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Li Z, Su J, Wang J, Yan L, Zhang H, Li X, Tai Y, Fang Y, Yan T. Ultrasound-guided core needle biopsy combined with immunohistochemistry and molecular testing improve the diagnostic accuracy of bone metastases from follicular thyroid carcinoma, two case reports and analyses. Clin Case Rep 2024; 12:e8959. [PMID: 38817707 PMCID: PMC11136645 DOI: 10.1002/ccr3.8959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/30/2024] [Accepted: 04/10/2024] [Indexed: 06/01/2024] Open
Abstract
Key Clinical Message Ultrasound-guided core needle biopsy combined with immunohistochemistry and molecular testing could improve the diagnostic accuracy of bone metastases from follicular thyroid carcinoma, help to predict distant metastasis and prognosis. Abstract Metastatic thyroid follicular carcinoma presenting initially with bone lesion is uncommon, its prime symptom is gradual onset, localized pain. Patient with bone metastasis who were diagnosed before thyroidectomy had a higher rate of mortality, clinician should be cautious in eliciting the clinical history and this insidious symptom in middle age group, carry out further examination. We are presenting two case reports of a follicular thyroid carcinoma with bone metastasis, ultrasound-guided core needle biopsy combined with immunohistochemistry (IHC) were carried out by our clinical team to determine the source and nature of the tumor, relevant literature was reviewed, molecular testing was discussed, we believe core needle biopsy combined with IHC and molecular testing improve the diagnostic accuracy of bone metastases from follicular thyroid carcinoma.
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Affiliation(s)
- Zhiyuan Li
- Outpatient DepartmentFifth Medical Center of Chinese PLA General HospitalBeijingChina
- Department of Endocrinology and MetabolismFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Jianbin Su
- Outpatient DepartmentFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Jinjing Wang
- Department of Endocrinology and MetabolismFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Li Yan
- Outpatient DepartmentFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Huiqiang Zhang
- Outpatient DepartmentFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Xinyu Li
- Center for Disease Control and Prevention of Xicheng DistrictBeijingChina
| | - Yanhong Tai
- Department of PathologyFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Yi Fang
- Department of Endocrinology and MetabolismFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Tao Yan
- Outpatient DepartmentFifth Medical Center of Chinese PLA General HospitalBeijingChina
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2
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Mavrogenis AF, Altsitzioglou P, Tsukamoto S, Errani C. Biopsy Techniques for Musculoskeletal Tumors: Basic Principles and Specialized Techniques. Curr Oncol 2024; 31:900-917. [PMID: 38392061 PMCID: PMC10888002 DOI: 10.3390/curroncol31020067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Biopsy is a pivotal component in the diagnostic process of bone and soft tissue tumors. The objective is to obtain adequate tissue without compromising local tumor dissemination and the patient's survival. This review explores contemporary principles and practices in musculoskeletal biopsies, emphasizing the critical role of diagnostic accuracy while also delving into the evolving landscape of liquid biopsies as a promising alternative in the field. A thorough literature search was done in PubMed and Google Scholar as well as in physical books in libraries to summarize the available biopsy techniques for musculoskeletal tumors, discuss the available methods, risk factors, and complications, and to emphasize the challenges related to biopsies in oncology. Research articles that studied the basic principles and specialized techniques of biopsy techniques in tumor patients were deemed eligible. Their advantages and disadvantages, technical and pathophysiological mechanisms, and possible risks and complications were reviewed, summarized, and discussed. An inadequately executed biopsy may hinder diagnosis and subsequently impact treatment outcomes. All lesions should be approached with a presumption of malignancy until proven otherwise. Liquid biopsies have emerged as a potent non-invasive tool for analyzing tumor phenotype, progression, and drug resistance and guiding treatment decisions in bone sarcomas and metastases. Despite advancements, several barriers remain in biopsies, including challenges related to costs, scalability, reproducibility, and isolation methods. It is paramount that orthopedic oncologists work together with radiologists and pathologists to enhance diagnosis, patient outcomes, and healthcare costs.
