Excisional biopsy of suspected benign soft tissue tumors of the upper extremity: correlation between preoperative diagnosis and actual pathology

Is a routine histopathological examination justified for all tumours resected from the upper extremity?

Most lesions of the upper extremity are common and benign, and the need for a routine pathology evaluation of these specimens has often been questioned. This study aimed to evaluate the concordance of the initial clinical and final histological diagnoses of tumours which, based on clinical presentation and intraoperative findings, are most likely benign or malignant, and to answer the question whether or not a routine histopathological examination is justified for all tumours in the upper extremity.

MATERIAL AND METHODS

We analysed the results of histopathological examinations of benign tumours resected in 346 patients and malignant tumours resected in 6 patients.

RESULTS

Our analysis showed a 100% concordance between the initial (clinical) diagnoses of the tumours as benign or malignant and their final histopathological diagnoses. Only in 12 cases (3.5%) of initially benign tumours did the clinical presentation and/or intraoperative findings raise doubts.

CONCLUSIONS

The results of this study show that a routine histological evaluation of all tumours resected from the upper extremity is not justified and may be confined to selected cases in which clinical presentation and/or intraoperative findings raise doubts.

Use of Routine Pathologic Evaluation of Nonmalignant Lesions in Hand Surgery: A National Study

BACKGROUND

Most lesions of the upper extremity are common and benign, and many have questioned the need for routine pathologic evaluation of these specimens. The authors aim to examine the national use of routine pathologic examination of nonmalignant hand lesions to help guide health care policy and practice patterns.

METHODS

The authors used a national level MarketScan database to form a cohort of adult patients who underwent excision of nonmalignant upper extremity lesions. The authors calculated the rate of submission for each surgical procedure and separately for each diagnosis. The authors also investigated demographic and clinical characteristics associated with the submission of surgical specimens using a multivariable logistic regression model. The authors calculated the total cost of routine pathologic evaluation.

RESULTS

The final study cohort included 222,947 patients and 182,962 specimens from 153,518 cases. The mean rate of submission was 69 percent. Older age, Northeast region, and high comorbidity scores showed significant correlation with the odds of having a specimen submitted for pathologic evaluation. Excision of primary wrist ganglion was the most performed procedure, and benign lesions larger than 4.0 cm were most frequently submitted for pathologic evaluation. The mean cost of routine pathologic examination was $133 per specimen, and the annual expenditure was $5 million.

CONCLUSIONS

The routine pathologic examination of benign hand lesions is used frequently but provides limited clinical benefit at a cost. To increase efficiency and improve quality of care, surgeons should be aware of the low value of routine pathologic evaluation and be more selective for cases for which diagnostic testing will change management.

Clinical Decision Making for a Soft Tissue Hand Mass: When and How to Biopsy

Evaluation of a hand mass and subsequent surgical treatment is a frequent clinical encounter for the practicing hand surgeon. The clinical evaluation of benign and malignant hand tumors has traditionally focused on diagnosis, surgical excision, and reconstruction. There is a paucity of literature discussing the determining factors for a hand mass biopsy, its appropriate technique, and postbiopsy preparation and handling. This review discusses the approaches of the hand surgeon and orthopedic oncologist to a soft tissue mass in the hand and clarifies the term biopsy. Special attention is focused on preoperative decisions and indications for core needle, incisional, and excisional biopsies of hand masses. In addition, we include a discussion of surgical technique for obtaining a specimen, processing a specimen, and sending a specimen for pathological evaluation. This highlights specimen labeling and type of fixative utilized for pathological evaluation. This review features a section detailing clinical strategies to reduce morbidity associated with evaluation and treatment of benign and malignant hand masses and is based on recommendations from a synopsis of expert opinion and literature review.

Statistical and histological analysis of tumors of the upper extremity

Background

Tumors of the upper extremity are common and usually benign. The most commonly diagnosed are ganglion cysts: specific, non-neoplastic swellings localized mostly around the wrist.

Objective

The objective of this retrospective study was to determine the proportion of various types of nonganglionic hand tumors operated on at the authors’ institution in 2014.

Methods

A total of 246 patients, 141 women (57 %) and 105 men (43 %), with a mean age of 53 years and with tumorsof the upper extremity, were identified and treated in the authors’ institution in 2014.

Results

Almost half of the lesions were localized in the fingers (n = 119, 48 %), followed by the wrist (n=49, 20 %), metacarpus (n = 40, 16 %), and more proximal parts (n = 38, 16 %). The time between the patients noticing the lesion and surgery was a mean of 4 years (range, 1 month to 30 years). The most common lesion was giant cell tumor of the tendon sheath (n = 58, 23 %), followed by lipoma (n = 40, 16 %), epidermal cyst (n = 23, 9 %), enchondroma (n=16, 6 %), hemangioma (n = 14, 6 %), fibroma (n = 11, (4 %), glomus tumor (n = 10, (4 %), and rheumatoid nodule (n = 10, (4 %). Two cases of malignant fibrosarcoma were identified incidentally.

Conclusion

A brief review of the literature is made referring to the data presented here.