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Osman K, Hussain S, Downes F, Rajgor HD, Sumathi V, Botchu R, Evans S. The management of non-diagnostic soft tissue tumour biopsies using a multi-disciplinary team approach: A 10-year retrospective review at a specialist sarcoma unit. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1196-1202. [PMID: 36804280 DOI: 10.1016/j.ejso.2023.02.003] [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: 10/28/2022] [Revised: 01/21/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
Non-Diagnostic (ND) biopsies are occasionally encountered during the investigation of soft tissue sarcoma. We performed a retrospective review of all ND soft tissue biopsies discussed at our regional Multi-Disciplinary Team (MDT) meeting between 2004 & 2014 with the aim of establishing the incidence of ND biopsies, identifying predictive factors for repeat biopsies and evaluating the effectiveness of MDT decisions. We identified 80 ND out of 3233 biopsies. Diagnostic Yield (DY) was 97.5%, 76.0% and 77.8% for the first, second and third successive biopsy respectively. With an MDT approach utilising radiological and clinical information, the diagnostic success rate achieved was 98.5%, 82.0% and 77.8% for the first, second and third biopsies respectively. Malignant tumours (sarcoma & carcinoma) were 19 times more likely to undergo an increasing number of biopsies compared to benign lesions (p < 0.01), while repeat biopsies were less useful for suspected benign lesion. Although a repeat biopsy was only performed in 63% of cases, there were no patients originally diagnosed with a benign lesion that re-presented with the same lesion subsequently being malignant throughout the study period. Our study shows that a specialist MDT approach leads to high diagnostic rates and is a safe and effective method of preventing unnecessary, repeat biopsies where the initial biopsy is ND.
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Affiliation(s)
- Khabab Osman
- The Royal Orthopaedic Hospital, Birmingham, B31 2AP, United Kingdom; Birmingham Orthopaedic Network (BON), The Knowledge Hub, B31 2AP, United Kingdom.
| | - Shakir Hussain
- The Royal Orthopaedic Hospital, Birmingham, B31 2AP, United Kingdom; Birmingham Orthopaedic Network (BON), The Knowledge Hub, B31 2AP, United Kingdom
| | - Frederick Downes
- The Royal Orthopaedic Hospital, Birmingham, B31 2AP, United Kingdom
| | - Harshadkumar Dhirajlal Rajgor
- The Royal Orthopaedic Hospital, Birmingham, B31 2AP, United Kingdom; Birmingham Orthopaedic Network (BON), The Knowledge Hub, B31 2AP, United Kingdom
| | | | - Rajesh Botchu
- The Royal Orthopaedic Hospital, Birmingham, B31 2AP, United Kingdom
| | - Scott Evans
- The Royal Orthopaedic Hospital, Birmingham, B31 2AP, United Kingdom
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2
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El Sayed L, H Masmejean E, Lavollé A, Biau D, Peyre M. Clinical results after surgical resection of benign solitary schwannomas: A review of 150 cases. Orthop Traumatol Surg Res 2022; 108:103281. [PMID: 35477039 DOI: 10.1016/j.otsr.2022.103281] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 03/24/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Peripheral nerve schwannomas are the most common nerve tumors. While they are efficiently treated with surgery, the risk of neurological complications, especially sensory deficits, remains debated. HYPOTHESIS We postulate that rates of post-operative sensory deficits in peripheral schwannoma surgery are low and are not increased in schwannomas of the hand, in which preservation of discriminative tact is of prime functional importance. MATERIALS AND METHODS A retrospective multicenter study was carried out on 150 patients with an isolated peripheral schwannoma operated between 2002 and 2018, including 11 patients with schwannomas of the hand. All cases were reviewed preoperatively and postoperatively with a detailed exam of the neurological status. RESULTS Most schwannomas were located in the lower limbs (58%). The two main affected trunks were the posterior tibial nerve in the lower limb and the median nerve in the upper limb. The average preoperative tumor volume measured on MRI was 2.93 cm3 [0.11 cm3-25 cm3]. The most common preoperative symptoms were paresthesia (77.1%) and pseudo-Tinel sign (55.7%). Less frequently, pain (50.3%) and hypoesthesia (18.1%) were observed. On the other hand, preoperative neurological motor manifestations remained exceptional (3.3%). The rates of new post-operative motor deficits, paresthesias, and sensory deficits were 4.6%, 10.9% and 8% respectively and were not increased in schwannomas of the collateral nerves of the hand. CONCLUSION Surgical resection is a safe procedure for peripheral nerve schwannoma treatment with satisfying functional results and an acceptable risk of nerve injury, especially for sensory function. LEVEL OF PROOF D; Multicenter retrospective study.
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Affiliation(s)
- Laila El Sayed
- Hand and upper extremity surgery unit, Georges-Pompidou European Hospital (HEGP), Paris, France; University of Paris, Medical School, Paris, France.
| | - Emmanuel H Masmejean
- Hand and upper extremity surgery unit, Georges-Pompidou European Hospital (HEGP), Paris, France; University of Paris, Medical School, Paris, France; Clinique Blomet (Research Unit), Paris, France
| | | | - David Biau
- University of Paris, Medical School, Paris, France; Orthopedic Surgery, Hôpital Cochin, Paris, France
| | - Matthieu Peyre
- Genetics and Development of Brain Tumors - CRICM Inserm U1127 CNRS UMR 7225- Brain Institute - Hôpital Pitié-Salpêtrière, Paris, France
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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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4
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Ramkumar DB, Kelly SP, Ramkumar N, Gyftopoulos S, Raskin KA, Lozano-Calderon SA, Chang CY. Adjunct diagnostic strategies in improving diagnostic yields in image-guided biopsies of musculoskeletal neoplasms-A cost-effectiveness analysis. J Surg Oncol 2021; 124:1499-1507. [PMID: 34416016 DOI: 10.1002/jso.26654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 07/21/2021] [Accepted: 08/12/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Routine use of adjunct intraprocedural fresh frozen biopsy (FFP) or point-of-care (POC) cytology at the time of image-guided biopsy can improve diagnostic tissue yields for musculoskeletal neoplasms, but these are associated with increased costs. OBJECTIVE This study aimed to ascertain the most cost-effective adjunctive test for image-guided biopsies of musculoskeletal neoplasms. METHODS This expected value cost-effectiveness microsimulation compared the payoffs of cost (2020 United States dollars) and effectiveness (quality-adjusted life, in days) on each of the competing strategies. A literature review and institutional data were used to ascertain probabilities, diagnostic yields, utility values, and direct medical costs associated with each strategy. Payer and societal perspectives are presented. One- and two-way sensitivity analyses evaluated model uncertainties. RESULTS The total cost and effectiveness for each of the strategies were $1248.98, $1414.09, $1980.53, and 80.31, 79.74, 79.69 days for the use of FFP, permanent pathology only, and POC cytology, respectively. The use of FFP dominated the competing strategies. Sensitivity analyses revealed FFP as the most cost-effective across all clinically plausible values. CONCLUSIONS Adjunct FFP is most cost-effective in improving the diagnostic yield of image-guided biopsies for musculoskeletal neoplasms. These findings are robust to sensitivity analyses using clinically plausible probabilities.