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Affiliation(s)
- Andreas F. Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini, 157 72 Athens, Greece;
| | - Pavlos Altsitzioglou
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini, 157 72 Athens, Greece;
| | - Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara 634-8521, Japan;
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy;
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3
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Cho EB, Lee SK, Kim JY, Kim Y. Synovial Sarcoma in the Extremity: Diversity of Imaging Features for Diagnosis and Prognosis. Cancers (Basel) 2023; 15:4860. [PMID: 37835554 PMCID: PMC10571652 DOI: 10.3390/cancers15194860] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/15/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
Synovial sarcomas are rare and highly aggressive soft-tissue sarcomas, primarily affecting adolescents and young adults aged 15-40 years. These tumors typically arise in the deep soft tissues, often near the large joints of the extremities. While the radiological features of these tumors are not definitely indicative, the presence of calcification in a soft-tissue mass (occurring in 30% of cases), adjacent to a joint, strongly suggests the diagnosis. Cross-sectional imaging characteristics play a crucial role in diagnosing synovial sarcomas. They often reveal significant characteristics such as multilobulation and pronounced heterogeneity (forming the "triple sign"), in addition to features like hemorrhage and fluid-fluid levels with septa (resulting in the "bowl of grapes" appearance). Nevertheless, the existence of non-aggressive features, such as gradual growth (with an average time to diagnosis of 2-4 years) and small size (initially measuring < 5 cm) with well-defined margins, can lead to an initial misclassification as a benign lesion. Larger size, older age, and higher tumor grade have been established as adverse predictive indicators for both local disease recurrence and the occurrence of metastasis. Recently, the prognostic importance of CT and MRI characteristics for synovial sarcomas was elucidated. These include factors like the absence of calcification, the presence of cystic components, hemorrhage, the bowl of grape sign, the triple sign, and intercompartmental extension. Wide surgical excision remains the established approach for definitive treatment. Gaining insight into and identifying the diverse range of presentations of synovial sarcomas, which correlate with the prognosis, might be helpful in achieving the optimal patient management.
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Affiliation(s)
- Eun Byul Cho
- Department of Radiology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu 11765, Republic of Korea
| | - Seul Ki Lee
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jee-Young Kim
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Yuri Kim
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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4
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Hammad A, Ahmed O, Connell PP, Olson D, Balach T. Team Approach: Management of Pathologic Fractures. JBJS Rev 2023; 11:01874474-202301000-00004. [PMID: 36722819 DOI: 10.2106/jbjs.rvw.22.00166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
» Optimal care for pathologic fractures centers on the use of a multidisciplinary team; thus, whenever there is a concern for pathologic fracture and proper workup is unable to be performed, prompt referral to a center equipped to manage these injuries should occur. » Fixation strategies for pathologic fractures must take into account patient characteristics, cancer subtypes, and overall goals of treatment. » As the treatments of cancers improve, patient life expectancy with disease will improve as well. This will lead to an increase in the incidence of impending or completed pathologic fractures. The broader subspecialties of orthopaedics must be aware of general principles in the diagnosis and management of these injuries.
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Affiliation(s)
- Aws Hammad
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medicine & Biological Sciences, Chicago, Illinois
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Krishnan A, Marathe N, Degulmadi D, Mayi S, Rai RR, Bali SK, Parmar V, Amin P, Dave M, Dave BR. Transpedicular vertebral biopsy under O-arm navigation: a technical note. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00165-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Despite emerging techniques, sample inadequacy remains the most important factor that necessitates need for repeat biopsy. Transpedicular Biopsy has diagnostic accuracy ranging from 75 to 90% in both computed tomography guided or percutaneous C-arm guided biopsy. Presenting in this article is an add on technique as a modification to enhance quality and quantity of sample obtained using a self designed trocar cannula with computed tomography-based Navigation.
Main body
We have used transpedicular biopsy technique under C Arm fluoroscopy, previously, where we used a self-designed trocar and cannula in our study of 71 cases & reported an accuracy of 88.7% with no reported complications. This is add on modification of same technique where under 3D navigation, we introduce a pituitary forceps through a correctly positioned cannula. This helps for biopsy of soft lesions/ discal level pathologies. Also, multi-planar adjustment of cannula after initial Stealth O-Arm navigation helps in sampling of different regions of vertebral body by reinsertion of pituitary forceps with simple manipulation of cannula without withdrawal. This minimizes risk of fracturing pedicle. With our technical modification, cannulated drill bit with core opening can be drilled through cannula to retrieve a sample. Our technique has limitations being experience driven and also enabling technology dependent. However, same method can be applied using 2-dimensional fluoroscopy without navigation.
