Biopsy of hand, wrist, and forearm tumors

Hand and finger, ultrasound-guided, percutaneous core needle biopsies: A safe procedure with high diagnostic accuracy

Introduction/Purpose

To determine the diagnostic accuracy and complication rates of ultrasound-guided, percutaneous core needle biopsies of soft tissue masses in the hand and fingers.

Methods

Reports from all ultrasound-guided procedures between 21 May 2014 and 17 March 2022 were queried for keywords including "hand", OR "finger", AND "biopsy". Patient demographics, lesion size and location, biopsy needle gauge and the number of cores obtained were recorded. The final pathology of the mass excision was then compared with the core needle biopsy (CNB) for each patient.

Results

Sixty-six records were reviewed, and 37 patients met inclusion criteria. Maximum lesion diameter averaged 1.45 cm with a range between 0.4 and 4.3 cm. The frequency of needle gauges used was 14G (14%), 16G (24%), 18G (38%), 20G (11%) and 'not reported' (14%). The mean number of tissue cores obtained was 2.9 (SD 1.2; range 1 to 6), excluding nine cases that reported 'multiple'. The frequency of CNB diagnoses included tenosynovial giant cell tumour (TGCT) at 30%, ganglion cyst at 11% and epidermal inclusion cyst at 5%. CNB was 100% sensitive in detecting the three (8%) malignancies. Of the 37 tumours biopsied, 16 were surgically excised. One angiomyoma was originally diagnosed as a haemangioma on CNB, but all other histologic results were concordant for a diagnostic accuracy of 97%.

Discussion

Small soft tissue masses in the hands and fingers, even those less than 1 cm, are often amenable to ultrasound-guided CNB. Performance under image guidance facilitates retrieval of core specimens adquate for histologic diagnosis with relatively few passes using higher gauge needles.

Conclusion

Overall, ultrasound-guided CNB of the hand and fingers is safe and highly accurate in diagnosing soft tissue tumours. The accuracy is unrelated to the needle's gauge, the number of passes and the size of the lesions.

Diagnosis and treatment of hand tumors

Hand tumors are a very common problem in hand surgery. While these lesions are most often benign, malignant lesions often have an atypical presentation and are discovered late, very often during an inappropriate treatment. To optimize the care of hand tumors and to reduce diagnostic and treatment errors, we will review the broad diagnostic and therapeutic principles and the most common clinical presentations.

Tricks and pitfalls in the surgical treatment of malignant bone tumours of the forearm in children and adolescents

Malignant bone tumours around the forearm are rare. Nowadays, oncological and surgical management of bone sarcomas of this region has improved significantly. Although the anatomical features are complex, limb-sparing surgery is possible with wide surgical resection. Biological reconstruction methods are promising in this anatomically unique region. In addition, meticulous soft-tissue reconstruction yields good functional results in the hand and wrist. This study reviews malignant bone tumours of the forearm and their oncological and surgical management. Malignant bone tumours should be treated with a multidisciplinary approach based on chemotherapy, radiotherapy and limb salvage procedures.

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.

Role of FNAC in diagnosing lesions of hand and wrist

BACKGROUND

Swellings in the hand and wrist are frequently encountered in clinical practice and fine needle aspiration cytology (FNAC) is used as a primary diagnostic modality in most of them. A wide spectrum of lesions can be encountered at these sites. The aim of this study was to report the prevalence and spectrum of hand and wrist lesions and evaluate the diagnostic role of FNAC.

METHODS

All the patients who presented with palpable lesions in the hand or wrist between January 2011 and July 2016 were reviewed, retrospectively.

RESULTS

1312 cases were subjected to FNAC of hand and wrist swellings, of which 1136 (86.6%) cases were satisfactory. Age ranged from 5 months to 90 years with M: F = 0.7:1. 138 (12.1%) were diagnosed as inflammatory lesions, 875 (77.0%) as benign, non-neoplastic (tumor-like) lesions and 123 (10.8%) were neoplastic lesions. The inflammatory lesions included 75 cases of synovitis, 30 cases of tuberculosis, 28 cases of abscess, one case of cysticercosis, two cases of gout, and fat necrosis each. In the benign, non-neoplastic (tumor-like) lesions, the most common lesion was ganglion (775 cases). The neoplastic lesions included 78 benign lesions with the most common being giant cell tumor of tendon sheath (61 cases). There were 40 cases of mesenchymal lesions, four cases of appendageal tumors and one case of malignancy (squamous cell carcinoma). Mesenchymal lesions accounted for 3.5% (40/1136) cases.