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Affiliation(s)
- Dipak B Ramkumar
- Department of Orthopaedic Surgery, Section of Orthopaedic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.,Section of Orthopaedic Oncology, Division of Orthopaedic Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Sean P Kelly
- Department of Orthopaedic Surgery, Section of Orthopaedic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Kevin A Raskin
- Department of Orthopaedic Surgery, Section of Orthopaedic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Santiago A Lozano-Calderon
- Department of Orthopaedic Surgery, Section of Orthopaedic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Connie Y Chang
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Casas MGE, Rosario M, Battad G, Mercado AC, Hermogenes TA, Hernandez A, Dy-Ledesma J, Alomesen A, Valera JL, Dy AC. Challenge of treating skeletal muscle metastasis during the COVID-19 pandemic in a low-resource setting. Ecancermedicalscience 2021; 15:1235. [PMID: 34221118 PMCID: PMC8225338 DOI: 10.3332/ecancer.2021.1235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Indexed: 11/06/2022] Open
Abstract
Background The authors report on an extremely rare case of skeletal muscle metastasis from primary lung cancer that involved the radial nerve and humerus, which was ‘over-treated’ with wide tumour resection and frozen autograft reconstruction upon misdiagnosis of sarcoma by intraoperative frozen section, amid pressure of expediting hospital care in a low-resource setting during the coronavirus disease (COVID-19) pandemic. Case presentation A 61-year-old male living outside Metro Manila presented with painful mass in his left distal arm during the enhanced community quarantine, and requested admission upon testing negative for COVID-19. Imaging studies suggested a diagnosis of soft tissue sarcoma involving the radial nerve and humerus, and intending to prevent nosocomial severe acute respiratory syndrome coronavirus 2infection of patient, treatment was expedited by foregoing biopsy and opting for intraoperative frozen section prior to resection. Frozen section findings suggested malignancy intraoperatively, and surgical team proceeded with wide tumour resection and frozen autograft reconstruction of the humerus using plates and screws. However, permanent sections revealed metastatic carcinoma from primary non-small cell lung cancer, with positron emission tomography (PET) scan confirming lung mass in the right apical lobe. Conclusion The report concludes that establishment of a definite tumour diagnosis by final histopathological analysis is indispensable, even when planning for emergent surgery in the time of the COVID-19 pandemic.
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Affiliation(s)
- Maria Gloria Elisha Casas
- Department of Surgery, University of the East Ramon Magsaysay Memorial Medical Center (UERMMMC), Doa Imelda, Quezon City 1113, Philippines
| | - Mamer Rosario
- Department of Surgery, University of the East Ramon Magsaysay Memorial Medical Center (UERMMMC), Doa Imelda, Quezon City 1113, Philippines.,Department of Orthopaedics, East Avenue Medical Center, Diliman, Quezon City 1101, Philippines
| | - Geoffrey Battad
- Department of Surgery, University of the East Ramon Magsaysay Memorial Medical Center (UERMMMC), Doa Imelda, Quezon City 1113, Philippines.,Department of Orthopaedics, East Avenue Medical Center, Diliman, Quezon City 1101, Philippines
| | - Adrienne Camille Mercado
- Department of Surgery, University of the East Ramon Magsaysay Memorial Medical Center (UERMMMC), Doa Imelda, Quezon City 1113, Philippines
| | - Trisha Ann Hermogenes
- Department of Orthopaedics, East Avenue Medical Center, Diliman, Quezon City 1101, Philippines
| | - Alvin Hernandez
- Department of Orthopaedics, East Avenue Medical Center, Diliman, Quezon City 1101, Philippines
| | - Janelyn Dy-Ledesma
- Department of Pathology, UERMMMC, Doa Imelda, Quezon City 1113, Philippines
| | - Avelino Alomesen
- Department of Pathology, East Avenue Medical Center, Diliman, Quezon City 1101, Philippines
| | | | - Arnel Christian Dy
- Department of Pathology, UERMMMC, Doa Imelda, Quezon City 1113, Philippines
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Banks JS, Garner HW, Chow AZ, Peterson JJ, Bestic JM, Wessell DE. Radiology-pathology correlation for bone and soft tissue tumors or tumor-like masses: single institutional experience after implementation of a weekly conference. Skeletal Radiol 2021; 50:731-738. [PMID: 32965551 DOI: 10.1007/s00256-020-03616-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the frequency of non-diagnostic and discordant results from bone and soft tissue biopsies performed at our institution over a 3-year period and to investigate whether implementation of a weekly musculoskeletal radiology-pathology correlation conference decreased the time to appropriate patient management in cases of discordance. METHODS Consecutive image-guided core needle biopsy results obtained over a 12 month period of time were reviewed in a retrospective fashion. Following implementation of the correlation conference, subsequent consecutive image-guided core needle biopsy results obtained over a 26 month period of time were reviewed in a prospective fashion. For non-diagnostic and discordant cases, the time in days from date of availability of the biopsy result to date of documentation of a specific follow-up action plan was recorded. RESULTS Diagnostic yield was 96.5% and 94.9% for the retrospective and prospective periods, respectively. There were four discordant results in the retrospective cohort (1.7%) and seven discordant results in the prospective cohort (2.1%). Following implementation of the weekly correlation conference, there was significant decrease (p < 0.05) in median time from a discordant biopsy result to follow-up action plan. There were no unnecessary surgeries, litigation, or other unfavorable consequences in either cohort. CONCLUSION Image-guided core needle biopsies of bone and soft tissue provide high diagnostic yield, often with specific diagnoses. The statistically significant decrease in number of days to follow-up action plan for discordant results suggests radiology-pathology review has a positive impact on patient care. Subjective benefits from communication and educational standpoints are also noteworthy.
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Affiliation(s)
- James S Banks
- Department of Radiology, Aventura Hospital and Medical Center, 20900 Biscayne Blvd, Aventura, FL, 33180, USA
| | - Hillary W Garner
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Andrew Z Chow
- Department of Radiology, Mayo Clinic Health System, 1025 Marsh Street, Mankato, MN, 56001, USA
| | - Jeffrey J Peterson
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Joseph M Bestic
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Daniel E Wessell
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
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Miwa S, Yamamoto N, Hayashi K, Takeuchi A, Igarashi K, Tada K, Higuchi T, Yonezawa H, Morinaga S, Araki Y, Asano Y, Ikeda H, Nojima T, Tsuchiya H. Diagnostic accuracies of intraoperative frozen section and permanent section examinations for histological grades during open biopsy of bone tumors. Int J Clin Oncol 2020; 26:613-619. [PMID: 33225397 DOI: 10.1007/s10147-020-01836-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND A histological diagnosis obtained from an intraoperative frozen section (FS) during biopsy confirms the adequacy of tumor tissue in the specimen. However, some cases show a discrepancy among the intraoperative FS diagnosis, permanent section (PS) diagnosis of the biopsy specimen, and the final diagnosis of the excised tumor specimen. In this study, we retrospectively investigated the diagnostic accuracy of the FS and PS for different types of bone tumors. METHODS This study included 377 patients with 411 bone tumors who underwent tumor excision after an open biopsy with intraoperative FS diagnosis. FS, PS, and final diagnoses of the patients were classified into benign tumors/tumor-like lesions, intermediate malignancies, and malignant tumors. To assess diagnostic accuracy, the histological grades in FS and PS diagnoses were compared with those in the final diagnoses. RESULTS The overall diagnostic accuracies of FS and PS were 93% and 97%, respectively. The accuracy of FS and PS for histological grade was 84% and 93% for chondrogenic tumors, 90% and 96% for osteogenic tumors, 97% and 98% for osteoclastic giant cell-rich tumors, 100% and 100% for tumors of undefined neoplastic nature, and 95% and 99% for other bone tumors, respectively. CONCLUSION These data suggest that surgical planning based on PS diagnosis is recommended for chondrogenic and osteogenic tumors.