Conclusion
Our technique of using pituitary forceps through cannula is highly effective in getting adequate representative sample with spectrum ranging from hard sclerotic lesions to soft lesions and discal pathologies. This procedure can be used with traditional 2-dimensional fluoroscopy as well as with 3-dimensional navigated precision.
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6
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Uddin A, Flanagan G, Reilly I. Surgical excision of complex lipoma from the foot: A case report. Clin Case Rep 2022; 10:e5953. [PMID: 35769241 PMCID: PMC9210133 DOI: 10.1002/ccr3.5953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/11/2022] [Accepted: 05/26/2022] [Indexed: 12/02/2022] Open
Abstract
Malignant soft tissue tumors of the foot and ankle are rare but diagnostic imaging and/or interventional biopsy are vital to establish the nature and grading of a suspicious tumor prior to definitive surgical intervention. The purpose of the study is to provide an account on how a symptomatic mass of the plantar aspect of the foot warranted a referral to a sarcoma center, highlighting the importance of having access to diagnostic imaging and a pathway to refer suspected cases to specialist centers. A single patient with a symptomatic soft tissue tumor of the plantar foot was referred from our service to the regional sarcoma center who considered to be benign, and therefore, open surgical resection was performed by our team. Histopathological analysis identified the excised mass as a lipoma. At 2 years, postoperatively there was no recurrence, and the patient presented with an asymptomatic foot. United Kingdom (UK) guidelines suggest that all soft tissue masses of suspicious nature, greater than 50 mm, deep seated irrespective of size, or fast growing lesions should be referred to a sarcoma unit prior to surgical management. European guidance identifies a threshold of 15 mm for a mass in the foot. Patients presenting with red flag symptoms irrespective of size of mass should be referred to a sarcoma center. Advanced imaging and multidisciplinary input to enable appropriate surgical planning is recommended for suspicious soft tissue tumors that present to the foot and ankle surgeon.
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Affiliation(s)
- Akram Uddin
- Department of Podiatric Surgery Northamptonshire Healthcare NHS Foundation Trust Northamptonshire UK
- Department of Podiatric Surgery Essex Partnership University NHS Foundation Trust Bedford UK
| | - George Flanagan
- Department of Podiatric Surgery Northamptonshire Healthcare NHS Foundation Trust Northamptonshire UK
| | - Ian Reilly
- Department of Podiatric Surgery Northamptonshire Healthcare NHS Foundation Trust Northamptonshire UK
- Department of Podiatry University of Huddersfield Huddersfield UK
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7
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Artificial intelligence significantly improves the diagnostic accuracy of deep myxoid soft tissue lesions in histology. Sci Rep 2022; 12:6965. [PMID: 35484289 PMCID: PMC9051062 DOI: 10.1038/s41598-022-11009-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/18/2022] [Indexed: 12/04/2022] Open
Abstract
Deep myxoid soft tissue lesions have posed a diagnostic challenge for pathologists due to significant histological overlap and regional heterogeneity, especially when dealing with small biopsies which have profoundly low accuracy. However, accurate diagnosis is important owing to difference in biological behaviors and response to adjuvant therapy, that will guide the extent of surgery and the need for neo-adjuvant therapy. Herein, we trained two convolutional neural network models based on a total of 149,130 images representing diagnoses of extra skeletal myxoid chondrosarcoma, intramuscular myxoma, low-grade fibromyxoid sarcoma, myxofibrosarcoma and myxoid liposarcoma. Both AI models outperformed all the pathologists, with a significant improvement of accuracy up to 97% compared to average pathologists of 69.7% (p < 0.00001), corresponding to 90% reduction in error rate. The area under curve of the best AI model was on average 0.9976. It could assist pathologists in clinical practice for accurate diagnosis of deep soft tissue myxoid lesions, and guide clinicians for precise and optimal treatment for patients.
