1
|
Gami A, Shah A, Shankaralingappa S, Salunke AA, Gandhi J, Patel K, Bharwani N, Trivedi P, Pandya S. Does an excision of needle bone biopsy tract affect the prognosis in patients with primary bone tumor? J Orthop 2024; 48:13-19. [PMID: 38059219 PMCID: PMC10696180 DOI: 10.1016/j.jor.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
Background Opinion remains divided as to whether excision of needle biopsy tract is beneficial and affect the prognosis. The aim of the study was to compare the outcomes in patients of primary malignant bone tumor who had undergone surgery with or without biopsy tract excision. Methods From January 2017 to June 2020, 240 patients with primary malignant bone tumors who underwent percutaneous needle biopsy followed by surgery were included. We categorized patients into Biopsy tract excision (Group1:185 patients) and Non Biopsy tract excision (Group 2:55 patients). Median follow-up of patients was 58.6 months (range; 12-61.8months). Results Demographics, histopathological type, tumor location, type of surgery were similar in biopsy tract excision and non excision group. We found biopsy tract seeding in two cases out of 185 (1.1 %). Local recurrence in biopsy tract excision and non excision group was observed in 3.2 % and 1.8 % respectively with p value 0.58. The mean local recurrence free survival rate in group 1 and 2 was 60 and 44 months respectively. Limb salvage was performed in 71.6 % and in amputation in 28.3 % cases. The local recurrence in limb-salvage and amputation group was observed in 3.4 % (6/172) and 1.4 % (1/68) respectively. Conclusion There was no significant difference in the rate of local recurrence between patients who were treated by biopsy tract excision or non tract excision. Percutenous needle bone biopsy tract leads to minimal risk of tumor seeding during surgical resection of primary bone tumors.We recommend the further multi centre studies with more number of patients to reach a consensus on resection of needle biopsy tract during surgical management of primary bone tumors.
Collapse
Affiliation(s)
- Amisha Gami
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Ashini Shah
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | | | - Abhijeet Ashok Salunke
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Jahnavi Gandhi
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Keval Patel
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Nandlal Bharwani
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Priti Trivedi
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
- Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| |
Collapse
|
2
|
Biopsy Path Contamination in Primary Bone Sarcomas. Rev Bras Ortop 2019; 54:33-36. [PMID: 31363240 PMCID: PMC6424802 DOI: 10.1016/j.rbo.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/05/2017] [Indexed: 12/02/2022] Open
Abstract
Objective To determine the incidence of contamination of the biopsy pathway in patients with primary bone sarcomas, as well as the clinical characteristics that influenced this outcome. Materials and Methods The anatomopathological reports of the patients who were treated by the Orthopedic Oncology Sector of the Orthopedic and Traumatology Department of this institution were retrospectively evaluated. Results Of the 148 patients included for evaluation in the present study, only 1 presented contamination by neoplastic cells in his biopsy pathway. Conclusion The bone biopsy procedure in patients with primary bone sarcomas presents great safety regarding pathway contamination when performed in specialized centers that treat this type of pathology.
