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Hu X, Wang C, Zeng Y, Yang X, Min L. Clinical Perspectives on Surgical Reconstruction of Eccentric Tumors at the Distal Femur with Unicondylar Resection. Orthop Surg 2024; 16:1761-1769. [PMID: 38923385 PMCID: PMC11293928 DOI: 10.1111/os.14119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 06/28/2024] Open
Abstract
The distal femur is one of the most common sites for primary bone tumors. As the tumor progresses and bone destruction worsens, it can severely affect knee function and even pose a threat to life. In cases where only one condyle is affected and requires resection, preserving the healthy contralateral condyle can substantially enhance the biomechanics of the knee. Furthermore, preserving bone stock may enable future salvage procedures in the event of initial surgery failure, be it from fractures or osteoarthritis. Distal femoral unicondyle resection can offer better functional outcomes in select cases. However, it is essential to prioritize oncological safety with adequate margins over short-term knee function. Currently, the primary methods for reconstruction after the excision of a unicondylar tumor include allograft transplantation (bi- or uni-condylar) and prosthetic or allograft-prosthesis composite replacement (APC). However, there is currently some controversy regarding the optimal surgical reconstruction method, and a consensus within the academic community has yet to be reached. Moreover, due to the rarity of bone tumors, extensive clinical data from a single center is limited. Current studies are mainly retrospective and single-center, lacking sufficient cases and follow-up duration. This article reviews surgical reconstruction after solitary condylar excision in distal femoral tumors. It summarizes, compares, and analyzes mainstream reconstruction methods, exploring their technical details and clinical outcomes to highlight their potential in bone oncology.
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Affiliation(s)
- Xin Hu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China HospitalSichuan UniversityChengduChina
| | - Chende Wang
- National Engineering Research Center for BiomaterialsSichuan UniversityChengduChina
- Provincial Engineering Research Center for Biomaterials Genome of SichuanSichuan UniversityChengduChina
| | - Yi Zeng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Xiao Yang
- National Engineering Research Center for BiomaterialsSichuan UniversityChengduChina
- Provincial Engineering Research Center for Biomaterials Genome of SichuanSichuan UniversityChengduChina
| | - Li Min
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China HospitalSichuan UniversityChengduChina
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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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He S, Zhong A, Lei J, Deng Z, Zhu X, Wei R, Huang H, Chen Z, Cai L, Xie Y. Application of Indocyanine Green Fluorescence Imaging in Assisting Biopsy of Musculoskeletal Tumors. Cancers (Basel) 2023; 15:cancers15082402. [PMID: 37190330 DOI: 10.3390/cancers15082402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
(1) Background: Biopsies are the gold standard for the diagnosis of musculoskeletal tumors. In this study, we aimed to explore whether indocyanine green near-infrared fluorescence imaging can assist in the biopsy of bone and soft tissue tumors and improve the success rate of biopsy. (2) Method: We recruited patients with clinically considered bone and soft tissue tumors and planned biopsies. In the test group, indocyanine green (0.3 mg/kg) was injected. After identifying the lesion, a near-infrared fluorescence camera system was used to verify the ex vivo specimens of the biopsy in real time. If the biopsy specimens were not developed, we assumed that we failed to acquire lesions, so the needle track and needle position were adjusted for the supplementary biopsy, and then real-time imaging was performed again. Finally, we conducted a pathological examination. In the control group, normal biopsy was performed. (3) Results: The total diagnosis rate of musculoskeletal tumors in the test group was 94.92% (56/59) and that in the control group was 82.36% (42/51). In the test group, 14 cases were not developed, as seen from real-time fluorescence in the core biopsy, and then underwent the supplementary biopsy after changing the puncture direction and the location of the needle channel immediately, of which 7 cases showed new fluorescence. (4) Conclusions: Using the near-infrared fluorescence real-time development technique to assist the biopsy of musculoskeletal tumors may improve the accuracy of core biopsy and help to avoid missed diagnoses, especially for some selected tumors.
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Affiliation(s)
- Siyuan He
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Ang Zhong
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jun Lei
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Zhouming Deng
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Xiaobin Zhu
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Renxiong Wei
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Huayi Huang
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Zhenyi Chen
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Lin Cai
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yuanlong Xie
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
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Li S, Que Y, Yang R, He P, Xu S, Hu Y. Construction of Osteosarcoma Diagnosis Model by Random Forest and Artificial Neural Network. J Pers Med 2023; 13:jpm13030447. [PMID: 36983630 PMCID: PMC10056981 DOI: 10.3390/jpm13030447] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/19/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023] Open
Abstract
Osteosarcoma accounts for 28% of primary bone malignancies in adults and up to 56% in children and adolescents (<20 years). However, early diagnosis and treatment are still inadequate, and new improvements are still needed. Missed diagnoses exist due to fewer traditional diagnostic methods, and clinical symptoms are often already present before diagnosis. This study aimed to develop novel and efficient predictive models for the diagnosis of osteosarcoma and to identify potential targets for exploring osteosarcoma markers. First, osteosarcoma and normal tissue expression microarray datasets were downloaded from the Gene Expression Omnibus (GEO). Then we screened the differentially expressed genes (DEGs) in the osteosarcoma and normal groups in the training group. Next, in order to explore the biologically relevant role of DEGs, Metascape and enrichment analyses were also performed on DEGs. The “randomForest” and “neuralnet” packages in R software were used to select representative genes and construct diagnostic models for osteosarcoma. The next step is to validate the model of the artificial neural network. Then, we performed an immune infiltration analysis by using the training set data. Finally, we constructed a prognostic model using representative genes for prognostic analysis. The copy number of osteosarcoma was also analyzed. A random forest classifier identified nine representative genes (ANK1, TGFBR3, RSF21, HSPB8, ITGA7, RHD, AASS, GREM2, NFASC). HSPB8, RHD, AASS, and NFASC were genes we identified that have not been previously reported to be associated with osteosarcoma. The osteosarcoma diagnostic model we constructed has good performance with areas under the curves (AUCs) of 1 and 0.987 in the training and validation groups, respectively. This study opens new horizons for the early diagnosis of osteosarcoma and provides representative markers for the future treatment of osteosarcoma. This is the first study to pioneer the establishment of a genetic diagnosis model for osteosarcoma and advance the development of osteosarcoma diagnosis and treatment.
