imaging findings (30 on the hands and feet and 9 on the limbs and trunk). The investigated features were age, sex, presence of pain, subjective increasing tumor size, and duration of observation. RESULTS When we compared the tumors in the hands and feet, those <40 years of age (5/7 [71%] vs. 8/30 [27%], p=0.03) experiencing pain (7/7 [100%] vs. 13/30 [43%], p=0.007) were more common in patients with sarcomas than in patients with benign tumors. When we compared the tumors in the limbs and trunk, there was no significant difference in all investigated features. CONCLUSION Although clinical features were ineffective in distinguishing malignancy in most small-sized soft tissue tumors, we should pay attention to painful tumors of the hands and feet in younger patients.
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Affiliation(s)
- Keiichiro Iida
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University
| | - Akira Nabeshima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University
| | - Toshifumi Fujiwara
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University
| | - Nokitaka Setsu
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University
| | - Makoto Endo
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University
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The Management of an Open Biopsy Tract Site Infection and Ulceration in the Setting of Osteosarcoma. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202207000-00008. [PMID: 35797610 PMCID: PMC9263486 DOI: 10.5435/jaaosglobal-d-22-00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022]
Abstract
Biopsy site infection in the setting of osteosarcoma is a potentially devastating complication. We present the case of a 16-year-old adolescent girl with a distal femur osteosarcoma who developed an open biopsy site ulceration and infection after initiation of neoadjuvant chemotherapy. This was treated with careful local excision of the ulcerated biopsy site and systemic antibiotic therapy throughout the duration of her chemotherapy course. She subsequently underwent wide resection of the tumor en bloc with a generous ellipse around the biopsy scar and reconstruction with cemented knee megaprosthesis. No recurrence of either infection or malignancy was observed. This case represents the successful treatment of a biopsy site ulceration and infection in a patient with osteosarcoma and may merit adoption in future instances of this complication.
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Oebisu N, Hoshi M, Ieguchi M, Takada J, Iwai T, Ohsawa M, Nakamura H. Contrast-enhanced color Doppler ultrasonography increases diagnostic accuracy for soft tissue tumors. Oncol Rep 2014; 32:1654-60. [PMID: 25109621 DOI: 10.3892/or.2014.3378] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 07/17/2014] [Indexed: 11/06/2022] Open
Abstract
Resolution of ultrasonography (US) has undergone marked development. Additionally, a new-generation contrast medium (Sonazoid) used for US is newly available. Contrast-enhanced US has been widely used for evaluating several types of cancer. In the present study, we evaluated the ability of color Doppler US (CDUS) and Sonazoid to differentiate between benign and malignant soft tissue tumors. A total of 180 patients (87 male, 93 female) were enrolled in the present study. The patient ages ranged from 1 to 91 years (mean 58.1±20.0 years). The maximum size, depth, tumor margins, shape, echogenicity and textural pattern were measured on gray-scale images. CDUS was used to evaluate the intratumoral blood flow with and without Sonazoid. Peak systolic flow velocity (Vp), mean flow velocity (Vm), resistivity index (RI) and pulsatility index (PI) of each detected intratumoral artery were automatically calculated with power Doppler US (PDUS). The present study included 118 benign and 62 malignant tumors. Statistical significances were found in size, depth, tumor margin and textural pattern but not in shape or echogenicity on gray-scale images. Before Sonazoid injection, CDUS findings showed 55% sensitivity, 77% specificity and 69% accuracy, whereas contrast-enhanced CDUS showed 87% sensitivity, 68% specificity and 74% accuracy. There were no statistically significant differences between malignant and benign tumors regarding the mean Vp, Vm, RI and PI values determined on PDUS. In conclusion, contrast-enhanced CDUS proved to be a reliable diagnostic tool for detecting malignant potential in soft tissue tumors.