Collapse
|
3
|
Berger-Richardson D, Burtenshaw SM, Ibrahim AM, Gladdy RA, Auer R, Beecroft R, Dickson BC, Purgina B, Ambacher K, Nessim C, Swallow CJ. Early and Late Complications of Percutaneous Core Needle Biopsy of Retroperitoneal Tumors at Two Tertiary Sarcoma Centers. Ann Surg Oncol 2019; 26:4692-4698. [PMID: 31372868 DOI: 10.1245/s10434-019-07656-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Concern persists regarding percutaneous core needle biopsy (CNB) of a potentially malignant lesion of the retroperitoneum due to the perceived risk of immediate complications and adverse oncologic outcomes, including needle tract seeding (NTS). OBJECTIVE The aim of this study was to evaluate the incidence of (1) early complications and (2) NTS following CNB of suspected retroperitoneal sarcoma (RPS). METHODS Patients who underwent CNB of an RP mass with pre-biopsy suspicion of sarcoma were identified from a prospective database at two centers: (1) Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto (2009-2015); and (2) The Ottawa Hospital (1999-2015). Early complications, including bleeding, pain, infection, and organ injury, were recorded. Instances of NTS were identified from long-term follow-up of patients who underwent resection of primary RPS at these two centers after initial CNB (1996-2013). RESULTS Of 358 percutaneous CNBs of suspected RPS performed over the study period, 7 (2.0%) resulted in minor bleeding with no transfusion, 3 (0.8%) resulted in significant pain, 1 (0.3%) resulted in unplanned admission to hospital for observation, and 1 (0.3%) resulted in a pneumothorax. There were no infections. In 203 patients who underwent resection of RPS following CNB, crude cumulative local recurrence was 24% at 5 years. At a median follow-up of 44 months, there was one case of NTS (approximately 0.5%). CONCLUSION This large bi-institutional experience with CNB of an RP mass demonstrates that both the early complication rate and the incidence of NTS are very low. Physicians and patients can be reassured that the benefits of CNB in diagnosing sarcoma and determining its histologic subtype and grade far outweigh the risks.
Collapse
Affiliation(s)
- David Berger-Richardson
- Department of Surgery, University of Toronto, Toronto, ON, Canada. .,Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.
| | - Sally M Burtenshaw
- Division of General Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and Sinai Health System, Toronto, ON, Canada
| | | | - Rebecca A Gladdy
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Division of General Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and Sinai Health System, Toronto, ON, Canada
| | - Rebecca Auer
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Surgery, University of Ottawa, Ottawa, ON, Canada.,Division of General Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Rob Beecroft
- Joint Department of Medical Imaging, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Brendan C Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada
| | - Bibianna Purgina
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Carolyn Nessim
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Surgery, University of Ottawa, Ottawa, ON, Canada.,Division of General Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Carol J Swallow
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Division of General Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and Sinai Health System, Toronto, ON, Canada
| |
Collapse
|
4
|
Barrientos-Ruiz I, Ortiz-Cruz EJ, Serrano-Montilla J, Bernabeu-Taboada D, Pozo-Kreilinger JJ. Are Biopsy Tracts a Concern for Seeding and Local Recurrence in Sarcomas? Clin Orthop Relat Res 2017; 475:511-518. [PMID: 27655183 PMCID: PMC5213942 DOI: 10.1007/s11999-016-5090-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 09/12/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND A biopsy is the final step in the diagnosis of sarcomas. Complete resection of the biopsy tract traditionally has been recommended in musculoskeletal oncology guidelines, as that tract is considered potentially seeded with tumor cells. However, to our knowledge, the frequency and implications of contamination of the biopsy tract-specifically with respect to the likelihood of local