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Hong AM, Sundaram A, Perianayagam G, Lo H, Lawless A, Zhou D, McDonough J, Thompson SR, Maclean F, Connolly EA, Coker D, Mar J, Lazarakis S, Johnston A. Surgery at specialised sarcoma centres improves patient outcomes - A systematic review by the Australia and New Zealand sarcoma association clinical practice guidelines working party. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106951. [PMID: 37301636 DOI: 10.1016/j.ejso.2023.06.003] [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: 05/16/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Optimal management of sarcoma requires multidisciplinary team input throughout the process of diagnosis, treatment and follow up. This systematic review aimed to evaluate the impact of surgery performed at specialised sarcoma centres on outcomes. METHODS A systematic review was conducted using the population, intervention, comparison and outcome (PICO) model. Medline, Embase, Cochrane Central databases were queried for publications that evaluated the local control, limb salvage rate, 30-day and 90-day surgical mortality, and overall survival in patients undergoing surgery in a specialist sarcoma centre compared with non-specialist centre. Each study was screened by two independent reviewers for suitability. A qualitative synthesis of the results was performed. RESULTS Sixty-six studies were identified. The majority of studies were Level III-3 as assessed by the NHMRC Evidence Hierarchy, whilst just over half of the studies were of good quality. Definitive surgery performed at specialised sarcoma centres was associated with improved local control as defined by lower rate of local relapse, higher rate of negative surgical margins, improved local recurrence free survival and higher limb conservation rate. Available evidences show a favourable pattern of lower 30-day and 90-day mortality rates, and greater overall survival when surgery was performed in specialist sarcoma centres compared with non-specialised centres. CONCLUSIONS Evidences support better oncological outcomes when surgery is performed at specialised sarcoma centre. Patients with suspected sarcoma should be referred early to a specialised sarcoma centre for multidisciplinary management, which includes planned biopsy and definitive surgery.
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Affiliation(s)
- Angela M Hong
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, 2050, Australia.
| | - Abay Sundaram
- Department of Orthopaedic Surgery, Sir Charles Gardiner Hospital, Nedlands, WA, 6009, Australia
| | - Ganaps Perianayagam
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - Helen Lo
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, 2050, Australia; Mid North Coast Cancer Institute, Port Macquarie, NSW, 2444, Australia
| | - Anna Lawless
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, 2050, Australia
| | - Deborah Zhou
- NHMRC Clinical Trials Centre, The University of Sydney, NSW, 2006, Australia; Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, 2050, Australia
| | | | - Stephen R Thompson
- Faculty of Medicine, University of New South Wales, Randwick, NSW, 2131, Australia; Department of Radiation Oncology, Prince of Wales Hospital, Randwick, NSW, 2132, Australia
| | - Fiona Maclean
- Douglass Hanly Moir Pathology, North Ryde, NSW, 2113, Australia
| | - Elizabeth A Connolly
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, 2050, Australia; Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, 2050, Australia
| | - David Coker
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia; Department of Melanoma and Surgical Oncology, and Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - Jasmine Mar
- Australia and New Zealand Sarcoma Association, Parkville, Victoria, 3010, Australia
| | - Smaro Lazarakis
- Health Sciences Library, Royal Melbourne Hospital, Parkville, Victoria, 3010, Australia
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Strönisch A, Märdian S, Flörcken A. Centralized and Interdisciplinary Therapy Management in the Treatment of Sarcomas. Life (Basel) 2023; 13:life13040979. [PMID: 37109507 PMCID: PMC10144040 DOI: 10.3390/life13040979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Sarcoma treatment requires a high level of expertise due to its rarity and heterogeneity. Sarcoma patients should, therefore, be referred to an expert centre as early as possible to ensure optimal treatment. Numerous studies have been carried out to provide evidence for this strategy. In compliance with the 2020 PRISMA guidelines, a systematic search was conducted in PubMed, EMBASE, Ovid Medline, ClinicalTrials.gov and Cochrane Library databases. The subject of these studies was the centralised treatment of adult sarcoma patients at expert centres and the use of interdisciplinary tumour boards. Uncertainty in therapy, delays in referral to expert centres, and limited access to therapeutic modalities continue to be a challenge in sarcoma therapy. At expert centres, diagnostic procedures were more frequently and adequately performed, and treatment was associated with an improvement in outcomes in the majority of studies: patients benefited from longer survival, lower local recurrence rates and a better postoperative outcome. The implementation of an interdisciplinary tumour board was associated with discrepant results. In a greater number of studies, it was associated with a lower local relapse rate, better overall survival and surgical outcome. In two studies, however, a shorter overall survival was observed. The establishment of expert centres and the consistent use of interdisciplinary tumour boards are important structures for ensuring multidisciplinary therapy approaches. There is growing evidence that this holds great potential for optimising sarcoma therapy.