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Affiliation(s)
- Naoto Oebisu
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545‑8585, Japan
| | - Manabu Hoshi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545‑8585, Japan
| | - Makoto Ieguchi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545‑8585, Japan
| | - Jun Takada
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545‑8585, Japan
| | - Tadashi Iwai
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545‑8585, Japan
| | - Masahiko Ohsawa
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545‑8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545‑8585, Japan
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Current concepts in the biopsy of musculoskeletal tumors. ScientificWorldJournal 2013; 2013:538152. [PMID: 23844403 PMCID: PMC3690267 DOI: 10.1155/2013/538152] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/19/2013] [Indexed: 12/13/2022] Open
Abstract
In the management of bone and soft tissue tumors, accurate diagnosis, using a combination of clinical, radiographic, and histological data, is critical to optimize outcome. On occasion, diagnosis can be made by careful history, physical examination, and images alone. However, the ultimate diagnosis usually depends on histologic analysis by an experienced pathologist. Biopsy is a very important and complex surgery in the staging process. It must be done carefully, so as not to adversely affect the outcome. Technical considerations include proper location and orientation of the biopsy incision and meticulous hemostasis. It is necessary to obtain tissue for a histological diagnosis without spreading the tumor and so compromise the treatment. Furthermore, the surgeon does not open compartmental barriers, anatomic planes, joint space, and tissue area around neurovascular bundles. Nevertheless, avoid producing a hematoma. Biopsy should be carefully planned according to the site and definitive surgery and should be performed by an orthopedic surgeon with an experience in musculoskeletal oncology who will perform the definitive surgery. Improperly done, it can complicate patient care and sometimes even eliminate treatment options. Different biopsy techniques are suitable: fine-needle aspiration, core-needle biopsy, and incisional biopsy. The choice of biopsy depends on the size, the location of the lesion, and the experience of the pathologist.
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Difficulties in the diagnosis of plexiform ameloblastoma. Oral Maxillofac Surg 2011; 16:115-8. [PMID: 21360116 DOI: 10.1007/s10006-011-0265-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 02/14/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Plexiform ameloblastoma is a rare and benign odontogenic tumor which may reach grotesque proportions affecting over a region of lower molars. The correct diagnosis is essential to reduce this risk of local recurrences and obtain an effective treatment. CASE REPORT A 10-year-old female patient, Caucasian, presented a complaint of painless facial asymmetry. The clinical and imaginological examinations showed an increase in volume in the left mandibular body related to radiolucent unilocular injury near the apex of the first molar, expansion of the vestibular cortical bone, and tooth root resorption ipsilaterally. The former intraosseous biopsy suggested an aneurysmal bone cyst. In reopening the previous marsupialization, a new biopsy was performed with histopathologic findings compatible with plexiform ameloblastoma associated with acute inflammation. Curettage was performed in the region associated with cryotherapy. At the last biopsy, the diagnosis of plexiform ameloblastoma was confirmed with multiple cystic formations and areas of foreign body reaction. The patient is being followed for 2 years and yet remains clinically and radiographically stable with no recurrence. DISCUSSION This case reports the importance of selecting the correct area of biopsy of an intraosseous extended lesion to contribute to the diagnosis and treatment of plexiform ameloblastoma.
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Dalén BPM, Meis-Kindblom JM, Sumathi VP, Ryd W, Kindblom LG. Fine-needle aspiration cytology and core needle biopsy in the preoperative diagnosis of desmoid tumors. Acta Orthop 2006; 77:926-31. [PMID: 17260203 DOI: 10.1080/17453670610013240] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Desmoid tumors have a tendency to recur locally, and traditionally they have been treated surgically. No treatment is sometimes indicated, however; this requires a morphological diagnosis that is not based on a surgical specimen. In this study we aimed to identify the diagnostic accuracy of needle and core biopsy for the morphological diagnosis of desmoid. METHODS We compared the diagnostic accuracy of fine-needle aspiration (FNA) and core needle biopsy (CNB) in 69 and 26 patients, respectively, who had had surgical resections for desmoid. We also reviewed 15 additional cases that had been incorrectly diagnosed as desmoid on FNA but which had different diagnoses after surgery. RESULTS FNA-based diagnoses of desmoid/fibromatosis were rendered in 35 of 69 cases, and other benign spindle cell proliferations in 26 cases and spindle cell sarcoma in the remaining 4 cases. All 26 CNBs were either suggested to correspond to desmoid (24) or other benign spindle cell lesions (2). Of the 15 FNAs incorrectly diagnosed as desmoid, 2 were found to be sarcomas. INTERPRETATION FNA is fairly reliable for recognition of the benign nature of desmoids. Occasional over- and under-diagnosis of malignancy can occur, however. CNB appears to be more reliable.
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Affiliation(s)
- B P Mikael Dalén
- Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden.