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Affiliation(s)
- Shinji Miwa
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Kentaro Igarashi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Kaoru Tada
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Takashi Higuchi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Hirotaka Yonezawa
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Sei Morinaga
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Yoshihiro Araki
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Yohei Asano
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Hiroko Ikeda
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Takayuki Nojima
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.,Department of Pathology, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
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He Y, Pan I, Bao B, Halsey K, Chang M, Liu H, Peng S, Sebro RA, Guan J, Yi T, Delworth AT, Eweje F, States LJ, Zhang PJ, Zhang Z, Wu J, Peng X, Bai HX. Deep learning-based classification of primary bone tumors on radiographs: A preliminary study. EBioMedicine 2020; 62:103121. [PMID: 33232868 PMCID: PMC7689511 DOI: 10.1016/j.ebiom.2020.103121] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To develop a deep learning model to classify primary bone tumors from preoperative radiographs and compare performance with radiologists. METHODS A total of 1356 patients (2899 images) with histologically confirmed primary bone tumors and pre-operative radiographs were identified from five institutions' pathology databases. Manual cropping was performed by radiologists to label the lesions. Binary discriminatory capacity (benign versus not-benign and malignant versus not-malignant) and three-way classification (benign versus intermediate versus malignant) performance of our model were evaluated. The generalizability of our model was investigated on data from external test set. Final model performance was compared with interpretation from five radiologists of varying level of experience using the Permutations tests. FINDINGS For benign vs. not benign, model achieved area under curve (AUC) of 0•894 and 0•877 on cross-validation and external testing, respectively. For malignant vs. not malignant, model achieved AUC of 0•907 and 0•916 on cross-validation and external testing, respectively. For three-way classification, model achieved 72•1% accuracy vs. 74•6% and 72•1% for the two subspecialists on cross-validation (p = 0•03 and p = 0•52, respectively). On external testing, model achieved 73•4% accuracy vs. 69•3%, 73•4%, 73•1%, 67•9%, and 63•4% for the two subspecialists and three junior radiologists (p = 0•14, p = 0•89, p = 0•93, p = 0•02, p < 0•01 for radiologists 1-5, respectively). INTERPRETATION Deep learning can classify primary bone tumors using conventional radiographs in a multi-institutional dataset with similar accuracy compared to subspecialists, and better performance than junior radiologists. FUNDING The project described was supported by RSNA Research & Education Foundation, through grant number RSCH2004 to Harrison X. Bai.
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Affiliation(s)
- Yu He
- Department of Radiology, The Second Xiangya Hospital of Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Ian Pan
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence 02912, USA
| | - Bingting Bao
- Department of Radiology, The Second Xiangya Hospital of Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Kasey Halsey
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence 02912, USA
| | | | - Hui Liu
- Department of Radiology, The Second Xiangya Hospital of Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Shuping Peng
- Department of Radiology, The Second Xiangya Hospital of Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Ronnie A Sebro
- Musculoskeletal Imaging, Department of Radiology, University of Pennsylvania, Philadelphia 19104, USA
| | - Jing Guan
- Department of Radiology, The Second Xiangya Hospital of Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Thomas Yi
- Warren Alpert Medical School of Brown University, Providence 02903, USA
| | | | - Feyisope Eweje
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia 19104, USA
| | - Lisa J States
- Department of Radiology, Children's Hospital of Philadelphia, 19104, USA
| | - Paul J Zhang
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
| | - Zishu Zhang
- Department of Radiology, The Second Xiangya Hospital of Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Jing Wu
- Department of Radiology, The Second Xiangya Hospital of Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China.
| | - Xianjing Peng
- Department of Radiology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, Hunan 410008, PR China.
| | - Harrison X Bai
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence 02912, USA.
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Miwa S, Yamamoto N, Hayashi K, Takeuchi A, Igarashi K, Tada K, Higuchi T, Yonezawa H, Morinaga S, Araki Y, Asano Y, Ikeda H, Nojima T, Tsuchiya H. Accuracy of histological grades from intraoperative frozen-section diagnoses of soft-tissue tumors. Int J Clin Oncol 2020; 25:2158-2165. [PMID: 32779038 DOI: 10.1007/s10147-020-01762-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/05/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND For excised tumor specimens, histological grades can differ between the biopsy diagnosis and the final diagnosis. METHODS We retrospectively investigated the diagnostic accuracies of histological grades for frozen-section and permanent-section diagnoses from patients with soft-tissue tumors. Frozen-section, permanent-section, and final diagnoses were classified as benign tumors/tumor-like lesions, intermediate malignancies, or malignant tumors. Diagnostic accuracies of the histological grades from the frozen and permanent sections were evaluated by comparing the final diagnoses for the resected specimens. RESULTS The diagnostic accuracies of the histological grades for the frozen- and permanent-section diagnoses were 95% (387/408 lesions) and 97% (395/408 lesions), respectively. Among the tumor types, the diagnostic accuracies of the histological grades for the frozen-section and permanent-section diagnoses were 84% and 87% for adipocytic tumors, 87% and 91% for fibroblastic/myofibroblastic tumors, 99% and 100% for nerve-sheath tumors, 98% and 98% for fibrohistiocytic tumors, 90% and 98% for tumors of uncertain differentiation, 100% and 100% for vascular tumors, and 97% and 98% for other tumors, respectively. CONCLUSIONS Histological grades from frozen-section diagnoses yielded low diagnostic accuracies in adipocytic and fibroblastic/myofibroblastic tumors. Treatment should be planned based on permanent-section diagnosis and radiological findings for these tumors.
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Affiliation(s)
- Shinji Miwa
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 13-1 Takara-machi, Kanazawa, 920-8640, Japan.
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Kentaro Igarashi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Kaoru Tada
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Takashi Higuchi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Hirotaka Yonezawa
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Sei Morinaga
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Yoshihiro Araki
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Yohei Asano
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Hiroko Ikeda
- Department of Pathology, Kanazawa University School of Medicine, Kanazawa, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Takayuki Nojima
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
- Department of Pathology, Kanazawa University School of Medicine, Kanazawa, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
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10
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Winkler D, Fritzsche H, Schaser KD, Hofbauer C. Biopsie muskuloskeletaler Tumoren. DER ORTHOPADE 2020; 49:88-97. [DOI: 10.1007/s00132-020-03875-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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11
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The Accuracy and Clinical Utility of Intraoperative Frozen Section Analysis in Open Biopsy of Bone. J Am Acad Orthop Surg 2019; 27:410-417. [PMID: 30379758 DOI: 10.5435/jaaos-d-18-00071] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Open biopsy of bone is the diagnostic benchmark for the diagnosis of skeletal lesions. Intraoperative pathology consultation with frozen section analysis is commonly performed to confirm adequacy of lesional tissue and guide intraoperative decision making. The purpose of this study was to determine the accuracy and clinical utility of intraoperative frozen section during open bone biopsy. METHODS A retrospective review of 485 open biopsies of osseous lesions from 474 patients between 1997 and 2014 was performed. Pathology reports, operative notes, and prebiopsy imaging were assessed to determine the accuracy rates of frozen section analysis compared with final pathology. Pearson chi-squared and Fisher exact tests were performed to compare the accuracy and clinical utility rates based on soft-tissue extension, previous biopsy, lesional consistency, disease, and location. RESULTS Overall diagnostic yield of open bone biopsy was 95.3%. Frozen section analysis was accurate in 54.2%, equivocal positive in 21.2%, equivocal negative in 21.0%, and incorrect in 3.5% of cases. Previous nondiagnostic biopsy and the type of disease were found to have statistically significant effects on the accuracy of frozen section analysis. CONCLUSION Frozen section analysis was diagnostic in approximately one half of open biopsy cases. Additional information in equivocal positive results suggests that frozen section analysis is helpful for intraoperative decision making (clinical utility) in 75.4% of cases. LEVEL OF EVIDENCE Retrospective review level IV.