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Affiliation(s)
- Annika Strönisch
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Sven Märdian
- Centre for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Anne Flörcken
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, German Cancer Consortium (DKTK), Partner Site Berlin, and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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Ashford R, Aujla RS. Bone and Soft Tissue Tumours. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1007/978-3-030-78529-1_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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Tamvakopoulos GS, Rose B, Saifuddin A, Skinner JA, Pollock R. Managing NON-DIAGNOSTIC biopsies in musculoskeletal tumours in a specialist centre: Deciding on the algorithm. Eur J Surg Oncol 2020; 47:1207-1213. [PMID: 33077295 DOI: 10.1016/j.ejso.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Core needle biopsy is an effective method of obtaining tissue diagnosis. However, a diagnostic dilemma arises when lesional tissue is non-diagnostic which obviates considering radiological guided re-biopsy (RB) or an open surgical biopsy but the question raised is which serves as a better diagnostic tool. PATIENT AND METHODS We retrospectively reviewed data from a prospectively collected database of 4516 core needle biopsies performed in our specialist musculoskeletal tumour centre over a 6-year period. Our aim was to evaluate the management of non-diagnostic biopsies (NDB) and establish a safe and accurate diagnostic strategy in the presence of a NDB. RESULTS Two hundred fifteen (4.8%) NDB cases with complete follow-up were identified. Of these 157 (73%) were treated definitively on the basis of imaging and 58 (27%) had a RB, 48 (83%) of which led to a positive histological diagnosis. The remaining 10 were again non-diagnostic giving a total of 167 patients being treated definitively without a tissue diagnosis. The sensitivity and specificity for multidisciplinary team (MDT) assessment as a diagnostic tool was 0.75 and 0.88 respectively while that for RB was 0.91 and 0.9. CONCLUSION Re-biopsy after first non-diagnostic core needle biopsy offers high sensitivity and specificity, especially in the presence of malignancy. In the absence of tissue diagnosis, however, MDT assessment is also highly accurate and a safe strategy in managing this complex group of patients. LEVEL OF EVIDENCE Diagnostic Level III.
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Affiliation(s)
| | - Barry Rose
- Department of Orthopaedic Oncology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - John A Skinner
- Department of Orthopaedic Oncology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Robin Pollock
- Department of Orthopaedic Oncology, Royal National Orthopaedic Hospital, Stanmore, UK
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Scudday TS, Danisa OA, Zuckerman LM. Management of Pelvic Chondroblastic Osteosarcoma after Urgent Spinal Decompression - A Report of 2 Cases. J Orthop Case Rep 2016; 6:72-5. [PMID: 27299134 PMCID: PMC4845420 DOI: 10.13107/jocr.2250-0685.383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Pelvic sarcoma presenting with neurologic symptoms is rare. Workup of neurological deficits, whether elective or emergent should address the possibility of a space occupying lesion including pelvic sarcoma. Poor biopsy technique and incomplete workup of musculoskeletal tumors results in misdiagnosis or major errors in 18% of biopsies. The sequelae of a suboptimal biopsy include local recurrence, a more extensive resection, or extremity amputation. Pelvic chondroblastic osteosarcoma presenting with neurological deficits has not been previously reported. We report two cases of chondroblastic osteosarcoma that were treated with urgent decompression of the lumbar spine due to neurologic symptoms. Case presentations: Our two cases, a 25 year old Hispanic female and 22 year old Hispanic male, both presented with neurologic changes due to a space occupying tumor in the lumbar spine and pelvis. Both underwent spinal decompression following incomplete workup. A repeat biopsy was required in both cases due to a questionable initial diagnosis. Once the diagnosis was confirmed, they underwent definitive resection and treatment that was more morbid due to the primary decompressions. Conclusion: We stress the importance of proper biopsy techniques as well as the need to complete a full preoperative staging workup prior to any surgical procedures involving musculoskeletal tumors. We review the current literature on lumbar chondroblastic osteosarcomas and review the issues surrounding biopsy of musculoskeletal tumors. Our cases underline the need for complete workup and correct biopsy techniques to ensure patients have the best chance at tumor free survival with minimal morbidity.