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Rotenberg L, Verhille R, Schulz-Wendtland R, Verswijfel G, Gelin J, Van Migem D, Janssens JP. Multicenter clinical experience with large core soft tissue biopsy without vacuum assistance. Eur J Cancer Prev 2004; 13:491-8. [PMID: 15548942 DOI: 10.1097/00008469-200412000-00005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The increasing interest in accurate pretreatment diagnosis of solid tumours by morphology, immunohistochemistry, genetics and molecular biology requires clinicians to obtain undamaged large core biopsies. Simultaneously, medical imaging and surgery give priority to minimal tissue injury, affordable technology and optimal patient compliance. A new large core soft tissue biopsy device has been developed to meet the above criteria. After intensive preclinical testing, 30 patients gave informed consent and 26 underwent the new diagnostic biopsy procedure. The sample was studied by morphology, immunohistochemistry and, where indicated, by molecular biology. Successful diagnosis was considered when in line with clinical follow-up and, as for all malignant lesions, when confirmed by open biopsy or surgery. No difficulties in the technique were encountered in 25 patients. In one patient the procedure was prematurely stopped because of anxiety. In all other 25 procedures a complete diagnosis was reached with regard to morphology, immunohistochemistry and molecular biology. A number of radiologists suggested some automation of the technique. This new large core soft tissue biopsy system performs well in the clinical context without injury to the breast parenchyma or artefacts in the harvested tissue specimen. The system meets almost all of the proposed technical and financial requirements. Automation is underway.
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Affiliation(s)
- L Rotenberg
- Centre de Radiologie Henri Hartmann, 26 boulevard Victor Hugo, 92200 Neuilly sur Seine, France
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Goldberg EP, Hadba AR, Almond BA, Marotta JS. Intratumoral cancer chemotherapy and immunotherapy: opportunities for nonsystemic preoperative drug delivery. J Pharm Pharmacol 2002; 54:159-80. [PMID: 11848280 DOI: 10.1211/0022357021778268] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The recent literature documents the growing interest in local intratumoral chemotherapy as well as systemic preoperative chemotherapy with evidence for improved outcomes using these therapeutic modalities. Nevertheless, with few exceptions, the conventional wisdom and standard of care for clinical and surgical oncology remains surgery followed by radiation and/or systemic chemotherapy, as deemed appropriate based on clinical findings. This, in spite of the fact that the toxicity of conventional systemic chemotherapy and immunotherapy affords limited effectiveness and frequently compromises the quality of life for patients. Indeed, with systemic chemotherapy, the oncologist (and the patient) often walks a fine line between attempting tumour remission with prolonged survival and damaging the patient's vital functions to the point of death. In this context, it has probably been obvious for more than 100 years, due in part to the pioneering work of Ehrlich (1878), that targeted or localized drug delivery should be a major goal of chemotherapy. However, there is still only limited clinical use of nonsystemic intratumoral chemotherapy for even those high mortality cancers which are characterized by well defined primary lesions i.e. breast, colorectal, lung, prostate, and skin. There has been a proliferation of intratumoral chemotherapy and immunotherapy research during the past two to three years. It is therefore the objective of this review to focus much more attention upon intratumoral therapeutic concepts which could limit adverse systemic events and which might combine clinically feasible methods for localized preoperative chemotherapy and/or immunotherapy with surgery. Since our review of intratumoral chemoimmunotherapy almost 20 years ago (McLaughlin & Goldberg 1983), there have been few comprehensive reviews of this field; only one of broad scope (Brincker 1993), three devoted specifically to gliomas (Tomita 1991; Walter et al. 1995; Haroun & Brem 2000), one on hepatomas (Venook 2000), one concerning veterinary applications (Theon 1998), and one older review of dermatological applications (Goette 1981). However, none have shed light on practical opportunities for combining intratumoral therapy with subsequent surgical resection. Given the state-of-the-art in clinical and surgical oncology, and the advances that have been made in intratumoral drug delivery, minimally invasive tumour access i.e. fine needle biopsy, new drugs and drug delivery systems, and preoperative chemotherapy, it is timely to present a review of studies which may suggest future opportunities for safer, more effective, and clinically practical non-systemic therapy.
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Affiliation(s)
- Eugene P Goldberg
- Biomaterials Center, Department of Materials Science and Engineering, University of Florida, Gainesville 32611, USA.
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