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Qi D, Zhao M, Hu T, Zhang G. Diagnostic yield of percutaneous core needle biopsy in suspected soft tissue lesions of extremities. J Int Med Res 2019; 47:2598-2606. [PMID: 31117871 PMCID: PMC6567717 DOI: 10.1177/0300060519849294] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 04/17/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This retrospective study was performed to investigate the diagnostic yield of percutaneous core needle biopsy (CNB) for suspected soft tissue lesions of the extremities. METHODS The medical records of 139 consecutive patients who underwent percutaneous CNB for suspected soft tissue lesions of the extremities from January 2014 to December 2016 at a single institution were reviewed. The pathologic findings or clinical follow-ups were used to evaluate the performance of CNB. Alterations in the treatment regimen from pre- to post-biopsy were also analyzed. Complications, when present, were documented. RESULTS In total, 141 biopsy procedures were performed in 139 patients. In total, 136 (96%) biopsies were successful, among which 5 were false-negative and 131 were diagnosed accurately. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CNB in the differentiation of malignant from benign lesions were 94%, 100%, 96%, 100%, and 90%, respectively. The treatment regimen was altered based on the biopsy findings in 25 cases. Two patients developed mild nerve injury but fully recovered during follow-up. CONCLUSIONS CNB is effective and safe, with high sensitivity, specificity, and accuracy for the diagnosis of soft tissue lesions, especially for differentiating malignant from benign lesions.
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Affiliation(s)
- Dianwen Qi
- Department of Musculoskeletal Tumor, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Ming Zhao
- Department of Musculoskeletal Tumor, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Tongyu Hu
- Department of Musculoskeletal Tumor, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Guochuan Zhang
- Department of Musculoskeletal Tumor, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
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Favril S, Abma E, Blasi F, Stock E, Devriendt N, Vanderperren K, de Rooster H. Clinical use of organic near-infrared fluorescent contrast agents in image-guided oncologic procedures and its potential in veterinary oncology. Vet Rec 2018; 183:354. [DOI: 10.1136/vr.104851] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/11/2018] [Accepted: 04/17/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Sophie Favril
- Small Animal Department, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
- Cancer Research Institute Ghent (CRIG); Ghent Belgium
| | - Eline Abma
- Small Animal Department, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
- Cancer Research Institute Ghent (CRIG); Ghent Belgium
| | - Francesco Blasi
- Ephoran Multi-Imaging Solutions s.r.l.; Colleretto Giacosa Italy
| | - Emmelie Stock
- Department of Medical Imaging of Domestic Animals, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - Nausikaa Devriendt
- Small Animal Department, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - Katrien Vanderperren
- Department of Medical Imaging of Domestic Animals, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
- Cancer Research Institute Ghent (CRIG); Ghent Belgium
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New Techniques for Diagnosis and Treatment of Musculoskeletal Tumors: Methods of Intraoperative Margin Detection. Tech Orthop 2018. [DOI: 10.1097/bto.0000000000000290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Redondo A, Bagué S, Bernabeu D, Ortiz-Cruz E, Valverde C, Alvarez R, Martinez-Trufero J, Lopez-Martin JA, Correa R, Cruz J, Lopez-Pousa A, Santos A, García Del Muro X, Martin-Broto J. Malignant bone tumors (other than Ewing's): clinical practice guidelines for diagnosis, treatment and follow-up by Spanish Group for Research on Sarcomas (GEIS). Cancer Chemother Pharmacol 2017; 80:1113-1131. [PMID: 29038849 PMCID: PMC5686259 DOI: 10.1007/s00280-017-3436-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/15/2017] [Indexed: 12/17/2022]
Abstract
Primary malignant bone tumors are uncommon and heterogeneous malignancies. This document is a guideline developed by the Spanish Group for Research on Sarcoma with the participation of different specialists involved in the diagnosis and treatment of bone sarcomas. The aim is to provide practical recommendations with the intention of helping in the clinical decision-making process. The diagnosis and treatment of bone tumors requires a multidisciplinary approach, involving as a minimum pathologists, radiologists, surgeons, and radiation and medical oncologists. Early referral to a specialist center could improve patients' survival. The multidisciplinary management of osteosarcoma, chondrosarcoma, chordoma, giant cell tumor of bone and other rare bone tumors is reviewed in this guideline. Ewing's sarcoma will be the focus of a separate guideline because of its specific biological, clinical and therapeutic features. Each statement has been accompanied by the level of evidence and grade of recommendation on the basis of the available data. Surgical excision is the mainstay of treatment of a localized bone tumor, with various techniques available depending on the histologic type, grade and location of the tumor. Chemotherapy plays an important role in some chemosensitive subtypes (such as high-grade osteosarcoma). In other subtypes, historically considered chemoresistant (such as chordoma or giant cell tumor of bone), new targeted therapies have emerged recently, with a very significant efficacy in the case of denosumab. Radiation therapy is usually necessary in the treatment of chordoma and sometimes of other bone tumors.
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Affiliation(s)
- Andrés Redondo
- Hospital La Paz, Paseo Castellama, 261, 28046, Madrid, Spain.