recurrence-and the factors that affect cell seeding are not well described. QUESTIONS/PURPOSES We asked: (1) How often are biopsy tracts contaminated with pathologically detectable tumor cells at the time of tumor resection? (2) What factors, in particular biopsy type (open versus percutaneous), are associated with tumoral seeding? (3) Is biopsy tract contamination associated with local recurrence? METHODS This is a retrospective study of a database with patient data collected from a single center between 2000 and 2013. We treated 221 patients with sarcomas. A total of 27 patients (12%) were excluded and 14 (6%) were lost to followup. One hundred eighty patients finally were included in the analysis who either had biopsies at our center (112) or biopsies at outside institutions (68). Of those performed at our center, 15 (13%) were open and 97 (87%) were percutaneous; of those at outside centers, those numbers were 47 (69%) and 21 (31%) respectively. Median followup was 40 months (range, 24-152 months). During the study period, we generally performed percutaneous biopsies as a standard practice for the diagnosis of bone and soft tissue sarcomas and open biopsies were done when the percutaneous procedure failed to provide a histologic characterization. The mean age of the population was 48 years (range, 7-87 years); 60% were male; 42% had bone sarcomas. Nineteen patients had preoperative radiotherapy and 56 had postoperative radiotherapy. Fifty-seven patients received neoadjuvant chemotherapy and 73 had adjuvant chemotherapy. We determined what proportion of biopsy tracts were contaminated by pathologic analysis of the biopsy tract specimen; during the period in question, our routine practice was to excise the biopsy tract whenever possible at the time of the definitive resection. Using the logistic regression test and Mantel-Haenszel test, we compared open with percutaneous biopsies in terms of the proportion of those that were contaminated at our site and for outside referral biopsies separately, because we do not assume the level of expertise was the same (our site is a referral tumor center). We compared the local recurrence-free survival between patients with and without contamination and between open and percutaneous biopsies using the Kaplan Meier test, again separating those performed at our site from those referred for purposes of this analysis. RESULTS Twenty-one of 180 biopsy tracts were contaminated (12%). Twenty of 62 (32%) of the open biopsies and one of 118 (0.8%) of the percutaneous core needle biopsies had cell seeding (odds ratio [OR], 56; 95% CI, 7-428; p < 0.001. One of 97 (1%) percutaneous biopsies performed in our center, and none of the 21 (0%) percutaneous biopsies performed in other centers had contaminated biopsy tracts (p = 0.047). Two of 15 (13%) open biopsies performed at our center and 18 of 41(38%) open biopsies performed at other centers had contaminated biopsy tracts (OR, 4; 95% CI, 1-7; p = 0.001). Four of 74 (5%) bone sarcomas and 18 of 106 (17%) soft tissue sarcomas had biopsy tract contamination (OR, 3; 95% CI, 1-10; p = 0.023). The local recurrence-free survival was longer for patients without contaminated tracts (mean, 107 months; 95% CI, 74-141 months) than for those with biopsy tract seeding (mean, 11 months; 95% CI, 1-20 months; p < 0.001). CONCLUSIONS Open biopsies were associated with an increased risk of tumoral seeding of the biopsy site, and tumoral seeding was associated with an increased risk of local recurrence. However, it is possible that other factors, such as increased complexity of the tumor or a difficult location, influenced the decision to obtain an open biopsy. Even so, based on these results, we believe that higher risk of local recurrence may be caused by an incomplete biopsy tract resection. In our opinion, the percutaneous biopsy with neoadjuvant or adjuvant therapy is the preferred method of biopsy at our center. LEVEL OF EVIDENCE Level III, therapeutic study.
Collapse
Affiliation(s)
- Irene Barrientos-Ruiz
- grid.81821.320000000089709163Orthopaedic Oncologist Unit, La Paz University Hospital, Paseo de la Castellana 261, Madrid, Spain ,MD Anderson International Hospital, Calle Arturo Soria 270, Madrid, Spain
| | - Eduardo José Ortiz-Cruz