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Affiliation(s)
- Travis Spencer Scudday
- Department of Orthopaedic Surgery, Loma Linda University Medical Center. Loma Linda, CA, USA
| | - Olumide Ayodele Danisa
- Department of Orthopaedic Surgery, Loma Linda University Medical Center. Loma Linda, CA, USA
| | - Lee Michael Zuckerman
- Department of Orthopaedic Surgery, Loma Linda University Medical Center. Loma Linda, CA, USA
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Abstract
From an era where amputation was the only option to the current day function preserving resections and complex reconstructions has been a major advance in the treatment of musculoskeletal sarcomas. The objectives of extremity reconstruction after oncologic resection include providing skeletal stability where necessary, adequate wound coverage to allow early subsequent adjuvant therapy, optimising the aesthetic outcome and preservation of functional capability with early return to function. This article highlights the concepts of surgical margins in oncology, discusses the principles governing safe surgical resection in these tumors and summarises the current modalities and recent developments relevant to reconstruction after limb salvage. The rationale of choice of a particular resection modality and the unique challenges of reconstruction in skeletally immature individuals are also discussed. Striking the right balance between adequate resection, while yet retaining or reconstructing tissue for acceptable function and cosmesis is a difficult task. Complications are not uncommon and patients and their families need to be counseled regarding the potential setbacks that may occur in the course of their eventual road to recovery, Limb salvage entails a well orchestrated effort involving various specialties and better outcomes are likely to be achieved with centralization of expertise at regional centers.
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Affiliation(s)
- Ajay Puri
- Department of Orthopaedic Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India,Address for correspondence: Prof. Ajay Puri, Room No. 45, Tata Memorial Hospital, E. Borges Road, Parel, Mumbai - 400 012, Maharashtra, India. E-mail:
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Abstract
The treatment of musculoskeletal sarcomas has made vast strides in the last few decades. From an era where amputation was the only option to the current day function preserving resections and complex reconstructions has been a major advance. The objectives of extremity reconstruction after oncologic resection include providing skeletal stability where necessary, adequate wound coverage to allow early subsequent adjuvant therapy, optimising the aesthetic outcome and preservation of functional capability with early return to function. This article highlights the concepts of surgical margins in oncology, discusses the principles governing safe surgical resection in these tumors and summarises the current modalities and recent developments relevant to reconstruction after limb salvage. The rationale of choice of a particular resection modality, the unique challenges of reconstruction in skeletally immature individuals and the impact of adjuvant modalities like chemotherapy and radiotherapy on surgical outcomes are also discussed.
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Affiliation(s)
- Ajay Puri
- Department of Orthopaedic Oncology Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
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Abstract
Osteosarcoma is the most common primary osseous malignancy excluding malignant neoplasms of marrow origin (myeloma, lymphoma and leukemia) and accounts for approximately 20% of bone cancers. It predominantly affects patients younger than 20 years and mainly occurs in the long bones of the extremities, the most common being the metaphyseal area around the knee. These are classified as primary (central or surface) and secondary osteosarcomas arising in preexisting conditions. The conventional plain radiograph is the best for probable diagnosis as it describes features like sun burst appearance, Codman's triangle, new bone formation in soft tissues along with permeative pattern of destruction of the bone and other characteristics for specific subtypes of osteosarcomas. X-ray chest can detect metastasis in the lungs, but computerized tomography (CT) scan of the thorax is more helpful. Magnetic resonance imaging (MRI) of the lesion delineates its extent into the soft tissues, the medullary canal, the joint, skip lesions and the proximity of the tumor to the neurovascular structures. Tc99 bone scan detects the osseous metastases. Positron Emission Tomography (PET) is used for metastatic workup and/or local recurrence after resection. The role of biochemical markers like alkaline phosphatase and lactate dehydrogenase is pertinent for prognosis and treatment response. The biopsy confirms the diagnosis and reveals the grade of the tumor. Enneking system for staging malignant musculoskeletal tumors and American Joint Committee on Cancer (AJCC) staging systems are most commonly used for extremity sarcomas.