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Bianchi G, Laranga R, Spinnato P, Ostetto F, Bubbico E, Righi A, Donati DM. Sensitivity, Specificity, and Predictive Values of Tru-Cut ® Biopsy in Grading Primary Localized Myxoid Liposarcomas of the Extremities. Cancers (Basel) 2023; 15:cancers15051391. [PMID: 36900184 PMCID: PMC10000105 DOI: 10.3390/cancers15051391] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
(1) Background: Histological diagnosis and tumor grading are major prognostic and predictive factors in soft tissue sarcomas (STS), as they dictate the treatment strategies with a direct impact on patient survival. This study aims to investigate the grading accuracy, sensitivity, and specificity of Tru-Cut® biopsy (TCB) in primary localized myxoid liposarcomas (MLs) of the extremities and its impact on patient prognosis. (2) Methods: Patients with ML undergoing TCB and a subsequent tumor resection between 2007 and 2021 were evaluated. Concordance between the preoperative assessment and definitive histology was calculated with a weighted Cohen's kappa coefficient. Sensitivity, specificity, and diagnostic accuracy were calculated. (3) Results: Of 144 biopsies, the histological grade concordance rate was 63% (Kappa 0.2819). Neoadjuvant chemotherapy and/or radiotherapy impacted concordance with a downgrading effect in high-grade tumors. Among forty patients not treated in neoadjuvant settings, the sensitivity of TCB was 57%, the specificity was 100%, and the overall predictive values of positive and negative TCB were 100% and 50%, respectively. Misdiagnosis did not impact overall survival. (4) Conclusions: TCB may underestimate ML grading due to tumor heterogeneity. Neoadjuvant ChT and/or radiotherapy are associated with pathological downgrading; however, discordance in diagnosis does not modify patient prognosis because systemic treatment decision-making also includes other variables.
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Affiliation(s)
- Giuseppe Bianchi
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Roberta Laranga
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
- Correspondence:
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Federico Ostetto
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Elisa Bubbico
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Alberto Righi
- Anatomy and Pathological Histology, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Davide Maria Donati
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy
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Masada KM, Blumenthal SR, Cipriano CA. Fixation Principles for Pathologic Fractures in Metasatic Disease. Orthop Clin North Am 2023; 54:47-57. [PMID: 36402510 DOI: 10.1016/j.ocl.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The management of pathologic fractures differs from nonpathologic fractures with respect to preoperative evaluation, surgical strategies, adjuvant therapies, and complication rates. These issues must be understood to provide appropriate musculoskeletal care for patients with metastatic disease.
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Affiliation(s)
- Kendall M Masada
- Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market Street, 6th Floor, Philadelphia, PA 19104, USA.
| | - Sarah R Blumenthal
- Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market Street, 6th Floor, Philadelphia, PA 19104, USA
| | - Cara A Cipriano
- Hospital of the University of Pennsylvania, 3737 Market Street, 6th Floor, Philadelphia, PA 19104, USA
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Fang M, Wang B, Zheng B, Yan W. The preoperative value of fine-needle aspiration in adult soft tissue lesions: An analysis of 514 cases at Shanghai Cancer Center. Cancer Med 2022; 12:2722-2730. [PMID: 35984371 PMCID: PMC9939172 DOI: 10.1002/cam4.5156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Fine-needle aspiration (FNA) cytology is a rapid, inexpensive, and uncomplicated method. However, its role in the assessment of soft tissue lesions (STL) remains controversial, and its ability to guide surgical treatment remains unclear. This study investigated the positive predictive value (PPV) of FNA for detecting malignancy and its guiding role in the surgical treatment of STL. METHODS We retrospectively reviewed 514 patients with STL who underwent preoperative FNA and surgical resection between March 2015 and August 2021. Imaging assessments confirmed that radical surgery was possible. The FNA results were compared with the final postoperative histopathology. RESULTS Of the 514 patients with STL, 496 (mean age, 48.9 years; range, 21-91 years) were eligible for analysis, the male to female ratio was 111:100. According to the 496 FNA results, 90 (18.2%) were positive for malignancy, 84 (16.9%) were suspicious for malignancy, 80 (16.1%) were spindle cell present, and 242 (48.8%) were negative for malignant cells. Compared with postoperative histopathology, FNA correctly detected all 90 malignant lesions and 203 of the 242 benign lesions. A total of 39 false-negative results were obtained. FNA showed an accuracy of 88.3%, sensitivity of 69.8%, specificity of 100%, negative predictive value (NPV) of 83.9%, and PPV of 100%. In the other seven validation cohorts (n = 1157), FNA had a consistently high PPV, with values all more than 93%. CONCLUSION Our results demonstrate that FNA has a high PPV for detecting malignancy. For patients with resectable lesions and malignant FNA, the core needle biopsy (CNB) step can be omitted with multidisciplinary evaluation, and subsequent radical surgery can be performed.
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Affiliation(s)
- Meng Fang
- Department of Musculoskeletal OncologyFudan University Shanghai Cancer CenterShanghaiChina,Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
| | - Bingnan Wang
- Department of Musculoskeletal OncologyFudan University Shanghai Cancer CenterShanghaiChina,Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
| | - Biqiang Zheng
- Department of Musculoskeletal OncologyFudan University Shanghai Cancer CenterShanghaiChina,Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
| | - Wangjun Yan
- Department of Musculoskeletal OncologyFudan University Shanghai Cancer CenterShanghaiChina,Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
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Goulding KA, Wilke BK, Kiernan HC, Houdek MT, Sherman CE. Skeletal Sarcomas: Diagnosis, Treatment, and Follow-up from the Orthopedic Oncologist Perspective. Radiol Clin North Am 2022; 60:193-203. [DOI: 10.1016/j.rcl.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Thaler M, Khosravi I. Therapy management in bone sarcoma. MEMO-MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2020. [DOI: 10.1007/s12254-020-00595-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
SummaryBone sarcomas are rare, representing only 0.2% of all diagnosed cancers. Incidence is higher in children and adolescents, but bone sarcomas are still numerically outnumbered by benign bone tumors in this patient cohort. This article summarizes the management of treatment for bone sarcomas. Systemic therapy, surgical therapy, and radiotherapy are presented. Osteosarcoma, chondrosarcoma, and Ewing sarcoma are among the most frequently occurring bone sarcomas in all age groups. In recent decades, multimodal treatment of these rare entities has increased disease-free survival for these patients. As malignant primary bone tumors are rare cancers, and since management is complex, the standard of treatment should be performed by reference centers. If possible, wide en-bloc resection of the bone sarcoma should be performed. The role of radiotherapy in osteosarcoma and chondrosarcoma is limited, but Ewing sarcoma is a radiation-responsive tumor. In primary bone sarcomas, the efficacy of chemotherapy varies according to histological type. Prognosis is poor in patients with osteosarcoma or Ewing’s sarcoma if surgery without neoaqdjuvant chemotherapy is performed. Despite advances in surgical, medical, and radiation therapy, few significant positive changes in overall survival have been observed in patients with these diseases in recent decades.
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Seeger LL. Revisiting tract seeding and compartmental anatomy for percutaneous image-guided musculoskeletal biopsies. Skeletal Radiol 2019; 48:499-501. [PMID: 30613932 DOI: 10.1007/s00256-018-3127-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/25/2018] [Accepted: 12/03/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Leanne L Seeger
- David Geffen School of Medicine, University of California Los Angeles, 200 UCLA Medical Plaza Suite 165-57, Los Angeles, CA, 90095, USA.