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Mosku N, Heesen P, Studer G, Bode B, Spataro V, Klass ND, Kern L, Scaglioni MF, Fuchs B. Biopsy Ratio of Suspected to Confirmed Sarcoma Diagnosis. Cancers (Basel) 2022; 14:cancers14071632. [PMID: 35406402 PMCID: PMC8996854 DOI: 10.3390/cancers14071632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/04/2022] [Accepted: 03/18/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Determining the biology of mesenchymal tumor, imaging alone is usually not enough, and the final diagnosis is established through tissue analysis If the indication to perform a biopsy is not established frequently enough, an undesired unplanned resection of a sarcoma may result, and conversely, a patient’s discomfort as well as costs may increase. In here, using a real-world data registry of quality, we included the absolute number of a consecutive series of patients, to determine the prevalence of biopsies and its related diagnosis, to establish a reference, which may allow for the definition of a quality indicator for the work-up within a multidisciplinary team. Abstract The ratio of malignancy in suspicious soft tissue and bone neoplasms (RMST) has not been often addressed in the literature. However, this value is important to understand whether biopsies are performed too often, or not often enough, and may therefore serve as a quality indicator of work-up for a multidisciplinary team (MDT). A prerequisite for the RMST of an MDT is the assessment of absolute real-world data to avoid bias and to allow comparison among other MDTs. Analyzing 950 consecutive biopsies for sarcoma-suspected lesions over a 3.2-year period, 55% sarcomas were confirmed; 28% turned out to be benign mesenchymal tumors, and 17% non-mesenchymal tumors, respectively. Of these, 3.5% were metastases from other solid malignancies, 1.5% hematologic tumors and 13% sarcoma simulators, which most often were degenerative or inflammatory processes. The RMST for biopsied lipomatous lesions was 39%. The ratio of unplanned resections was 10% in this series. Reorganizing sarcoma work-up into integrating practice units (IPU) allows the assessment of real-world data with absolute values over the geography, thereby enabling the definition of quality indicators and addressing cost efficiency aspects of sarcoma care.
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Affiliation(s)
- Nasian Mosku
- Faculty of Medicine, University of Lucerne, 6000 Lucerne, Switzerland; (N.M.); (G.S.); (M.F.S.)
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Philip Heesen
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Gabriela Studer
- Faculty of Medicine, University of Lucerne, 6000 Lucerne, Switzerland; (N.M.); (G.S.); (M.F.S.)
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Beata Bode
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Vito Spataro
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Natalie D. Klass
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Lars Kern
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Mario F. Scaglioni
- Faculty of Medicine, University of Lucerne, 6000 Lucerne, Switzerland; (N.M.); (G.S.); (M.F.S.)
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Bruno Fuchs
- Faculty of Medicine, University of Lucerne, 6000 Lucerne, Switzerland; (N.M.); (G.S.); (M.F.S.)
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
- Correspondence: ; Tel.: +41-41-229-50-00
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9
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Ariizumi T, Kawashima H, Yamagishi T, Oike N, Murayama Y, Umezu H, Endo N, Ogose A. Diagnostic accuracy of fine needle aspiration cytology and core needle biopsy in bone and soft tissue tumor: A comparative study of the image-guided and blindly performed procedure. Ann Diagn Pathol 2022; 59:151936. [DOI: 10.1016/j.anndiagpath.2022.151936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 02/05/2022] [Accepted: 03/15/2022] [Indexed: 11/27/2022]
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10
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Accuracy of core needle biopsy for histologic diagnosis of soft tissue sarcoma. Sci Rep 2022; 12:1886. [PMID: 35115589 PMCID: PMC8813997 DOI: 10.1038/s41598-022-05752-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/14/2022] [Indexed: 11/08/2022] Open
Abstract
The biopsy technique of choice in soft tissue sarcoma (STS) diagnosis is controversial. We examined the diagnostic accuracy of percutaneous core needle biopsy (CNB) and compared it to open incisional biopsy. A retrospective study included 91 incisional biopsies and 102 CNBs. A pair-match investigation was conducted on 19 patient pairs, comparing sensitivity, specificity, and diagnostic accuracy. Furthermore, we investigated the role of molecular pathology in sarcoma diagnostics. In 81/91 (89%) patients with incisional biopsy, the entity was confirmed by definitive pathology, whereas this was the case in 89/102 (87%) CNB patients (p = 0.52). Grading remained unchanged in 46/55 (84%) of incisional and 54/62 (87%) of CNBs (p = 0.61). The pair matched analysis showed that the correct entity was determined in 96% of incisional and 97.6% of core needle biopsies. The time between the initial consultation and the interdisciplinary tumor board's treatment recommendation was shorter in core needle biopsies (8.37 vs. 15.63 days; p < 0.002). Incisional biopsies led to two wound infections and one hematoma, whereas wound infection occurred in one patient after CNB. CNB leads to faster diagnosis while reaching the same histological accuracy and is less burdensome for patients. Still, surgeons need to remain aware of the possibility of biopsy failure.