CONCLUSION

FNAC is very useful and simple investigation for early diagnosis of lesions of hand and wrist. The lesions encountered at these sites most commonly are benign.

[A retrospective study of hand and wrist tumors in adults]

OBJECTIVES

Epidemiologic data concerning hand and wrist tumors are still few and sometimes conflicting. In our department, tumor surgeons and hand surgeons manage together those tumors and they have a specific recruitment. This collaboration permitted to make an epidemiologic study of the tumors of the hand operated in the unit.

METHODS

We made a retrospective study of all the cases of wrist and hand tumors operated in the unit, from January 1980 to September 2008. Files were collected from diagnostic encoding, letters of consultations and the register of the department of histology.

RESULTS

The mean age of the population was 48 years (from 16 to 94 years). The series included 623 tumors treated in 620 patients (372 women and 248 men). Tumors concerned soft tissues in 525 cases (84.1%), bone tissue in 70 cases (11.4%) and skin in 28 cases (4.5%). The prevalence of malign tumors was 1.3% in this study.

CONCLUSIONS

This series is the third in number of cases and the data are comparable of those from other studies. The prevalence of bone tumors (11.4%) is higher than in others studies (from 1.6 to 6.6%) and the prevalence of skin tumors is lower. Except for skin tumors which recruitment modalities are more variable, this series seems to be a good reflection of the prevalence of the different types of hand and wrist tumors.

Fine-needle aspiration biopsy of the distal extremities: a study of 141 cases

We reviewed our cytopathology databases for an 11-year period to identify all fine-needle aspiration biopsy (FNAB) cases of palpable masses of the hand, wrist, ankle, or foot. Cases were included only if there was a subsequent tissue biopsy or a minimum 1-year clinical follow-up. Of 141 aspirates, 41, 23, 34, and 43 were from the hand, wrist, ankle, and foot, respectively. Specific benign or malignant diagnoses were achievable in 71.6% of cases, whereas the remaining cases were given a descriptive diagnosis (26.2%) or, infrequently, a "suspicious for" diagnosis (2.1%). Overall sensitivity and specificity for distinguishing a benign from malignant entity from all 4 sites were 100% and 96%, respectively, whereas positive and negative predictive values were 88% and 100%, respectively. The most common lesion was a ganglion. Of the benign neoplasms, giant cell tumor of tendon sheath (17) and desmoid-type fibromatosis (7) were most common. Of 31 malignancies, 24 were sarcomas: sarcoma not otherwise specified (6), high-grade pleomorphic sarcoma (5), and Ewing sarcoma (3) were most common. Seven nonsarcomas included melanoma (3), metastatic squamous carcinoma (2), and malignant lymphoma (2). An FNAB-procured cytopathologic diagnosis is clinically reliable in a high percentage of distal extremity mass lesions.

Upper extremity compartmental anatomy: clinical relevance to radiologists

Malignant tumors of the upper extremity are uncommon, and their care should be referred to specialized facilities with experience treating these lesions. The Musculoskeletal Tumor Society (MSTS) staging system is used by the surgeon to determine appropriate surgical management, assess prognosis, and communicate with other healthcare providers. Magnetic resonance imaging (MRI) is employed pre-operatively to identify a lesion's compartment of origin, determine extent of spread, and plan biopsy and resection approaches. Involvement of neurovascular structures may result in devastating loss of upper extremity function, requiring amputation. Violation of high-resistance compartmental barriers necessitates more extensive surgical resection. Biopsy may be performed by the radiologist using imaging guidance. Knowledge of compartmental anatomy allows the radiologist or surgeon to use an easily excisable biopsy approach and prevent iatrogenic spread to unaffected compartments. Case examples are presented to illustrate the importance of compartmental anatomy in the management of benign and malignant upper extremity tumors.