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Boffano M, Piana R. Letter to the Editor Regarding "Intraneural Ewing Sarcoma of Fibular Nerve: Case Report, Radiologic Findings and Review of Literature". World Neurosurg X 2019; 2:100017. [PMID: 31218291 PMCID: PMC6580878 DOI: 10.1016/j.wnsx.2019.100017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Michele Boffano
- Oncologic and Orthopaedic Surgery - AOU Città della Salute e della Scienza Torino, Turin, Italy; and Regional Reference Centre for Bone and Soft Tissue Sarcomas, Turin, Piedmont, Italy
| | - Raimondo Piana
- Oncologic and Orthopaedic Surgery - AOU Città della Salute e della Scienza Torino, Turin, Italy; and Regional Reference Centre for Bone and Soft Tissue Sarcomas, Turin, Piedmont, Italy
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Baldi J, Attala D, Scotto di Uccio A, Laquintana V, Biagini R, Zoccali C. The effectiveness of a standard drill connected to a core biopsy needle: How to obtain specimens in very strong bone tumors. Injury 2018; 49:1612-1616. [PMID: 29903579 DOI: 10.1016/j.injury.2018.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Core biopsy is today recognized as the gold standard for the diagnosis of bone lesions; unfortunately, when the bone is too solid it can be very difficult to penetrate it; in case of failure, open biopsy is indicated but it is associated with greater contamination and complications. A possible solution is to connect a common orthopedic drill to the core biopsy needle. The aim of the presenting study was to present a technique useful for performing biopsies in case of very strong bone lesions and to evaluate the adequacy and quality of the obtained specimen. MATERIALS AND METHODS A standard bone biopsy set was connected to a commercial drill to perform bone biopsies. Data was collected over a 2-year period (2015-2016). Information regarding technical success, diagnostic data and complication rates was all collated to assess the technical feasibility of this technique. RESULTS Out of 357 bone biopsies, 34 patients underwent the procedure using a common orthopedic drill connected to a core biopsy needle. Diagnostic material was obtained in each patient and the artifacts were considered irrelevant. No major complications occurred in any patient. DISCUSSION The use of a core biopsy needle connected to a common orthopedic drill facilitates the penetration of thick cortical bone by simply applying continuous speed and pressure; nevertheless, the biopsy needle we use is not designed for a drilling procedure and for this reason it can be damaged, but if the biopsy is performed with particular attention, the mechanical failure can be avoided CONCLUSIONS: Bone biopsy using a commercial hand drill has a technically high success rate with minimal complications. Further studies with more cases are necessary to verify our results.
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Affiliation(s)
- J Baldi
- Oncological Orthopaedics Department, Regina Elena National Cancer Institute, Via Elio Chianesi no 53, 00144 Rome, Italy.
| | - D Attala
- Sant'Anna Hospital, Orthopedics and Traumatology, Pomezia, Italy
| | - A Scotto di Uccio
- School of Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - V Laquintana
- Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi no 53, 00144 Rome, Italy
| | - R Biagini
- Oncological Orthopaedics Department, Regina Elena National Cancer Institute, Via Elio Chianesi no 53, 00144 Rome, Italy
| | - C Zoccali
- Oncological Orthopaedics Department, Regina Elena National Cancer Institute, Via Elio Chianesi no 53, 00144 Rome, Italy
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Ní Mhuircheartaigh J, McMahon C, Lin YC, Wu J. Diagnostic yield of percutaneous biopsy for sclerotic bone lesions: Influence of mean Hounsfield units. Clin Imaging 2017; 46:53-56. [DOI: 10.1016/j.clinimag.2017.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 06/15/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
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14
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Tong Z, Zhang M, Chen B, Zhu Y, Wei J, Li X. Use of percutaneous core needle biopsy for diagnosing acral bone tumors. J Bone Oncol 2017. [DOI: 10.1016/j.jbo.2016.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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Mathieson A, Wallace R, Cleary R, Simpson H, Lucas M. Ultrasonic Needles for Bone Biopsy. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2017; 64:433-440. [PMID: 28114012 DOI: 10.1109/tuffc.2016.2633286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Bone biopsy is an invasive clinical procedure, where a bone sample is recovered for analysis during the diagnosis of a medical condition. When the architecture of the bone tissue is required to be preserved, a core-needle biopsy is taken. Although this procedure is performed while the patient is under local anaesthesia, the patient can still experience significant discomfort. Additionally, large haematoma can be induced in the soft tissue surrounding the biopsy site due to the large axial and rotational forces, which are applied through the needle to penetrate bone. It is well documented that power ultrasonic surgical devices offer the advantages of low cutting force, high accuracy, and preservation of soft tissues. This paper reports a study of the design, analysis, and test of two novel power ultrasonic needles for bone biopsy that operate using different configurations to penetrate bone. The first utilizes micrometric vibrations generated at the distil tip of a full-wavelength resonant ultrasonic device, while the second utilizes an ultrasonic-sonic approach, where vibrational energy generated by a resonant ultrasonic horn is transferred to a needle via the chaotic motion of a free-mass. It is shown that the dynamic behavior of the devices identified through experimental techniques closely match the behavior calculated through numerical and finite-element analysis methods, demonstrating that they are effective design tools for these devices. Both devices were able to recover trabecular bone from the metaphysis of an ovine femur, and the biopsy samples were found to be comparable to a sample extracted using a conventional biopsy needle. Furthermore, the resonant needle device was also able to extract a cortical bone sample from the central diaphysis, which is the strongest part of the bone, and the biopsy was found to be superior to the sample recovered by a conventional bone biopsy needle.
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Abstract
OBJECTIVES To determine the utility and necessity of submitting tissue sections from the biopsy tracts of osteosarcoma resection specimens. METHODS The prevalence of residual tumor in representative sections of osteosarcoma biopsy tracts was assessed in a series of 97 osteosarcoma resection specimens. RESULTS No residual tumor cells were identified in 97 sampled biopsy tracts (0%; 95% confidence interval, 0%-2.5%). CONCLUSIONS Pathologists do not need to submit sections of resected biopsy tracts unless there is clinical or gross evidence that would warrant further examination.
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Affiliation(s)
- Justin M M Cates
- From the Department of Pathology, Vanderbilt University Medical Center, Nashville, TN.