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11
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Jager L, Johnson DN, Sukhanova M, Streich L, Chapa AR, Alexiev BA. Diagnosis of giant cell-rich bone tumors on core needle biopsy: a practical approach. Pathol Res Pract 2022; 231:153777. [DOI: 10.1016/j.prp.2022.153777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 12/01/2022]
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12
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Stanborough RO, Long JR, Garner HW. Bone and Soft Tissue Tumors. Radiol Clin North Am 2022; 60:311-326. [DOI: 10.1016/j.rcl.2021.11.009] [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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13
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Gala KB, Shetty NS, Janu AK, Shetty N, Kulkarni SS. Percutaneous CT Guided Vertebral Biopsy: Anatomy and Technical Considerations. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1729778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractIn this review article, the authors discuss the anatomy and technical aspects of CT-guided biopsy of vertebral lesions. CT guidance is highly useful for vertebral biopsies, as the anatomy of the spine is complex and varies widely across the levels. Prebiopsy imaging should be reviewed and later correlated with the final histopathological diagnosis. The majority of the spine biopsies are performed under local anesthesia, except those in critical locations and pediatric age groups. The biopsy sample is sent for histopathological analysis and/or microbiological analysis depending on the indications. It is preferable to use a coaxial system for biopsies, so multiple cores can be obtained with a single needle puncture, thus minimizing the negative yield and complications. Complications after image-guided percutaneous biopsy are rare and can be managed easily.
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Affiliation(s)
- Kunal Bharat Gala
- Division of Interventional Radiology, Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nitin S. Shetty
- Division of Interventional Radiology, Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Amit Kumar Janu
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Neeraj Shetty
- Division of Interventional Radiology, Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Suyash S. Kulkarni
- Division of Interventional Radiology, Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
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14
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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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15
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Comparison of Tru-Cut Biopsy and Incisional Biopsy in Achieving Prompt Diagnosis of Maxillofacial Pathology. J Maxillofac Oral Surg 2021; 20:479-485. [PMID: 34408377 DOI: 10.1007/s12663-021-01557-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/27/2021] [Indexed: 10/21/2022] Open
Abstract
Tru-cut (core needle) biopsy has many advantages over open biopsy. It is quick and easy to perform, may be carried out in the outpatient department, avoids incision through previously irradiated skin and has few complications. The purpose of this study is to compare the two available biopsy techniques that are Tru-cut biopsy and incisional biopsy in achieving prompt diagnosis of maxillofacial pathology. A prospective study was conducted in 25 patients reported to our department. The Tru-cut biopsy was performed by using 14 gauge disposable Tru-cut biopsy needles (Baxter, made in the USA) by means of two successive insertions with different angulations of the needle into the core of the lesion followed by incisional biopsy. The diagnostic criteria which were evaluated include: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Tru-cut biopsy had sensitivity of 68.42%; specificity of 83.33%; PPV of 92.86%; NPV of 45.45% with accuracy rate of 72%. The Tru-cut biopsy method was evaluated as a very helpful method for prompt diagnosis of maxillofacial pathology since it is practical to perform, causes minimum trauma to the tissue, decreases the metastatic risk of malignant lesions during the procedure and relatively free from complications.
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16
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Percutaneous Spine Biopsy: A Review of the Current Literature. J Am Acad Orthop Surg 2021; 29:e681-e692. [PMID: 33591122 DOI: 10.5435/jaaos-d-20-00100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 01/01/2021] [Indexed: 02/07/2023] Open
Abstract
Spine lesions are often the result of pathologic processes elsewhere in the body; prompt and accurate diagnosis are crucial to optimize treatment. Despite modern advances in imaging modalities, definitive diagnosis ultimately requires biopsy and histologic analysis. Although open surgical biopsy has traditionally been considered the benchmark, percutaneous image-guided needle biopsy of the spine has proven to be a safe and highly effective method in making a diagnosis. Choosing the optimal biopsy approach, instrumentation and modality of image guidance may depend on a number of factors including lesion type, location, and level within the spine. Knowledge of relevant anatomy, indications, contraindications, and potential complications are critical to a successful biopsy procedure.