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Affiliation(s)
- Zile Singh Kundu
- Department of Orthopaedics, Pt B D Sharma PGIMS, Rohtak, Haryana, India,Address for correspondence: Prof. Zile Singh Kundu, 1393, Sector-3, Rohtak, Haryana - 124 001, India. E-mail:
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Biau DJ, Weiss KR, Bhumbra RS, Davidson D, Brown C, Wunder JS, Ferguson PC. Using the CUSUM test to control the proportion of inadequate open biopsies of musculoskeletal tumors. Clin Orthop Relat Res 2013; 471:905-14. [PMID: 22968530 PMCID: PMC3563785 DOI: 10.1007/s11999-012-2544-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biopsies of musculoskeletal tumors lead to alterations in treatment in almost 20% of cases. Control charts are useful to ensure that a process is operating at a predetermined level of performance, although their use has not been demonstrated in assessing the adequacy of musculoskeletal biopsies. QUESTIONS/PURPOSES We therefore (1) assessed the incidence of and the reasons for inadequate musculoskeletal biopsies when following guidelines for performing the procedure; and (2) implemented a process control chart, the CUSUM test, to monitor the proportion of inadequate biopsies. METHODS We prospectively studied 116 incisional biopsies. The biopsy was performed according to 10 rules to (1) minimize contamination in the tissues surrounding the tumor; and (2) improve accuracy. A frozen section was systematically performed to confirm that a representative specimen was obtained. Procedures were considered inadequate if: (1) another biopsy was necessary; (2) the biopsy tract was not appropriately placed; and (3) the treatment provided based on the diagnosis from the biopsy was not appropriate. RESULTS Five (4.3%) of the 116 incisional biopsy procedures were considered failures. Three patients required a second repeat open biopsy and two were considered to receive inappropriate treatment. No alarm was raised by the control chart and the performance was deemed adequate over the monitoring period. CONCLUSIONS The proportion of inadequate musculoskeletal open biopsies performed at a referral center was low. Using a statistical process control method to monitor the failures provided a continuous measure of the performance.
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Affiliation(s)
- David J. Biau
- />Department of Orthopaedic Surgery, Hospital Cochin, Paris, France
| | - Kurt R. Weiss
- />Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Shadyside Medical Center, Pittsburgh, PA USA
| | - Rej S. Bhumbra
- />London Sarcoma Service, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Darin Davidson
- />Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA USA
| | - Chris Brown
- />University Musculoskeletal Oncology Unit, Mount Sinai Hospital, 600 University Avenue, Room 476G, Toronto, ON M5G 1X5 Canada
- />Sarcoma Site Group, Department of Surgical Oncology, Princess Margaret Hospital, Toronto, ON Canada
| | - Jay S. Wunder
- />University Musculoskeletal Oncology Unit, Mount Sinai Hospital, 600 University Avenue, Room 476G, Toronto, ON M5G 1X5 Canada
- />Sarcoma Site Group, Department of Surgical Oncology, Princess Margaret Hospital, Toronto, ON Canada
| | - Peter C. Ferguson
- />University Musculoskeletal Oncology Unit, Mount Sinai Hospital, 600 University Avenue, Room 476G, Toronto, ON M5G 1X5 Canada
- />Sarcoma Site Group, Department of Surgical Oncology, Princess Margaret Hospital, Toronto, ON Canada
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Jagadeesan J, Davies JA, Raurell A, Ashford RU. Intraoperative portable ultrasonography localization of clinically impalpable soft-tissue tumors. World J Surg Oncol 2012; 10:243. [PMID: 23148766 PMCID: PMC3544693 DOI: 10.1186/1477-7819-10-243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/15/2012] [Indexed: 11/16/2022] Open
Abstract
Background Most soft-tissue tumors are clinically palpable; however, some can be impalpable to clinical examination making it difficult to plan surgical management. Methods We present a simple method of perioperative tumor localization using a portable ultrasonography machine. Results We used the technique for seven cases, on each occasion identifying the tumor and facilitating the optimal surgical approach. Conclusion The technique is reproducible and readily available, and we recommend its use.