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17
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Qi D, Hu T, Zhang G. Evaluation of the use of fluoroscopy guided needle biopsies for diagnosing cases of suspected pathological fractures. Asia Pac J Clin Oncol 2016; 12:235-41. [PMID: 26996135 DOI: 10.1111/ajco.12488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 10/31/2015] [Accepted: 01/16/2016] [Indexed: 01/01/2023]
Abstract
AIM Establishing an early and accurate diagnosis in cases of suspected pathological fractures is crucial to initiate optimal treatment without delay. The use of percutaneous biopsy has become popular over the past few years. However, there is a paucity of information regarding the efficacy and safety of percutaneous biopsy procedures guided by fluoroscopy. METHODS A total of 137 percutaneous C-arm fluoroscopy-guided core needle biopsy (CNB) procedures were performed in 135 patients with suspected pathological fractures. The sensitivity, specificity, accuracy, and overall prognostic value of these procedures were evaluated. Complications, if any, were documented for all cases. RESULTS The overall sensitivity, specificity, and accuracy were 82.0%, 100%, and 83.2%, respectively. The positive and negative predictive value was 100% and 28.1%, respectively. There were 23 "false negative" cases in our study, of which 15 were benign lesions and eight were malignant tumors. No "false-positives" were found. Major procedure-related complications occurred in three patients (2.2%). These complications, however, did not alter the prognosis of these patients. CONCLUSION Percutaneous C-arm fluoroscopy-guided biopsy procedures are both effective and safe for diagnosis of suspected pathological fractures in the appendicular skeleton.
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Affiliation(s)
- Dianwen Qi
- Department of Musculoskeletal Tumor, Third Hospital of Hebei Medical University, Hebei, China
| | - Tongyu Hu
- Department of Musculoskeletal Tumor, Third Hospital of Hebei Medical University, Hebei, China
| | - Guochuan Zhang
- Department of Musculoskeletal Tumor, Third Hospital of Hebei Medical University, Hebei, China
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Trieu J, Schlicht SM, Choong PFM. Diagnosing musculoskeletal tumours: How accurate is CT-guided core needle biopsy? Eur J Surg Oncol 2016; 42:1049-56. [PMID: 27178775 DOI: 10.1016/j.ejso.2016.02.242] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 02/03/2016] [Accepted: 02/12/2016] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Biopsy is a critical juncture in the diagnostic process for evaluating musculoskeletal tumours. The traditional diagnostic standard of open biopsy yields highly accurate diagnoses but associated with it is a significant rate of procedural complications. Imaging-guided needle biopsy is now being widely adopted as a competitive and minimally-invasive alternative with significantly lower complication rates. We assess its diagnostic outcomes at a tertiary referral centre in Melbourne, Australia. METHOD Data pertaining to biopsy and surgical histology were retrieved from the musculoskeletal tumour database at St Vincent's Hospital, Fitzroy following approval from the Human Research Ethics Committee (HREC 091/13). Data analyses were performed in STATA 12 to assess diagnostic parameters and related outcomes. RESULTS Bone tumours (n = 380) yielded accuracy of 80.8% with diagnostic error of 7.1% and undiagnostic rates of 12.1%. Soft-tissue tumours (n = 751) yielded accuracy of 83.2% with diagnostic error of 10.5% and undiagnostic rates of 6.3%. Biopsy of benign tumours (n = 648, accuracy = 85.3%, error = 5.9%, undiagnostic 8.8%) was more accurate than malignant tumours (n = 501, accuracy = 75.8%, error 14.0%, undiagnostic 7.4%). The overall procedural complication rate was 0.7%. DISCUSSION CT-guided core needle biopsy is a safe, accurate, and highly effective procedure that obviates the need for open and surgical biopsy in a significant number of cases. When combined with fusion imaging, CT guidance is an accurate method of targeting specific regions of interest.
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Affiliation(s)
- J Trieu
- St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Australia
| | - S M Schlicht
- Department of Radiology, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Australia
| | - P F M Choong
- Department of Orthopaedics, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Australia; Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne, Australia; University of Melbourne, Department of Surgery, St Vincent's Hospital, 29 Regent Street, Fitzroy, Australia.
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Identifying impending pathologic fractures and treatment considerations in patients with metastatic bone disease. CURRENT ORTHOPAEDIC PRACTICE 2015. [DOI: 10.1097/bco.0000000000000273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Traina F, Errani C, Toscano A, Pungetti C, Fabbri D, Mazzotti A, Donati D, Faldini C. Current concepts in the biopsy of musculoskeletal tumors: AAOS exhibit selection. J Bone Joint Surg Am 2015; 97:e7. [PMID: 25609446 DOI: 10.2106/jbjs.n.00661] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A musculoskeletal tumor biopsy can involve fine needle aspiration, core needle biopsy, or incisional biopsy. Controversy regarding the diagnostic yield of these biopsy techniques continues. The purpose of this article is to summarize the current concepts in the biopsy of musculoskeletal tumors. METHODS We performed a literature review of clinical articles reporting on the biopsy of bone and soft-tissue primary tumors. Clinical articles were excluded on the basis on abstract content if they represented case reports, review or opinion articles, or technique descriptions. Eighteen of the thirty-nine articles that remained were excluded because the results did not indicate the diagnostic accuracy of the various biopsy techniques. Thus, twenty-one articles with diagnostic data on the biopsy of bone and soft-tissue tumors were included in this review. RESULTS Core needle biopsy appeared to be more accurate than fine needle aspiration, and incisional biopsy appeared to be more accurate than both of these techniques, but the differences did not reach significance. Incisional biopsy was more expensive than the percutaneous biopsy methods. In deep musculoskeletal tumors, incorporation of ultrasonography or computed tomography for guidance is easy and safe and can be useful for increasing the accuracy of the biopsy. Advantages of a percutaneous technique compared with an incisional one are the low risk of contamination and the minimally invasive nature. Certain anatomic locations and histologic types were associated with diagnostic difficulty. Vertebral tumors had the lowest diagnostic accuracy regardless of the biopsy technique. Myxoid, infection, and round cell histologies were associated with the lowest diagnostic accuracy. CONCLUSIONS The current literature has not clarified the optimal biopsy technique for the diagnosis of bone and soft-tissue tumors. However, core needle biopsy is usually preferable to incisional biopsy because of the low risk of contamination and the low cost. In addition, the use of imaging guidance increases the diagnostic accuracy of musculoskeletal biopsies and reduces the risk of complications. If the result of a percutaneous biopsy is nondiagnostic, a small incisional biopsy should be performed. LEVEL OF EVIDENCE Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Francesco Traina
- Orthopaedic Service, Istituti Ortopedici Rizzoli, Via Pupilli 1, Bologna 40136, Italy. E-mail address for F. Traina: . E-mail address for C. Errani: . E-mail address for A. Toscano: . E-mail address for C. Pungetti: . E-mail address for D. Fabbri: . E-mail address for A. Mazzotti: . E-mail address for D. Donati: . E-mail address for C. Faldini:
| | - Costantino Errani