| | - Silvia Bagué
- Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quintí, 89, 08026, Barcelona, Spain
| | - Daniel Bernabeu
- Hospital La Paz, Paseo Castellama, 261, 28046, Madrid, Spain
| | | | - Claudia Valverde
- Hospital Vall d'Hebrón, Passeig de la Vall d'Hebrón 119-129, 08035, Barcelona, Spain
| | - Rosa Alvarez
- Hospital Gregorio Marañón, C/ Dr Esquerdo 46, 28007, Marid, Spain
| | | | | | - Raquel Correa
- Hospital Virgen de la Victoria, Campus de Teatinos s/nº, 29010, Málaga, Spain
| | - Josefina Cruz
- Hospital Universitario de Canarias, Carretera de Ofra s/n, 38320, San Cristóbal de la Laguna, Santa Cruz De Tenerife, Spain
| | - Antonio Lopez-Pousa
- Hospital de la Santa Creu i Sant Pau, C/. Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Aurelio Santos
- Hospital Virgen del Rocío, Av Manuel Siurot s/n, 41013, Sevilla, Spain
| | - Xavier García Del Muro
- Institut Catalá d'Oncologia Hospitalet, Avinguda de la GranVia de l´Hospitalet 199-203, L´Hospitalet de Llobregat, Barcelona, Spain
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Musculoskeletal Imaging-Guided Biopsies: Assessment of Techniques and Applicability. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0224-x] [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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17
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Ceraulo A, Ouziel A, Lavergne E, Perrier L, Decouvelaere AV, Chotel F, Thiesse P, Marec-Berard P. Percutaneous guided biopsy for diagnosing suspected primary malignant bone tumors in pediatric patients: a safe, accurate, and cost-saving procedure. Pediatr Radiol 2017; 47:235-244. [PMID: 27942776 DOI: 10.1007/s00247-016-3735-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 09/14/2016] [Accepted: 10/18/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Percutaneous biopsy is the reference diagnostic procedure for adult musculoskeletal tumors. Its place in pediatrics is controversial and open biopsy remains recommended. OBJECTIVE To assess diagnostic performance and feasibility of percutaneous biopsy performed on children and young adults for suspected malignant bone tumors. MATERIALS AND METHODS We conducted a 5-year retrospective study including patients ≤21 years who underwent a bone biopsy for a suspected malignant bone tumor. We assessed diagnostic yield (percentage of analyzable biopsies), accuracy (percentage of accurate diagnoses among all analyzable biopsies) and efficacy (percentage of accurate diagnoses among all biopsies), costs, anesthetic requirements and sample availability for biomedical research. Patients diagnosed with an open biopsy were used to compare diagnostic performances, anesthetic requirements and costs. RESULTS We included 90 percutaneous and 27 open biopsies in 117 patients. For percutaneous biopsy, diagnostic yield was 95.5% (95% confidence interval [CI] 88.8-98.7%), accuracy was 96.2% (95% CI 86.8-99.5%) and efficacy was 89.3% (95% CI 78.1-96.0%). There was no statistical difference with open biopsy (Fisher exact test, P > 0.05). Mean costs were reduced with percutaneous biopsy: €1,937 (standard deviation [SD] €2,408) versus €6,362 (SD €5,033; Mann-Whitney, P < 0.0001). Thirty-two of the 48 (67%) patients included in clinical trials and diagnosed with percutaneous biopsy had suitable samples for ancillary analyses. CONCLUSION Percutaneous biopsy is a valid alternative to open biopsy for diagnosing pediatric and young adult primary malignant bone tumors.
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Affiliation(s)
- Antony Ceraulo
- Institut d'Hématologie et d'Oncologie Pédiatriques (IHOPe), 1, place du Pr. Joseph Renault, 69008, Lyon, France.
| | - Antoine Ouziel
- Institut d'Hématologie et d'Oncologie Pédiatriques (IHOPe), 1, place du Pr. Joseph Renault, 69008, Lyon, France
| | - Emilie Lavergne
- Clinical Research and Innovation Direction (DRCI), Cancer Center Léon Bérard, Lyon, France
| | - Lionel Perrier
- Clinical Research and Innovation Direction (DRCI), Cancer Center Léon Bérard, Lyon, France
| | | | - Franck Chotel
- Department of Pediatric Orthopedic Surgery, Hospices Civils de Lyon - Hôpital Femme-Mère Enfant, Bron, France
| | - Philippe Thiesse
- Department of Radiology, Cancer Center Léon Bérard, Lyon, France
| | - Perrine Marec-Berard
- Institut d'Hématologie et d'Oncologie Pédiatriques (IHOPe), 1, place du Pr. Joseph Renault, 69008, Lyon, France
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Levrini G, Pattacini P. Desmoplastic fibroma of the distal tibia: A case report of a minimally invasive histological diagnosis. Mol Clin Oncol 2016; 5:537-539. [PMID: 27882239 PMCID: PMC5103855 DOI: 10.3892/mco.2016.1022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 08/08/2016] [Indexed: 11/18/2022] Open
Abstract
Desmoplastic fibroma (DF) is a benign, rare fibroblastic intraosseous neoplasm histologically resembling a desmoid soft tissue tumor. Although classified as benign, DF frequently exhibits an aggressive behavior, has a moderate-to-high recurrence rate, and often causes pathological fractures and extensive bone destruction. This case report presents an incidentally detected DF of the tibia, which was diagnosed using a minimally invasive approach. A 36-year-old African female patient was referred to the Department of Diagnostic Imaging of Arcispedale Santa Maria Nuova-IRCCS (Reggio Emilia, Italy), to be examined by a computed tomography scan on an outpatient basis, after an x-ray examination of the tibia, which was performed after an injury to exclude the presence of a fracture, revealed a hyperlucency of unknown origin. The aim of this study was to discuss the clinical, histological, immunohistochemical and radiographic characteristics of this rare neoplasm, with a focus on image-guided bone biopsy.
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Affiliation(s)
- Gabriele Levrini
- Department of Diagnostic Imaging, Arcispedale Santa Maria Nuova-IRCCS, I-42100 Reggio Emilia, Italy
| | - Pierpaolo Pattacini
- Department of Diagnostic Imaging, Arcispedale Santa Maria Nuova-IRCCS, I-42100 Reggio Emilia, Italy
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19
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Ferguson KB, McGlynn J, Jane M, Ritchie D, Mahendra A. Outcome of image-guided biopsies: Retrospective review of the West of Scotland musculoskeletal oncology service. Surgeon 2016; 14:87-90. [DOI: 10.1016/j.surge.2014.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 08/04/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022]
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20
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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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Visgauss JD, Eward WC, Brigman BE. Innovations in Intraoperative Tumor Visualization. Orthop Clin North Am 2016; 47:253-64. [PMID: 26614939 DOI: 10.1016/j.ocl.2015.08.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In the surgical management of solid tumors, adequacy of tumor resection has implications for local recurrence and survival. The standard method of intraoperative identification of tumor margin is frozen section pathologic analysis, which is time-consuming with potential for sampling error. Intraoperative tumor visualization has the potential to significantly improve surgical cancer care across disciplines, by guiding accuracy of biopsies, increasing adequacy of resections, directing adjuvant therapy, and even providing diagnostic information. We provide an outline of various methods of intraoperative tumor visualization developed to aid in the real-time assessment of tumor extent and adequacy of resection.
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Affiliation(s)
- Julia D Visgauss
- Department of Orthopaedic Surgery, Duke University, Box 3312 DUMC, Durham, NC 27710, USA
| | - William C Eward
- Department of Orthopaedic Surgery, Duke University, Box 3312 DUMC, Durham, NC 27710, USA
| | - Brian E Brigman
- Department of Orthopaedic Surgery, Duke University, Box 3312 DUMC, Durham, NC 27710, USA.
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Wide Local Excision for Dermatofibrosarcoma Protuberans: A Single-Center Series of 90 Patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:642549. [PMID: 26688814 PMCID: PMC4673335 DOI: 10.1155/2015/642549] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/05/2015] [Indexed: 01/19/2023]
Abstract
Background. Dermatofibrosarcoma protuberans (DFSP), a rare low-grade sarcoma of fibroblast origin, tends to extend in a finger-like fashion beyond macroscopic tumor margins. Therefore, incomplete removal and subsequent recurrence are common. This study aimed to determine the efficacy of wide local excision (WLE) for controlling local recurrence of DFSP. Methods. The medical records of 90 DFSP patients who received WLE at our hospital between June 1992 and January 2015 were retrospectively reviewed. WLE was conducted including a 3 cm (range, 1 to 5 cm) safety margin according to tumor size, location, and recurrence status. Clinical and tumor characteristics and surgical methods were evaluated for risk factor analysis and local recurrence-free survival. Results. DFSP occurred most often in patients in their 30s (30%) and on the trunk (51.1%). Five patients (5.5%) experienced local recurrence during the 43.4-month follow-up period. Recurrence was found at a mean of 10.8 months after WLE. Although no factors were significantly associated with recurrence, recurrences were more frequent in head and neck. Recurrence-free survival was 87% in 6 years and 77% in 7 years. Conclusions. WLE with adequate lateral and deep margins can effectively control local recurrence rate and is a simple and effective method to treat DFSP.