- grid.81821.320000000089709163Orthopaedic Oncologist Unit, La Paz University Hospital, Paseo de la Castellana 261, Madrid, Spain ,MD Anderson International Hospital, Calle Arturo Soria 270, Madrid, Spain
| | - José Serrano-Montilla
- grid.28479.300000000122065938Orthopaedic Oncologist Unit, Rey Juan Carlos University Hospital, Madrid, Spain
| | - Daniel Bernabeu-Taboada
- grid.81821.320000000089709163Musculoskeletal Radiology Unit, La Paz University Hospital, Madrid, Spain
| | - Jose Juan Pozo-Kreilinger
- grid.81821.320000000089709163Musculoskeletal Pathology Unit, La Paz University Hospital, Madrid, Spain
| |
Collapse
|
5
|
Berger‐Richardson D, Swallow CJ. Needle tract seeding after percutaneous biopsy of sarcoma: Risk/benefit considerations. Cancer 2016; 123:560-567. [DOI: 10.1002/cncr.30370] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 08/08/2016] [Indexed: 12/17/2022]
Affiliation(s)
- David Berger‐Richardson
- Division of General Surgery, Department of SurgeryUniversity of TorontoToronto Ontario Canada
- Institute of Medical ScienceUniversity of TorontoToronto Ontario Canada
- Lunenfeld‐Tanenbaum Research Institute, Mount Sinai HospitalToronto Ontario Canada
| | - Carol J. Swallow
- Division of General Surgery, Department of SurgeryUniversity of TorontoToronto Ontario Canada
- Institute of Medical ScienceUniversity of TorontoToronto Ontario Canada
- Lunenfeld‐Tanenbaum Research Institute, Mount Sinai HospitalToronto Ontario Canada
- Department of Surgical OncologyPrincess Margaret Cancer CentreToronto Ontario Canada
| |
Collapse
|
6
|
Oliveira MP, Lima PMDA, de Mello RJV. TUMOR CONTAMINATION IN THE BIOPSY PATH OF PRIMARY MALIGNANT BONE TUMORS. Rev Bras Ortop 2015; 47:631-7. [PMID: 27047877 PMCID: PMC4799461 DOI: 10.1016/s2255-4971(15)30015-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 01/13/2012] [Indexed: 02/08/2023] Open
Abstract
Objective: To study factors possibly associated with tumor contamination in the biopsy path of primary malignant bone tumors. Method: Thirty-five patients who underwent surgical treatment with diagnoses of osteosarcoma, Ewing's tumor and chondrosarcoma were studied retrospectively. The sample was analyzed to characterize the biopsy technique used, histological type of the tumor, neoadjuvant chemotherapy used, local recurrences and tumor contamination in the biopsy path. Results: Among the 35 patients studied, four cases of contamination occurred (11.43%): one from osteosarcoma, two from Ewing's tumor and one from chondrosarcoma. There was no association between the type of tumor and presence of tumor contamination in the biopsy path (p = 0.65). There was also no association between the presence of tumor contamination and the biopsy technique (p = 0.06). On the other hand, there were associations between the presence of tumor contamination and local recurrence (p = 0.01) and between tumor contamination and absence of neoadjuvant chemotherapy (p = 0.02). Conclusion: Tumor contamination in the biopsy path of primary malignant bone tumors was associated with local recurrence. On the other hand, the histological type of the tumor and the type of biopsy did not have an influence on tumor contamination. Neoadjuvant chemotherapy had a protective effect against this complication. Despite these findings, tumor contamination is a complication that should always be taken into consideration, and removal of the biopsy path is recommended in tumor resection surgery.
Collapse
Affiliation(s)
- Marcelo Parente Oliveira
- Orthopedist in the Orthopedics and Traumatology Clinic, HC-UFPE; Auxiliary Professor in the Cariri School of Medicine, Federal University of Ceará; Master's student in the Postgraduate Pathology Program, CCS-UFPE, Recife, PE, Brazil
| | - Pablo Moura de Andrade Lima
- MSc in Pathology from the Federal University of Pernambuco; Orthopedist responsible for the Orthopedic Oncology Group, Orthopedics and Traumatology Clinic, HC-UFPE, Recife, PE, Brazil
| | - Roberto José Vieira de Mello
- PhD in Pathology from the Federal University of Pernambuco; Associate Professor in the Department of Pathology, CCS-UFPE, Recife, PE, Brazil
| |
Collapse
|
7
|