- Orthopaedic Service, Istituti Ortopedici Rizzoli, Via Pupilli 1, Bologna 40136, Italy. E-mail address for F. Traina: . E-mail address for C. Errani: . E-mail address for A. Toscano: . E-mail address for C. Pungetti: . E-mail address for D. Fabbri: . E-mail address for A. Mazzotti: . E-mail address for D. Donati: . E-mail address for C. Faldini:
| | - Angelo Toscano
- Orthopaedic Service, Istituti Ortopedici Rizzoli, Via Pupilli 1, Bologna 40136, Italy. E-mail address for F. Traina: . E-mail address for C. Errani: . E-mail address for A. Toscano: . E-mail address for C. Pungetti: . E-mail address for D. Fabbri: . E-mail address for A. Mazzotti: . E-mail address for D. Donati: . E-mail address for C. Faldini:
| | - Camilla Pungetti
- Orthopaedic Service, Istituti Ortopedici Rizzoli, Via Pupilli 1, Bologna 40136, Italy. E-mail address for F. Traina: . E-mail address for C. Errani: . E-mail address for A. Toscano: . E-mail address for C. Pungetti: . E-mail address for D. Fabbri: . E-mail address for A. Mazzotti: . E-mail address for D. Donati: . E-mail address for C. Faldini:
| | - Daniele Fabbri
- Orthopaedic Service, Istituti Ortopedici Rizzoli, Via Pupilli 1, Bologna 40136, Italy. E-mail address for F. Traina: . E-mail address for C. Errani: . E-mail address for A. Toscano: . E-mail address for C. Pungetti: . E-mail address for D. Fabbri: . E-mail address for A. Mazzotti: . E-mail address for D. Donati: . E-mail address for C. Faldini:
| | - Antonio Mazzotti
- Orthopaedic Service, Istituti Ortopedici Rizzoli, Via Pupilli 1, Bologna 40136, Italy. E-mail address for F. Traina: . E-mail address for C. Errani: . E-mail address for A. Toscano: . E-mail address for C. Pungetti: . E-mail address for D. Fabbri: . E-mail address for A. Mazzotti: . E-mail address for D. Donati: . E-mail address for C. Faldini:
| | - Davide Donati
- Orthopaedic Service, Istituti Ortopedici Rizzoli, Via Pupilli 1, Bologna 40136, Italy. E-mail address for F. Traina: . E-mail address for C. Errani: . E-mail address for A. Toscano: . E-mail address for C. Pungetti: . E-mail address for D. Fabbri: . E-mail address for A. Mazzotti: . E-mail address for D. Donati: . E-mail address for C. Faldini:
| | - Cesare Faldini
- Orthopaedic Service, Istituti Ortopedici Rizzoli, Via Pupilli 1, Bologna 40136, Italy. E-mail address for F. Traina: . E-mail address for C. Errani: . E-mail address for A. Toscano: . E-mail address for C. Pungetti: . E-mail address for D. Fabbri: . E-mail address for A. Mazzotti: . E-mail address for D. Donati: . E-mail address for C. Faldini:
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Osteosarcoma metastasis: prospective role of ezrin. Tumour Biol 2014; 35:5055-9. [DOI: 10.1007/s13277-014-1799-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 02/25/2014] [Indexed: 12/13/2022] Open
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Initial CT-guided needle biopsy of extremity skeletal lesions: Diagnostic performance and experience of a tertiary musculoskeletal center. Eur J Radiol 2014; 83:360-5. [DOI: 10.1016/j.ejrad.2013.10.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 09/16/2013] [Accepted: 10/12/2013] [Indexed: 11/18/2022]
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Pohlig F, Lenze U, Lenze FW, Mühlhofer H, Schauwecker J, Rechl H, von Eisenhart-Rothe R. [Biopsies from bone and soft tissue sarcoma : a nationwide survey in Germany]. DER ORTHOPADE 2013; 42:934-40. [PMID: 24145965 DOI: 10.1007/s00132-013-2175-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM OF THE STUDY A biopsy is an essential step in the diagnostic cascade of malignant bone and soft tissue tumors. The objective is always the extraction of a representative tissue specimen in line with the approach for the definitive operation. The aim of this study therefore was to assess the diagnostic approaches regarding the biopsy of tumors in orthopedic centers in Germany. MATERIAL AND METHODS In total 60 hospitals with an orthopedic focus on tumors were contacted and provided with a newly developed questionnaire with 13 items regarding biopsy technique, indication criteria, execution, supportive imaging and histopathological results. Evaluation of the responses was performed by means of binary systems and proportional consent to every answer possibility was calculated. RESULTS The results of the questionnaire showed that open biopsies are performed in all centers and in 72 % of the hospitals percutaneous techniques are additionally applied. The most important criterion for an open or percutaneous procedure was the tumor location (80 %). The indications for either technique are assessed by a tumor orthopedic consultant in 68 % of the centers and special imaging is applied in 36 % of the institutions. The approach for the biopsy is defined by the orthopedic surgeon in 88 %. Percutanous biopsies are carried out by interventional radiologists in 60 % of the centers. Open biopsies are performed by residents under supervision by a tumor orthopedic consultant in 88 %. The histopathological results are discussed in 88 % of the hospitals in an interdisciplinary tumor board and in 64 % patients are informed about the diagnosis in an outpatient clinic. CONCLUSIONS Overall, biopsy of musculoskeletal tumors is performed according to the guidelines in most institutions. Only small differences were identified regarding the definition of the surgical approach and the application of imaging techniques during biopsy.
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Affiliation(s)
- F Pohlig
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland,
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CT Guided Bone Biopsy Using a Battery Powered Intraosseous Device. Cardiovasc Intervent Radiol 2013; 36:1405-10. [DOI: 10.1007/s00270-013-0617-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 02/15/2013] [Indexed: 11/26/2022]
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Huang AJ, Halpern EF, Rosenthal DI. Incidence of delayed complications following percutaneous CT-guided biopsy of bone and soft tissue lesions of the spine and extremities: a 2-year prospective study and analysis of risk factors. Skeletal Radiol 2013; 42:61-8. [PMID: 22729377 DOI: 10.1007/s00256-012-1433-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 04/20/2012] [Accepted: 04/24/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To prospectively evaluate the incidence of delayed complications (bleeding, pain, infection) following CT-guided biopsies of bone or soft tissue lesions and to identify risk factors that predispose to their occurrence. MATERIALS AND METHODS All adults presenting for CT-guided biopsy of a bone or soft tissue lesion were eligible for the study. Risk factors considered included patient gender and age, bone versus soft tissue, lesion location, lesion depth, anticoagulation, conscious sedation, coaxial biopsy technique, bleeding during the biopsy, dressing type and duration of placement, final diagnosis, needle gauge, number of passes, and number of days to follow-up. Outcomes measured included fever, pain, bruising/hematoma formation, and swelling and were collected by a follow-up phone call within 14 days of the biopsy. Fisher's exact test, the Wald Chi-square test, and univariate, multivariate, and stepwise logistic regression were performed to evaluate the influence of the risk factors on the outcomes. RESULTS A total of 386 patients participated in the study. The rates of post-biopsy fever, pain, bruising, and swelling were 1.0, 16.1, 15.6, and 9.6%, respectively. Anticoagulants were identified as a risk factor for fever. Increasing patient age was identified as a risk factor for pain. Female gender and lesion location were identified as risk factors for bruising. Increasing patient age and lesion location were identified as risk factors for swelling. CONCLUSIONS Patient age, female gender, and lesion location are risk factors for delayed minor complications following CT-guided biopsy of a bone or soft tissue lesion. There were no major complications. None of the complications in this series altered patient management.