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Maciel MJS, Tyng CJ, Barbosa PNVP, Bitencourt AGV, Matushita Junior JPK, Zurstrassen CE, Chung WT, Chojniak R. Computed tomography-guided percutaneous biopsy of bone lesions: rate of diagnostic success and complications. Radiol Bras 2015; 47:269-74. [PMID: 25741100 PMCID: PMC4341399 DOI: 10.1590/0100-3984.2013.0004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 03/14/2014] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To determine the rates of diagnostic success and complications of computed tomography (CT)-guided percutaneous biopsy of bone lesions suspected for malignancy. MATERIALS AND METHODS Retrospective study including 186 cases of CT-guided percutaneous biopsies of bone lesions in the period from January, 2010 to December, 2012. All the specimens were obtained with 8-10 gauge needles. The following data were collected: demographics, previous history of malignancy, data related to the lesion, to the procedure, and to histological results. RESULTS Most patients were women (57%), and the mean age was 53.0 ± 16.4 years. In 139 cases (74.6%), there was diagnostic suspicion of metastasis and the most common primary tumors were breast (32.1%) and prostate (11.8%). The bones most commonly involved were spine (36.0%), hip (32.8%) and long bones (18.3%). Complications occurred in only three cases (1.6%) including bone fracture, paresthesia with functional impairment, and needle breakage requiring surgical removal. The specimens collected from 183 lesions (98.4%) were considered appropriate for diagnosis. Malignant results were more frequently found in patients who had a suspected secondary lesion and history of known malignancy (p < 0.001), and in patients who underwent PET/CT-guided procedures (p = 0.011). CONCLUSION CT-guided percutaneous biopsy is a safe and effective procedure for the diagnosis of suspicious bone lesions.
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Affiliation(s)
| | - Chiang Jeng Tyng
- Master and Fellow PhD degree, Titular of Imaging Department - A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | | | | | | | | | - Wu Tu Chung
- PhD, Titular of Pelvic Surgery Department - A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Rubens Chojniak
- PhD, Director, Imaging Department - A.C.Camargo Cancer Center, São Paulo, SP, Brazil
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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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Multidisciplinary management of soft tissue sarcoma. ScientificWorldJournal 2013; 2013:852462. [PMID: 23983648 PMCID: PMC3745982 DOI: 10.1155/2013/852462] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 07/02/2013] [Indexed: 12/20/2022] Open
Abstract
Soft tissue sarcoma is a rare malignancy, with approximately 11,000 cases per year encountered in the United States. It is primarily encountered in adults but can affect patients of any age. There are many histologic subtypes and the malignancy can be low or high grade. Appropriate staging work up includes a physical exam, advanced imaging, and a carefully planned biopsy. This information is then used to guide the discussion of definitive treatment of the tumor which typically involves surgical resection with a negative margin in addition to neoadjuvant or adjuvant external beam radiation. Advances in imaging and radiation therapy have made limb salvage surgery the standard of care, with local control rates greater than 90% in most modern series. Currently, the role of chemotherapy is not well defined and this treatment is typically reserved for patients with metastatic or recurrent disease and for certain histologic subtypes. The goal of this paper is to review the current state of the art in multidisciplinary management of soft tissue sarcoma.
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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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Amann G, Liegl-Atzwanger B. [The use of frozen sections in the handling of soft tissue tumors]. DER PATHOLOGE 2012; 33:453-8. [PMID: 22955682 DOI: 10.1007/s00292-012-1606-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Due to the multiplicity of localizations and entities, handling of soft tissue tumors is a very challenging subject requiring intensive interdisciplinary collaboration. With respect to the use of intraoperative frozen sections, the following facts are of special relevance: 1) the usual criteria for malignancy, such as infiltrative growth and high mitotic rate are only restrictedly applicable to soft tissue tumors. 2) Correct diagnosis of the tumor entity often requires not only the use of immunohistochemistry but also the identification of genetic alterations by the polymerase chain reaction and/or fluorescence in situ hybridization. In many centres, 14G core biopsies taken from different tumor areas represent the preferred method for a diagnostic biopsy. Apart from cryocollection additional frozen section investigations are used especially in case of open biopsies for quality control of the submitted material or in cases of excision biopsies to ascertain a highly probable radiological diagnosis. The use of intraoperative frozen sections to clarify the resection margins is generally undisputed but should definitely be restricted to centres specialized and experienced in the handling of soft tissue tumors.
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Affiliation(s)
- G Amann
- Klinisches Institut für Pathologie, Medizinische Universität Wien, Währingerstr. 18-20, 1090, Wien, Österreich.
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Sezak M, Doganavsargil B, Kececi B, Argin M, Sabah D. Feasibility and clinical utility of intraoperative consultation with frozen section in osseous lesions. Virchows Arch 2012; 461:195-204. [PMID: 22772767 DOI: 10.1007/s00428-012-1269-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 05/26/2012] [Accepted: 06/13/2012] [Indexed: 12/01/2022]
Abstract
Intraoperative consultation (IOC) with frozen section (FS) allows the surgeon to make therapy decisions during the operation. However, there is relatively little information on the use of IOC in skeletal lesions. We performed a retrospective study to examine the indications for IOC and compare the histological findings of FS and permanent paraffin section (PS) results to determine its clinical benefits. Ninety-seven consecutive cases evaluated between 2008 and 2011 were retrieved from IOC archives of our Pathology Department. In 79 % of the cases, there was no prior core needle biopsy (CNB), and IOC was performed to confirm the clinical or radiological diagnosis. In 5 (5 %) cases, no definitive result could be obtained with FS, and diagnosis was deferred. The reasons for a deferred diagnosis (DD) included poor section quality in two lipomatous lesions and the sample heterogeneity in the others. When adjusted for DD, FS and PS results showed 100 % concordance in terms of discriminating "benign vs. malignant" and defining diagnostic categories as "benign non-tumoral," "benign tumoral/tumor-like," "malignant primary tumor," "malignant metastatic tumor," or "hematopoietic malignancy." The presence of non-sclerotic osseous tissues does not have a significant adverse impact on the FS section quality and diagnosis made by FS. Thus, sections with diagnostic value can be obtained from bone lesions via FS. In this study, specific diagnoses were made in 88 % of the cases. We believe that IOC with FS can be safely performed in tertiary referral centers where there is a multidisciplinary team working in collaboration.
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Affiliation(s)
- Murat Sezak
- Department of Pathology, Ege University Faculty of Medicine, 35100, Bornova, Izmir, Turkey.