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Affiliation(s)
- Jagajeevan Jagadeesan
- East Midlands Sarcoma Service, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK
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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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Puri A, Gulia A. Multimodality management of extremity soft tissue sarcomas-an Indian perspective. Indian J Surg Oncol 2011; 2:291-7. [PMID: 23204784 PMCID: PMC3338133 DOI: 10.1007/s13193-012-0125-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 01/18/2012] [Indexed: 10/14/2022] Open
Abstract
Soft-tissue sarcomas are a rare and heterogeneous group of tumors. The last few decades have seen rapid strides in the management of these complex lesions. The presence of a soft-tissue sarcoma in the extremity is no longer an indication for amputation. Function preserving alternatives for local control in these lesions are the norm without compromising on overall disease survival. Good functional and oncological results can be achieved with a combination of excision of the tumor and where required, suitable adjuvant therapies. These lesions are best managed at specialty centres where the requisite multidisciplinary care can be offered to the patient to optimise results. This article outlines the current understanding and emphasises the multimodality management of these challenging tumors. We also present Indian data of the incidence and oncologic outcomes of these lesions and suggest a treatment algorithm.
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Affiliation(s)
- Ajay Puri
- Orthopaedic Oncologist, Tata Memorial Hospital, Room No: 26, E. Borges Road, Parel, Mumbai, 400 012 India
| | - Ashish Gulia
- Orthopaedic Oncologist, Tata Memorial Hospital, Room No: 26, E. Borges Road, Parel, Mumbai, 400 012 India
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Abstract
Soft-tissue sarcomas are a rare and heterogeneous group of tumors. The last few decades have seen rapid strides in surgery with function preserving alternatives for local control in these lesions becoming the norm without compromising on overall disease survival. Good functional and oncological results can be achieved with a combination of excision of the tumor, and where required, suitable adjuvant therapies. These lesions are best managed at specialty centres where the requisite multidisciplinary care can be offered to the patient to optimise results. This overview is intended as a review of current understanding and the multimodality management of these challenging tumors.
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Affiliation(s)
- Ajay Puri
- Department of Orthopaedic Oncology, Tata Memorial Hospital, Mumbai, India,Address for correspondence: Prof. Ajay Puri, Room No: 26, Tata Memorial Hospital, E. Borges Road, Parel, Mumbai-400 012, India. E-mail:
| | - Ashish Gulia
- Department of Orthopaedic Oncology, Tata Memorial Hospital, Mumbai, India
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Clayer M. Preoperative core biopsy of soft-tissue tumours facilitates their surgical management: 10-year update. ANZ J Surg 2009; 79:407; author reply 407-8. [PMID: 19566534 DOI: 10.1111/j.1445-2197.2009.04905.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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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Ribeiro MB, Oliveira CRGD, Filippi RZ, Baptista AM, Caiero MT, Saito CF, Nascimento SABD, Camargo OPD. Estudo histopatológico do trajeto de biópsia de tumores musculoesqueléticos malignos. ACTA ORTOPEDICA BRASILEIRA 2009. [DOI: 10.1590/s1413-78522009000500005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Verificar se havia risco de contaminação por células neoplásicas no trajeto da biópsia e estudar as alterações histológicas locais. MÉTODOS: Realizou-se um estudo prospectivo com trajetos de biópsias de pacientes operados por tumores musculoesqueléticos malignos no Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo no período de abril de 2006 a abril de 2007. Foram estudados por histopatologia 25 casos. RESULTADOS: Houve implante de células neoplásicas em 32% dos trajetos. As alterações histológicas mais comuns nos casos positivos foram classificadas como: fibrose acentuada, componente inflamatório leve e neovascularização acentuada. CONCLUSÃO: Sugerimos a ressecção tradicional oncológica do trajeto junto com a peça.
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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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