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Affiliation(s)
- Ambrose J Huang
- Massachusetts General Hospital, 55 Fruit Street, Yawkey 6E, Boston, MA 02114, USA.
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Percutaneous core needle biopsy versus open biopsy in diagnostics of bone and soft tissue sarcoma: a retrospective study. Eur J Med Res 2012; 17:29. [PMID: 23114293 PMCID: PMC3507842 DOI: 10.1186/2047-783x-17-29] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 10/09/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Biopsy is a crucial step within the diagnostic cascade in patients with suspected bone or soft tissue sarcoma. Open biopsy is still considered the gold standard. However, recent literature suggests similar results for percutaneous biopsy techniques. Therefore, the aim of this retrospective analysis was to compare open and percutaneous core needle biopsy (CNB) regarding their accuracy in diagnosis of malignant musculoskeletal lesions. METHODS From January 2007 to December 2009, all patients with suspected malignant primary bone or soft tissue tumour undergoing a percutaneous CNB or open biopsy and a subsequent tumour resection at our department were identified and enrolled. Sensitivities, specificities, positive predictive values (PPV), negative predictive values (NPV) and diagnostic accuracy were calculated for both biopsy techniques and compared using Fisher's exact test. RESULTS A total of 77 patients were identified and enrolled in this study. Sensitivity, specificity, PPV, NPV and diagnostic accuracy were 100% for CNB in bone tumours. Sensitivity (95.5%), NPV (91.7%) and diagnostic accuracy (93.3%) for open biopsy in bone tumours showed slightly inferior results without statistical significance (p > 0.05). In soft tissue tumours favourable results were obtained in open biopsies compared to CNB with differences regarding sensitivity (100% vs. 81.8%, p = 0.5), NPV (100% vs. 50%, p = 0.09) and diagnostic accuracy (100% vs. 84.6%, p = 0,19) without statistical significance. The overall diagnostic accuracy was 92.9% for CNB and 98.0% for open biopsy (p = 0.55). A specific diagnosis could be obtained in 84.2% and 93.9%, respectively (p = 0.34). CONCLUSION In our study we found moderately inferior results for the percutaneous biopsy technique compared to open biopsy in soft tissue tumours whereas almost equal results were obtained for both biopsy techniques for bone tumours. Thus, CNB is a safe, minimal invasive and cost-effective technique for diagnosing bony lesions. In soft tissue masses, the indication for percutaneous core needle biopsy needs to be made carefully by an experienced orthopaedic oncologist with respect to the suspected entity, size of necrosis and location of the lesion to avoid incorrect or deficient results.
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A Population-Based Study of the Quality of Care in the Diagnosis of Large (≥5 cm) Soft Tissue Sarcomas. Am J Clin Oncol 2012; 35:455-61. [DOI: 10.1097/coc.0b013e3182185873] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Der proximale und komplette Femurersatz. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2012; 24:215-26. [DOI: 10.1007/s00064-011-0061-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rechl H, Kirchhoff C, Wörtler K, Lenze U, Töpfer A, von Eisenhart-Rothe R. [Diagnosis of malignant bone and soft tissue tumors]. DER ORTHOPADE 2012; 40:931-41; quiz 942-3. [PMID: 21874363 DOI: 10.1007/s00132-011-1821-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Primary sarcoma of bone is a rare entity but nevertheless a significant cause of mortality in children and adolescents. The focus of the preoperative evaluation is to set up a histological diagnosis, define local tumor extent and develop a therapy regimen. In addition to patient history and clinical findings a radiograph in two orthogonal planes is still of great importance. MRI plays a major role in the further clarification of the diagnosis, while CT is valuable in the diagnosis of tumors of the axial skeleton as well as in systemic staging. A PET-CT can be performed to obtain an overview of further tumor sites. Open bone biopsy is the final diagnostic step and should be carried out at the institution where the definitive treatment will be performed. Complications such as fracture, neural lesions and spread of tumor cells are relatively rare if the biopsy is performed appropriately; however, patients should be instructed to strictly avoid weight-bearing on the affected extremity.
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Affiliation(s)
- H Rechl
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.
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Hryhorczuk AL, Strouse PJ, Biermann JS. Accuracy of CT-guided percutaneous core needle biopsy for assessment of pediatric musculoskeletal lesions. Pediatr Radiol 2011; 41:848-57. [PMID: 21243347 DOI: 10.1007/s00247-010-1970-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 11/27/2010] [Accepted: 12/17/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND CT-guided percutaneous core needle biopsy has been shown in adults to be an effective diagnostic tool for a large number of musculoskeletal malignancies. OBJECTIVE To characterize our experience with CT-guided percutaneous core needle biopsy of pediatric bone lesions and determine its utility in diagnosing pediatric osseous lesions, in a population where such lesions are commonly benign. MATERIALS AND METHODS From 2000 to 2009, 61 children underwent 63 CT-guided percutaneous biopsies. Radiological, pathological and clinical records were reviewed. RESULTS Fourteen biopsies (22%) were performed on malignant lesions, while 49 biopsies (78%) were performed on benign lesions. Forty-nine of the 63 biopsies (78%) were adequate; these children underwent no further tissue sampling. Fourteen of the 63 biopsies (22%) were inadequate or non-conclusive. Of these patients, 12 underwent open biopsy. Retrospective analysis of percutaneous biopsies in these patients demonstrates that 9/12 provided clinically relevant information, and 4/12 patients received final diagnoses that confirmed initial core biopsy findings. No malignancies were diagnosed as benign on percutaneous biopsy. Overall, percutaneous core needle biopsy provided accurate diagnostic information in 84% (53/63) of biopsies. CONCLUSION Our results demonstrate that CT-guided percutaneous biopsy is safe and beneficial in children. This study supports the use of CT-guided percutaneous core needle biopsy for primary diagnosis of pediatric bone lesions.
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Affiliation(s)
- Anastasia L Hryhorczuk
- Department of Radiology, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
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Cribb GL, Steadman PB. Biopsy of bone tumours using a suction trap. J Surg Oncol 2009; 100:423-4. [PMID: 19455571 DOI: 10.1002/jso.21309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- G L Cribb
- The Wesley Hospital, Brisbane, Australia.