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Ashford RU, Benjamin L, Pendlebury S, Stalley PD. The modern surgical and non-surgical management of appendicular skeletal metastases. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.mporth.2012.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Eastley N, Newey M, Ashford RU. Skeletal metastases - the role of the orthopaedic and spinal surgeon. Surg Oncol 2012; 21:216-22. [PMID: 22554913 DOI: 10.1016/j.suronc.2012.04.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 04/09/2012] [Indexed: 11/28/2022]
Abstract
Developments in oncological and medical therapies mean that life expectancy of patients with metastatic bone disease (MBD) is often measured in years. Complications of MBD may dramatically and irreversibly affect patient quality of life, making the careful assessment and appropriate management of these patients essential. The roles of orthopaedic and spinal surgeons in MBD generally fall into one of four categories: diagnostic, the prophylactic fixation of metastatic deposits at risk of impending fracture (preventative surgery), the stabilisation or reconstruction of bones affected by pathological fractures (reactive surgery), or the decompression and stabilisation of the vertebral column, spinal cord, and nerve roots. Several key principals should be adhered to whenever operating on skeletal metastases. Discussions should be held early with an appropriate multi-disciplinary team prior to intervention. Detailed pre-assessment is essential to gauge a patient's suitability for surgery - recovery from elective surgery must be shorter than the anticipated survival. Staging and biopsies provide prognostic information. Primary bone tumours must be ruled out in the case of a solitary bone lesion to avoid inappropriate intervention. Prophylactic surgical fixation of a lesion prior to a pathological fracture reduces morbidity and length of hospital stay. Regardless of a lesion or pathological fracture's location, all regions of the affected bone must be addressed, to reduce the risk of subsequent fracture. Surgical implants should allow full weight bearing or return to function immediately. Post-operative radiotherapy should be utilised in all cases to minimise disease progression. Spinal surgery should be considered for those with spinal pain due to potentially reversible spinal instability or neurological compromise. The opinion of a spinal surgeon should be sought early, as delays in referral directly correlate to worse functional recovery following intervention. Patients who suffer a slowly progressive deficit, present within hours of complete neurological deficit, or have compression caused by bone alone are those most likely to benefit from surgery. Back pain in the presence of MBD should be regarded as impending spinal cord compression, and investigated urgently to allow intervention prior to the development of neurological compromise.
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Affiliation(s)
- Nicholas Eastley
- Department of Orthopaedics, Northampton General Hospital, Northampton General Hospital NHS Trust, Cliftonville, Northampton NN1 5BD, United Kingdom.
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Huang AJ, Kattapuram SV. Musculoskeletal Neoplasms: Biopsy and Intervention. Radiol Clin North Am 2011; 49:1287-305, vii. [DOI: 10.1016/j.rcl.2011.07.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Image-guided musculoskeletal (MSK) biopsies are safe and effective procedures that yield diagnostic accuracies up to 97%. When performed in conjunction with a multidisciplinary team, they provide crucial information that will affect patient care and outcome. Computed tomography and ultrasound are the main modalities used to carry out MSK biopsies, and various needles and techniques are available to help the radiologist perform these procedures safely.
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Affiliation(s)
- Huy B Q Le
- Vancouver General Hospital, Vancouver, British Columbia, Canada
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Kasraeian S, Allison DC, Ahlmann ER, Fedenko AN, Menendez LR. A comparison of fine-needle aspiration, core biopsy, and surgical biopsy in the diagnosis of extremity soft tissue masses. Clin Orthop Relat Res 2010; 468:2992-3002. [PMID: 20512437 PMCID: PMC2947686 DOI: 10.1007/s11999-010-1401-x] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biopsy tissue can be obtained through a fine needle, a wider coring needle, or through an open surgical incision. Though much literature exists regarding the diagnostic yield of these techniques individually, none compare accuracy of diagnosis in the same mass. QUESTIONS/PURPOSES We asked how the diagnostic accuracy of fine-needle aspiration, core biopsy, and open surgical biopsy compare in regard to identifying malignancy, establishing the exact diagnosis, and guiding the appropriate treatment of soft tissue masses. PATIENTS AND METHODS We prospectively studied 57 patients with palpable extremity soft tissue masses, performing fine-needle aspiration, followed by core biopsy, followed by surgical biopsy of the same mass. RESULTS Open surgical biopsy was 100% accurate on all accounts. With regard to determining malignancy, fine-needle aspiration and core biopsy had 79.17% and 79.2% sensitivity, 72.7% and 81.8% specificity, 67.9% and 76% positive predictive value, 82.8% and 84.4% negative predictive value, and an overall accuracy of 75.4% and 80.7%, respectively. In regard to determining exact diagnosis, fine-needle aspiration had a 33.3% accuracy and core biopsy had a 45.6% accuracy. With regard to eventual treatment, fine-needle aspiration was 38.6% accurate and core biopsy was 49.1% accurate. CONCLUSIONS In soft tissue mass diagnosis, core biopsy is more accurate than fine-needle aspiration on all accounts, and open biopsy is more accurate than both in determining malignancy, establishing the exact diagnosis, and the guiding appropriate treatment.
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Affiliation(s)
- Sina Kasraeian
- Department of Orthopedics, University of Southern California + Los Angeles County Medical Center, 1200 N State St, Ste 3900, Los Angeles, CA USA
| | - Daniel C. Allison
- Department of Orthopedics, University of Southern California + Los Angeles County Medical Center, 1200 N State St, Ste 3900, Los Angeles, CA USA
- Division of Musculoskeletal Oncology, Southern California Permanente Medical Group, 1011 Baldwin Park Boulevard, Baldwin Park, CA 91706 USA
| | - Elke R. Ahlmann
- Department of Orthopedics, University of Southern California + Los Angeles County Medical Center, 1200 N State St, Ste 3900, Los Angeles, CA USA
| | - Alexander N. Fedenko
- Department of Pathology, University of Southern California + Los Angeles County Medical Center, Los Angeles, CA USA
| | - Lawrence R. Menendez
- Department of Orthopedics, University of Southern California + Los Angeles County Medical Center, USC University Hospital, Los Angeles, CA USA
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Adams SC, Potter BK, Pitcher DJ, Temple HT. Office-based core needle biopsy of bone and soft tissue malignancies: an accurate alternative to open biopsy with infrequent complications. Clin Orthop Relat Res 2010; 468:2774-80. [PMID: 20582496 PMCID: PMC3049629 DOI: 10.1007/s11999-010-1422-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 05/26/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biopsy is a critical step in the diagnosis of musculoskeletal malignancy. As an alternative to open biopsy, percutaneous core needle biopsy techniques have been developed. As many studies combine office-based, image-guided, and operative biopsies, the accuracy of office-based core needle biopsy is not well documented. QUESTION/PURPOSES We asked whether (1) office-based core needle biopsy for the diagnosis of malignant musculoskeletal neoplasms would have few complications and diagnostic and accuracy rates comparable to those cited in the literature for core needle biopsy, (2) diagnostic errors related to office-based core needle biopsy would result in surgical treatment errors, and (3) tissue core quantity and tumor type would affect accuracy. PATIENTS AND METHODS We retrospectively reviewed 234 patients with 252 core needle biopsies of malignant bone and soft tissue neoplasms at one institution between 1999 and 2007. Biopsy accuracy and errors were determined on the basis of histologic evaluation of prior or subsequent biopsies and/or resected specimens, when available. We eliminated 19 patients who had needle biopsies: three had the core needle biopsy completed in the operating room and 16 had insufficient documentation or followup, leaving 233 for study. RESULTS Of the 233 core needle biopsies, 212 (91%) were diagnostic and accurate for malignancy. Fourteen (6%) biopsies were nondiagnostic. Major errors, defined as a benign diagnosis in a malignant tumor, occurred in seven cases (3%). Minor errors, defined as errors in histopathologic diagnosis or grade, occurred in 24 biopsies (10%). All nondiagnostic and major core needle biopsy errors were identified and addressed with either a diagnostic open biopsy or definitive wide local excision, resulting in no surgical treatment errors. Accuracy was not influenced by core number; however, myxoid lesions showed a correlation with biopsy error. There were no biopsy-related complications. CONCLUSIONS Office-based core needle biopsy for diagnosis of malignant musculoskeletal neoplasms has high diagnostic and accuracy rates without associated complications. LEVEL OF EVIDENCE Level II, diagnostic study. See the Guidelines for Authors for a complete description of the level of evidence.