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Synovial Sarcoma: A Clinical Review. ACTA ACUST UNITED AC 2021; 28:1909-1920. [PMID: 34069748 PMCID: PMC8161765 DOI: 10.3390/curroncol28030177] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 01/26/2023]
Abstract
Synovial sarcomas (SS) represent a unique subset of soft tissue sarcomas (STS) and account for 5–10% of all STS. Synovial sarcoma differs from other STS by the relatively young age at diagnosis and clinical presentation. Synovial sarcomas have unique genomic characteristics and are driven by a pathognomonic t(X;18) chromosomal translocation and subsequent formation of the SS18:SSX fusion oncogenes. Similar to other STS, diagnosis can be obtained from a combination of history, physical examination, magnetic resonance imaging, biopsy and subsequent pathology, immunohistochemistry and molecular analysis. Increasing size, age and tumor grade have been demonstrated to be negative predictive factors for both local disease recurrence and metastasis. Wide surgical excision remains the standard of care for definitive treatment with adjuvant radiation utilized for larger and deeper lesions. There remains controversy surrounding the role of chemotherapy in the treatment of SS and there appears to be survival benefit in certain populations. As the understanding of the molecular and immunologic characteristics of SS evolve, several potential systematic therapies have been proposed.
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AbdulGani AF, Al Ahmad M. Autoregressive parametric modeling combined ANOVA approach for label-free-based cancerous and normal cells discrimination. Heliyon 2021; 7:e07027. [PMID: 34036199 PMCID: PMC8134980 DOI: 10.1016/j.heliyon.2021.e07027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/28/2021] [Accepted: 05/05/2021] [Indexed: 12/01/2022] Open
Abstract
Label free based methods received huge interest in the field of bio cell characterizations because they do not cause any cell damage nor contribute any change in its compositions. This work takes a close outlook of cancerous cells discrimination from normal cells utilizing parametric modeling approach. Autoregressive (AR) modeling technique is used to fit the measured optical transmittance profiles of both cancer and normal cells. The transmitted light intensity, when passes through the cells, gets affected by their intercellular compositions and membrane properties. In this study, four types of cells: lung-cancerous and normal, liver-cancerous and normal, were suspended in their corresponding medium and their transmission characteristics were collected and processed. The AR coefficients of each type of the cell were analyzed with the statistical technique called Analysis of variance (ANOVA), which provided the significant coefficients. The poles extracted from the significant coefficients resulted in an improved demarcation for normal and cancer cells. These outcomes can be further utilized for cell classification using statistical tools.
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Li ADR, Liu Y, Plott J, Chen L, Montgomery JS, Shih A. Multi-Bevel Needle Design Enabling Accurate Insertion in Biopsy for Cancer Diagnosis. IEEE Trans Biomed Eng 2021; 68:1477-1486. [PMID: 33507862 PMCID: PMC8104469 DOI: 10.1109/tbme.2021.3054922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To obtain definitive cancer diagnosis for suspicious lesions, accurate needle deployment and adequate tissue sampling in needle biopsy are essential. However, the single-bevel needles in current biopsy devices often induce deflection during insertion, potentially causing lesion missampling/undersampling and cancer misdiagnosis. This study aims to reveal the biopsy needle design criteria enabling both low deflection and adequate tissue sampling. METHODS A novel model capable of predicting needle deflection and tissue deformation was first established to understand needle-tissue interaction with different needle tip geometries. Experiments of needle deflection and ex-vivo tissue biopsy were conducted for model validation. RESULTS The developed model showed a reasonably good prediction on the correlation of needle tip type vs. the resultant needle deflection and tissue sampling length. A new multi-bevel needle with the tissue separation point below the needle groove face has demonstrated to be an effective design with an 87% reduction in deflection magnitude and equivalently long tissue sampling length compared to the current single-bevel needle. CONCLUSION This study has revealed two critical design criteria for biopsy needles: 1) multiple bevel faces at the needle tip can generate forces to balance bending moments during insertion to enable a low needle deflection and 2) the tissue separation point should be below the needle groove face to ensure long tissue sampling length. SIGNIFICANCE The developed methodologies and findings in this study serve as proof-of-concept and can be utilized to investigate various biopsy procedures to improve cancer diagnostic accuracy as well as other procedures requiring accurate needle insertion.