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Maurer-Ertl W, Leithner A, Tauber S, Fröhlich EV, Kuerzl G, Glehr M, Zacherl M, Liegl B, Windhager R. Changes in histological diagnosis in soft tissue tumours from biopsy to final surgery specimen: causes and consequences. Eur Surg 2009. [DOI: 10.1007/s10353-009-0475-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ashford RU, Scolyer RA, McCarthy SW, Bonar SF, Karim RZ, Stalley PD. The role of intra-operative pathological evaluation in the management of musculoskeletal tumours. Recent Results Cancer Res 2009; 179:11-24. [PMID: 19230531 DOI: 10.1007/978-3-540-77960-5_2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A tissue biopsy is usually a critical aspect in guiding appropriate initial management in patients with musculoskeletal tumours. We have previously outlined the role of intra-operative frozen section in both the determination of adequacy of a biopsy and for its diagnostic utility. In this article, the options and techniques for intra-operative pathological evaluation, namely frozen section, fine needle aspiration cytology and touch imprint cytology are reviewed. Frozen section examination may be applicable in the following Sections, including (1) at core biopsy, (2) at surgical margins, (3) at confirming diagnosis prior to definitive treatment or to evaluate tumour spread, and (4) at establishing a diagnosis of a metastasis prior to intramedullary nailing. There are also situations in which frozen section is inappropriate. Pitfalls associated with frozen sections are also highlighted. There are also cost implications, which we have quantified, of performing frozen sections. In our experience that the use of intra-operative pathological evaluation reduces the non-diagnostic rate of bone and soft tissue sarcoma biopsies, eliminates the need for re-biopsy hence alleviating stress, and is a useful addition to the armamentarium in evaluating musculoskeletal tumours.
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Affiliation(s)
- Robert U Ashford
- East Midlands Sarcoma Service, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK.
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Lehnhardt M, Daigeler A, Homann H, Hauser J, Langer S, Steinsträßer L, Soimaru C, Puls A, Steinau H. Die Bedeutung von Referenzzentren in Diagnose und Therapie von Weichgewebssarkomen der Extremitäten. Chirurg 2008; 80:341-7. [DOI: 10.1007/s00104-008-1562-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Christopher Windham T, Sondak VK. Soft Tissue Sarcoma. Oncology 2007. [DOI: 10.1007/0-387-31056-8_58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Liu PT, Valadez SD, Chivers FS, Roberts CC, Beauchamp CP. Anatomically Based Guidelines for Core Needle Biopsy of Bone Tumors: Implications for Limb-sparing Surgery. Radiographics 2007; 27:189-205; discussion 206. [PMID: 17235007 DOI: 10.1148/rg.271065092] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Diagnostic image-guided needle biopsy plays a vital role in the work-up and treatment of patients with extremity bone tumors. The radiologist and the orthopedic oncologic surgeon should take a team approach to this procedure, especially when the bone lesion might be a primary sarcoma for which limb-sparing surgery (LSS) would be considered. A set of anatomically based guidelines were developed that can be used by the radiologist, in combination with case-by-case consultation with the surgeon, to plan image-guided core needle biopsies of extremity long bone lesions that may be treatable with LSS. By using these guidelines, along with the aforementioned consultation, the radiologist will be able to preserve the patient's chances of receiving optimal surgical treatment.
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Affiliation(s)
- Patrick T Liu
- Department of Radiology, Mayo Clinic College of Medicine, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA.
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Ashford RU, McCarthy SW, Scolyer RA, Bonar SF, Karim RZ, Stalley PD. Surgical biopsy with intra-operative frozen section. An accurate and cost-effective method for diagnosis of musculoskeletal sarcomas. ACTA ACUST UNITED AC 2006; 88:1207-11. [PMID: 16943474 DOI: 10.1302/0301-620x.88b9.17680] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The most appropriate protocol for the biopsy of musculoskeletal tumours is controversial, with some authors advocating CT-guided core biopsy. At our hospital the initial biopsies of most musculoskeletal tumours has been by operative core biopsy with evaluation by frozen section which determines whether diagnostic tissue has been obtained and, if possible, gives the definitive diagnosis. In order to determine the accuracy and cost-effectiveness of this protocol we have undertaken a retrospective audit of biopsies of musculoskeletal tumours performed over a period of two years. A total of 104 patients had biopsies according to this regime. All gave the diagnosis apart from one minor error which did not alter the management of the patient. There was no requirement for re-biopsy. This protocol was more labour-intensive and 38% more costly than CT-guided core biopsy (AU$1804 vs AU$1308). However, the accuracy and avoidance of the anxiety associated with repeat biopsy outweighed these disadvantages.
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Affiliation(s)
- R U Ashford
- Department of Orthopaedics, New South Wales Bone & Soft Tissue Sarcoma Service, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales 2050, Australia
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Buckley O, Benfayed W, Geoghegan T, Al-Ismail K, Munk PL, Torreggiani WC. CT-guided bone biopsy: Initial experience with a commercially available hand held Black and Decker drill. Eur J Radiol 2006; 61:176-80. [PMID: 16891079 DOI: 10.1016/j.ejrad.2006.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 06/12/2006] [Accepted: 06/27/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the use of a simple commercially available Black and Decker hand based drill in performing CT-guided bone biopsies. MATERIALS AND METHODS Three international institutions were enrolled in the study. In each centre, a fellowship trained musculoskeletal radiologist directed the assessment of a hand based commercial drill for performing CT-guided bone biopsies. A specially designed component was engineered which allowed the connection of a standard bone biopsy set to a commercial drill. The component was distributed to the three centres involved. Over a 3-year period, data from all three institutions was collected. Information regarding technical success, diagnostic data and complication rates were all collated to assess the technical feasibility of this technique. RESULTS In total 68 patients underwent bone biopsy using a hand held commercial drill. Technical success was achieved in 65 patients. Diagnostic material was obtained in 53 patients. Non-diagnostic material was obtained in 12 patients. Five out of the 12 patients with non-diagnostic material had repeat biopsies with diagnostic material obtained in 2 of these. No major complications occurred in any patient. CONCLUSION CT-guided bone biopsy using a hand held commercial drill has a technically high success rate with minimal complications.
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Affiliation(s)
- O Buckley
- Department of Radiology, The Adelaide and Meath, Hospital, Tallaght, Dublin 24, Ireland
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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: 95] [Impact Index Per Article: 5.0] [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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Gebhardt MC, Rosenthal DI, Arnell PM. Case records of the Massachusetts General Hospital. Case 8-2005. A 10-year-old boy with pain in the right thigh. N Engl J Med 2005; 352:1122-9. [PMID: 15784666 DOI: 10.1056/nejmcpc049038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Mark C Gebhardt
- Department of Orthopedics, Beth Israel Deaconess Medical Center, Boston, USA
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Tsukushi S, Katagiri H, Nakashima H, Shido Y, Arai E. Application and utility of computed tomography-guided needle biopsy with musculoskeletal lesions. J Orthop Sci 2004; 9:122-5. [PMID: 15045539 DOI: 10.1007/s00776-003-0754-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2003] [Accepted: 11/27/2003] [Indexed: 11/25/2022]
Abstract
A retrospective study was performed on 73 patients who underwent percutaneous computed tomography-guided needle biopsy between April 1998 and March 2003. All cases were treated by orthopedic surgeons at Nagoya Memorial Hospital. Diagnostic accuracy was examined statistically by anatomical location and diagnosis. The diagnostic accuracy for all 73 patients was 88% (64/73); and excluding patients with infection, it was 92% (55/60). No statistically significant difference was found by anatomical site. The accuracy was statistically significantly lower for primary bone tumors (P<0.005) and infection (P<0.05). The culture detection rate was 23% (3/13). No serious complications were seen. This report suggests that, with the advances in imaging technology and biopsy needles, one no longer sees the differences in diagnostic accuracy by anatomical site that result from the use of different biopsy needles for tumors of different locations and properties. Accuracy is thus determined largely by the disease. Infection was tuberculous in 4 of the 13 infection patients, and diagnosis was possible in all of these cases from the tissue examination. Needle biopsy seems useful in the sense that it can distinguish between tuberculous lesions in cases of spinal infection. In patients with a primary bone tumor, application of needle biopsy should be subjected to further consideration.