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Affiliation(s)
- Sheila C. Adams
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, University of Miami Hospital, 1400 NW 12th Avenue, Room 4036, Miami, FL 33136 USA
| | - Benjamin K. Potter
- Integrated Department of Orthopaedics and Rehabilitation, Walter Reed National Military Medical Center, Washington, DC USA ,Integrated Department of Orthopaedics and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD USA ,Department of Surgery, Uniformed Service University of Health Sciences, Bethesda, MD USA
| | - David J. Pitcher
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, University of Miami Hospital, 1400 NW 12th Avenue, Room 4036, Miami, FL 33136 USA
| | - H. Thomas Temple
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, University of Miami Hospital, 1400 NW 12th Avenue, Room 4036, Miami, FL 33136 USA
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De Marchi A, Brach del Prever EM, Linari A, Pozza S, Verga L, Albertini U, Forni M, Gino GC, Comandone A, Brach del Prever AM, Piana R, Faletti C. Accuracy of core-needle biopsy after contrast-enhanced ultrasound in soft-tissue tumours. Eur Radiol 2010; 20:2740-8. [PMID: 20582701 DOI: 10.1007/s00330-010-1847-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 03/24/2010] [Accepted: 04/12/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Percutaneous biopsies are gaining acceptance in the diagnosis of soft-tissue tumours. Sampling in the most representative area is not easy in sarcomas of huge dimension. We hypothesised that ultrasound (US) contrast medium could identify the representative area for focus core-needle biopsy (CNB) METHODS: This is a retrospective cohort series of 115 soft-tissue masses treated from January 2007 to November 2008. Accuracy of US-guided CNB after contrast-enhanced US (CEUS) was determined by comparing the histology of the biopsy with the definitive diagnosis in 105 surgically excised samples (42 benign, 63 malignant) and with the expected outcome in the remaining ten malignant cases not surgically treated. A myxoid component was present in 21 sarcomas (34.4%). RESULTS Of samples, 94.8% were adequate for diagnosis with 97.1% sensitivity and 92.5% specificity. Sensitivity and specificity in specific histopathological subgroupings were 100%, and in grading definition they were 100% and 96.8%. DISCUSSION US-guided CNB is safe and effective. US contrast medium depicts tumour vascular supply and identifies the representative area(s) for sampling. Sensitivity and specificity are also high in subgrouping and grading, including myxoid types. Discussion about biopsy is part of the essential multidisciplinary strategy for these tumours.
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Affiliation(s)
- Armanda De Marchi
- Department of Imaging, AO CTO/Maria Adelaide, Via Zuretti, 29, 10126, Turin, Italy.
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Imaging-guided percutaneous biopsy of pathologic fractures: a retrospective analysis of 129 cases. AJR Am J Roentgenol 2009; 193:504-8. [PMID: 19620449 DOI: 10.2214/ajr.08.1823] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of our study was to determine the diagnostic performance of imaging-guided percutaneous needle core biopsy and the factors associated with a nondiagnostic biopsy in patients with a pathologic fracture of the appendicular skeleton. MATERIALS AND METHODS A retrospective audit was performed of 129 consecutive patients presenting with a pathologic fracture. All patients underwent percutaneous needle core biopsy using CT (n = 98), fluoroscopy (n = 15), or ultrasound (n = 16) guidance. In all cases, either MRI or CT was available before biopsy to assess the presence and degree of the extraosseous tumor mass. The resulting sample was classified as diagnostic (group 1) or nondiagnostic (group 2) on histopathologic study. Diagnostic performance was evaluated on the basis of the diagnostic yield and the diagnostic accuracy, and these were related to the site of the lesion and presence or absence of an extraosseous mass. RESULTS Ninety-nine masses (77%) were classified as group 1 and 30 (23%) as group 2. The average cross-sectional diameter of lesions in group 1 was 5.7 x 5.9 cm. Of the 30 lesions composing group 2, no soft-tissue component was identified on prebiopsy cross-sectional imaging in 27 lesions (90%), but the remaining three (10%) showed a smaller extraosseous soft-tissue component compared with the lesions in group 1. CONCLUSION Imaging-guided core biopsy is a reliable method for obtaining a tissue diagnosis in pathologic fracture of the appendicular skeleton with a high rate of accuracy. However, those lesions that are purely intraosseous or have only very small extraosseous components are more likely to be associated with a nondiagnostic biopsy and should be considered for a primary open procedure.
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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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Abstract
Image guidance allows safe passage of needles, often into small and otherwise inaccessible lesions, and into the portions of the lesion most likely to yield useful samples, while avoiding damage to important structures. This article hopes to provide a useful guide to image-guided musculoskeletal biopsy for radiologists in practice and in training.
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Affiliation(s)
- Apoorva Gogna
- Department of Diagnostic Radiology, Changi General Hospital, 2 Simei Street 3, Singapore, Republic of Singapore
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Abstract
OBJECTIVE We present an overview of approaches for bone biopsy used to minimize potential tumor seeding of adjacent soft-tissue structures and compartments. We discuss a variety of approaches related to specific anatomic parts and review pertinent anatomy. CONCLUSION We provide important guidelines and key examples that will help readers perform percutaneous needle bone biopsy safely.
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Bui MM, Smith P, Agresta SV, Cheong D, Letson GD. Practical Issues of Intraoperative Frozen Section Diagnosis of Bone and Soft Tissue Lesions. Cancer Control 2008; 15:7-12. [DOI: 10.1177/107327480801500102] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Intraoperative pathologic diagnosis of bone and soft tissue lesions is an important yet challenging tool in clinical musculoskeletal oncology practice. There is limited information in the literature addressing the practical issues commonly encountered regarding intraoperative frozen section of musculoskeletal lesions. Methods A literature review and retrospective review of practical experience in intraoperative pathology consultation at our institute's sarcoma program were conducted to investigate the pitfalls and limitations of frozen section and potential solutions to overcome these problems. Results Frozen section evaluation is an essential and reliable procedure for guiding intraoperative decisions. Intraoperative cytology as an adjunct to frozen section enhances the accuracy of diagnosis of bone and soft tissue lesions. Cytology can accurately diagnose certain entities alone and is superior to frozen section for certain tumor types and for evaluating bone marrow margins. It is also invaluable in triaging cases for ancillary studies and for tumor banking. Practical working protocols can be developed to optimize the usefulness of intraoperative pathologic consultation. Conclusions Intraoperative pathology consultation should be done in an interdisciplinary approach by correlating clinical, radiologic, and pathologic information. As an adjunct to frozen section, cytology and gross examination enhance the accuracy of diagnosis of musculoskeletal lesions.
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Affiliation(s)
- Marilyn M. Bui
- Anatomic Pathology Service, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Prudence Smith
- Anatomic Pathology Service, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Samuel V. Agresta
- Anatomic Pathology Service, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - David Cheong
- Sarcoma Program at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - G. Douglas Letson
- Sarcoma Program at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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