Nascimento D, Suchard G, Hatem M, de Abreu A. The role of magnetic resonance imaging in the evaluation of bone tumours and tumour-like lesions. Insights Imaging 2014; 5:419-40. [PMID: 25005774 PMCID: PMC4141345 DOI: 10.1007/s13244-014-0339-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 05/11/2014] [Accepted: 05/20/2014] [Indexed: 01/21/2023] Open
Abstract
UNLABELLED Bone tumours and tumour-like lesions are frequently encountered by radiologists. Although radiographs are the primary screening technique, magnetic resonance imaging (MRI) can help narrow the differential or make a specific diagnosis when a lesion is indeterminate or shows signs of aggressiveness. MRI can extend the diagnostic evaluation by demonstrating several tissue components. Even when a specific diagnosis cannot be made, the differential diagnosis can be narrowed. MRI is superior to the other imaging modalities in detecting bone marrow lesions and tumoral tissue (faint lytic/sclerotic bone lesions can be difficult to visualise using only radiographs). Contrast-enhanced MRI can reveal the most vascularised parts of the tumour and MRI guidance makes it possible to avoid biopsing necrotic areas. MRI is very helpful in local staging and surgical planning by assessing the degree of intramedullary extension and invasion of the adjacent physeal plates, joints, muscle compartments and neurovascular bundles. It can be used in assessing response to neoadjuvant therapy and further restaging. The post-therapeutic follow-up should also be done using MRI. Despite the high quality of MRI, there are a few pitfalls and limitations of which one should be aware. Applications of MRI in bone tumours will probably continue to grow as new sequences are further studied. TEACHING POINTS • When a lesion is indeterminate or shows signs of aggressiveness, MRI is indicated. • When MRI does not lead to a diagnosis, biopsy is indicated. • MRI is superior to the other imaging modalities in detecting bone marrow lesions. • MRI is very helpful in local staging and surgical planning. • MRI is used in assessing the response to neoadjuvant therapy, restaging and post-therapeutic follow-up.
Collapse
Affiliation(s)
- Duarte Nascimento
- Serviço de Imagiologia do Serviço de Saúde da Região Autónoma da Madeira, Avenida Luís de Camões, nº 57, 9004-514 Funchal, Portugal
| | - Guilherme Suchard
- Serviço de Radiologia do Hospital Mãe de Deus, Rua José de Alencar, 286, Menino Deus, Porto Alegre, RS, 90880-480 Brazil
| | - Maruan Hatem
- Serviço de Radiologia do Hospital Mãe de Deus, Rua José de Alencar, 286, Menino Deus, Porto Alegre, RS, 90880-480 Brazil
| | - Armando de Abreu
- Serviço de Radiologia do Hospital Mãe de Deus, Rua José de Alencar, 286, Menino Deus, Porto Alegre, RS, 90880-480 Brazil
| |
Collapse
|
8
|
Oliveira MP, Lima PMDA, Silva HJD, Mello RJVD. Neoplasm seeding in biopsy tract of the musculoskeletal system. A systematic review. ACTA ORTOPEDICA BRASILEIRA 2014; 22:106-10. [PMID: 24899866 PMCID: PMC4031257 DOI: 10.1590/1413-78522014220200422] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 11/16/2011] [Indexed: 12/20/2022]
Abstract
To identify, through a systematic literature review, the characteristics of neoplasm seeding in biopsy performed on the musculoskeletal system. We performed a search on PubMed, MEDLINE, LILACS and SciELO from August to October 2010. We included articles that addressed the neoplasm seeding in biopsy performed on the musculoskeletal system. The search was limited to English, Spanish and Portuguese as publication languages, but it was not limited by year of publication. We retrieved 2858 articles, but only seven were selected based on inclusion and exclusion criteria. Other four papers were found in the references of selected articles, totalizing 11 articles that were used to perform this systematic review. Issues may be raised in the literature: age and gender don't seem to influence the occurrence of neoplasm seeding; without resection of the biopsy tract, the possibility of local recurrence is very real; the influence of the type of tumor in the occurrence of neoplasm seeding is uncertain; it is impossible to conclude whether the closed biopsy technique has a lower chance of neoplasm seeding; it is likely that adjuvant chemotherapy has a protective effect against neoplasm seeding; an unfavorable prognosis is expected according to neoplasm seeding results.
Collapse
|