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Affiliation(s)
- Satoshi Tsukushi
- Department of Orthopaedic Surgery, Nagoya Memorial Hospital, 305 Hirabari 4-chome, Tenpaku-ku, Nagoya 468-8520, Japan
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Abstract
BACKGROUND Biopsy of musculoskeletal tumours is hazardous and, when poorly performed, can compromise limb salvage surgery and patient survival. The aim of the present paper is to examine the early management of such patients referred to the Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, Australia with particular reference to biopsy. METHODS We conducted a prospective audit of all patients referred to our musculoskeletal tumour service during 2002. Inclusion criteria were: all patients with primary tumours of the musculoskeletal system. We compared the outcome of patients biopsied prior to referral with that of patients biopsied in a recognized treatment centre. RESULTS One hundred and forty-two patients were included. The referring surgeon performed biopsies in 29 cases, of which 20 were malignant lesions. The senior author biopsied the remaining 113 cases, of which 57 were malignant. Definitive treatment was hindered by a badly performed biopsy in 38% of patients biopsied by the referring surgeon. In 25% the definitive treatment had to be changed either to a more radical procedure than would have originally been necessary or to palliative rather than curative intent. Patients biopsied elsewhere were more likely to have an incomplete excision requiring re-excision, more likely to require amputation, and more likely to require adjuvant radiotherapy. CONCLUSIONS There is a high complication rate when patients with musculoskeletal tumours are biopsied by surgeons inexperienced in their management. These patients are better served by early referral to a specialist centre where staging investigations including biopsy can be performed with minimal morbidity.
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Affiliation(s)
- Robin C Pollock
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Thanos L, Mylona S, Kalioras V, Pomoni M, Batakis N. Percutaneous CT-guided interventional procedures in musculoskeletal system (our experience). Eur J Radiol 2004; 50:273-7. [PMID: 15145487 DOI: 10.1016/j.ejrad.2004.01.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2004] [Revised: 01/13/2004] [Accepted: 01/16/2004] [Indexed: 11/27/2022]
Abstract
Percutaneous interventional procedures include a broad spectrum of minimal invasive techniques, which are a useful diagnostic and therapeutic tool. In this study we present our experience in CT-guided percutaneous musculoskeletal biopsies, drainages of musculoskeletal abscesses, facet and sacroiliac joint injection and radiofrequency thermal ablation of painful metastases or osteoid osteomas.
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Affiliation(s)
- Loukas Thanos
- Radiology Department, Korgialeneio-Benakeio, Red-Cross Hospital of Athens, 1 Athanasaki Street, 11526 Athens, Greece.
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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: 126] [Impact Index Per Article: 5.7] [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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Shapeero LG, Vanel D, Verstraete KL, Bloem JL. Fast magnetic resonance imaging with contrast for soft tissue sarcoma viability. Clin Orthop Relat Res 2002:212-27. [PMID: 11953613 DOI: 10.1097/00003086-200204000-00026] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Because dynamic (fast) contrast-enhanced magnetic resonance imaging with its temporal resolution allows evaluation of contrast kinetics of soft tissue sarcomas, its efficacy for defining viable tumor in these neoplasms was studied for three applications: biopsy localization, chemotherapeutic response, and differentiation between recurrence and inflammation after treatment. After conventional T1-weighted and T2-weighted magnetic resonance sequences to localize the lesion, patients had dynamic contrast-enhanced magnetic resonance imaging with fast and ultrafast sequences and postprocessing techniques (subtraction, time-intensity curves, and parametric color-encoding). In 10 of 40 patients, dynamic imaging more precisely defined the most malignant foci of tumor for biopsy than conventional magnetic resonance imaging. After chemotherapy, dynamic imaging distinguished 11 good responders from 21 poor responders. In followup of 196 patients, dynamic imaging detected 42 early enhancing recurrences and excluded recurrent tumor in six late enhancing pseudotumors. Dynamic imaging can differentiate viable tumor from nonviable tumor and inflammation by showing two temporally different phases of contrast enhancement: an early phase correlative with viable tumor at histologic examination, and a late phase when all tissues enhance simultaneously and may be indistinguishable. By showing tumor viability, dynamic contrast-enhanced magnetic resonance imaging can help define biopsy sites, chemotherapeutic response, and presence or absence of recurrences and therefore affect the initial evaluation, treatment, and followup of patients with soft tissue sarcomas.
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Affiliation(s)
- Lorraine G Shapeero
- Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799, USA
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Pramesh CS, Deshpande MS, Pardiwala DN, Agarwal MG, Puri A. Core needle biopsy for bone tumours. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2001; 27:668-71. [PMID: 11669596 DOI: 10.1053/ejso.2001.1198] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Percutaneous core biopsy of bone lesions provides early and definitive diagnosis and guides decisions on management. It is an inexpensive examination technique and has negligible complication rates. METHODS We performed a prospective study of 136 patients who underwent core biopsies for bone lesions over an 18-month period. A Jamshidi (J) needle was used to obtain a core of tissue and specimens were sent for histopathological examination. Biopsy results were analysed for adequacy, ability to yield diagnostic information and for accuracy of diagnosis. RESULTS The mean age of patients was 27.5 years with a range of 3-72 years. There were 84 males and 52 females in the study. Histopathological diagnosis was obtained in 121 (89%) patients. The specimen was non-diagnostic in 15 patients. Fourteen patients required two attempts and two patients required three attempts at biopsy. Sixty-two of 64 patients (96.9%) who had a confirmed final diagnosis had an accurate J-needle histopathological diagnosis. None of the patients had any major complications. DISCUSSION Core needle biopsy is an important tool in the evaluation of bone lesions. It is a safe, reliable and accurate procedure and yields diagnostic information in a high proportion of patients. It has several advantages over an open bone biopsy.
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Affiliation(s)
- C S Pramesh
- Department of Surgical Oncology, Bone and Soft Tissue Services, Tata Memorial Hospital, Mumbai 400 012, India.
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