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Basu S, Gala RB, Solanki AM. Percutaneous wide bore needle biopsy for spinal lesions using the kyphoplasty cannula-a technical note. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2852-2856. [PMID: 33772382 DOI: 10.1007/s00586-021-06819-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/04/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Management of vertebral and discovertebral lesions depends on highly specific modalities like biopsy and histopathology. The transpedicular and transforaminal routes have gained popularity for obtaining samples for diagnosing these lesions. Sample inadequacy plays an important part in lowering the diagnostic accuracy. Present study introduces a technical modification by using a kyphoplasty cannula and pituitary forceps through it thus improving sample adequacy and diagnostic accuracy. METHODS Seventy-one patients with radiological evidence of spinal lesions from T1 to S1 were included. After obtaining samples via the transpedicular route they were sent for aerobic, anaerobic, acid fast bacilli & fungal cultures, Mycobacterium Tuberculosis/Radio Immuno Frequency (MTB/RIF) Assay and histopathological examination. In lesions with minimal vertebral erosions the transforaminal route was used to obtain samples from the disc space. RESULTS Sixty-eight patients (95.8%) had a definite diagnosis of which 37 patients (54.4%) tested positive for vertebral osteomyelitis/discitis. All the samples were found to be adequate on histopathological examination. The remaining 3 patients showed chronic inflammation and responded to oral and intravenous antibiotics. None of the patients underwent repeat biopsy. There were no perioperative complications. CONCLUSIONS Percutaneous transpedicular biopsy has evolved as the intervention of choice in diagnosing radiologically proven vertebral body lesions. Our technique of using a pituitary forceps through a cannula is highly effective in getting an adequate representative sample with excellent accuracy in diagnosis. This procedure is beneficial for soft tissue lesions and for infective pathology especially discitis.
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Affiliation(s)
- Saumyajit Basu
- Park clinic, 4, Gorky Terrace, Minto Park, Kolkata, 700017, India
| | - Rohan B Gala
- Park clinic, 4, Gorky Terrace, Minto Park, Kolkata, 700017, India.
| | - Anil M Solanki
- Park clinic, 4, Gorky Terrace, Minto Park, Kolkata, 700017, India
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21
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Pouedras M, Briand S, Crenn V, Cassagnau E, Gouin F. Non image-guided core needle biopsies can be used safely to improve diagnostic efficiency for soft tissue tumors. Surg Oncol 2021; 37:101518. [PMID: 33434767 DOI: 10.1016/j.suronc.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/11/2020] [Accepted: 12/27/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Front-line biopsy remains the rule in the management of soft tissue mass syndromes. Although open biopsy has long been considered the gold standard, it has recently been shown that a percutaneous biopsy is associated with a reduction in the rate of complications and cost, while maintaining high diagnostic accuracy. Though there is much literature regarding the diagnostic accuracy of image-guided and open biopsies for soft tissue tumors, the accuracy of percutaneous non image-guided biopsies has not been well documented. The objective of this study was to compare the failure rate of non image-guided biopsies, image-guided biopsies and open biopsies for the diagnosis of soft tissue tumors. We also attempted to identify the failure risk factors for non image-guided biopsies and we compared the diagnostic delay of the three types of biopsy. MATERIALS AND METHODS This was a continuous, single-center retrospective study. We reviewed the results from 337 patients managed with a biopsy (percutaneous or open) for a soft tissue tumor, all carried out in our center between January 2010 and December 2015. Biopsy technique was chosen by the treating orthopedic surgeon, according to the clinical and radiological characteristics of the mass. 141 patients (41.8%) had a non-image-guided biopsy as the first-line diagnostic procedure, 81 (24.0%) had an image-guided biopsy, and 115 (34.1%) an open biopsy. Diagnostic failure was defined either by a non-contributory biopsy, the need for repeat biopsy, or a major histological discordance obtained from the resected tumor piece. The risk factors studied were tumor characteristics, patient' characteristics and sampling modalities. Diagnostic delay was defined as the period between the day of the first external consultation at the hospital and the day of the notification of the diagnosis by the physician. RESULTS We obtained a failure rate of 9.9% (14 patients) for non image-guided biopsies. Eleven were non-contributive and three were considered as errors of diagnosis. The failure rate for image-guided biopsies was 18.5% (15 patients), with no significant difference compared with non image-guided biopsies. The open biopsies were associated with a failure rate of 6.9% (eight patients). We found no failure risk factors for non image-guided biopsies. Diagnostic delay was significantly shorter for non image-guided biopsies (p = 0.001). CONCLUSION When performed in a referral center by the patient's surgeon, a non-image-guided core needle biopsy is a safe procedure which ensures equivalent diagnostic accuracy for soft tissue tumors, while reducing the diagnostic delay.
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Affiliation(s)
- Marie Pouedras
- Orthopedics and Trauma Department, University Hospital of Nantes, 1, place Alexis Ricordeau, 44093, Nantes Cedex 1, France.
| | - Sylvain Briand
- Orthopedic and Traumatology Surgery Department, Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris, Paris-Sud University ORSAY, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France.
| | - Vincent Crenn
- Orthopedics and Trauma Department, University Hospital of Nantes, 1, place Alexis Ricordeau, 44093, Nantes Cedex 1, France; Inserm UMR 1238, Bone sarcomas and Remodeling of Calcified Tissues, France.
| | - Elisabeth Cassagnau
- Department of Pathology, University Hospital of Nantes, 1, place Alexis Ricordeau, 44093, Nantes Cedex 1, France.
| | - François Gouin
- Centre Léon Bérard, Department of Surgery, Lyon, France; Inserm U1238, Bone Sarcomas and Remodeling of Calcified Tissue, France.
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Gupta R, Sharma S, Verma S, Singh L, Gupta CR, Gupta S. Pediatric fine-needle aspiration cytology: An audit of 266 cases of pediatric tumors with cytologic-histologic correlation. Cytojournal 2020; 17:25. [PMID: 33273959 PMCID: PMC7708969 DOI: 10.25259/cytojournal_101_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 08/24/2020] [Indexed: 11/20/2022] Open
Abstract
Objectives: Fine-needle aspiration cytology (FNAC), a well-accepted minimally invasive diagnostic technique utilized in adults, is gradually gaining ground for pediatric patients as well. However, there are very few comprehensive reports in the literature on utility of FNA in pre-operative diagnosis of pediatric tumors. Material and Methods: An observational study was conducted at a cancer research center and a pediatric tertiary care hospital over a 5-year period. A cytologic-histologic correlation was performed for FNACs performed in pediatric patients for a clinical diagnosis of neoplastic lesions at both the centers. Relevant clinical details and histopathology, wherever available, were retrieved. Sensitivity, specificity, and accuracy of FNAC in diagnosis of malignant lesion were calculated from the cases with available histologic correlation. Results: Of the 266 cases included, there was a slight male predominance with lymphadenopathy being the most common presentation and non-Hodgkin’s lymphoma as the most frequent diagnosis in cases clinically suspected to have a neoplasm. Histologic correlation was available in 112 cases with 100% concordance in liver and kidney tumors. Few rare cytologic diagnoses such as papillary renal cell carcinoma, mesenchymal hamartoma of the liver, and thymolipoma could be accurately rendered on FNAC smears in conjunction with the clinic-radiologic features. The sensitivity, specificity, and accuracy of FNA in diagnosing malignant pediatric tumors were found to be 100%, 92.6%, and 97.7%, respectively. Conclusion: The present study underscores the high sensitivity and accuracy of FNAC in diagnosis of pediatric tumors, both in superficial and deep-seated locations. Awareness of the cytomorphologic features and clinic-radiologic correlation may assist the cytopathologists in rendering a precise diagnosis of rare pediatric tumors as well.
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Affiliation(s)
- Ruchika Gupta
- Department of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Sugandha Sharma
- Department of Pathology, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Sarika Verma
- Department of Pathology, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Lavleen Singh
- Department of Pathology, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Chhabi R Gupta
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Sanjay Gupta
- Department of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
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Köster J, Ghanei I, Domanski HA. Comparative cytological and histological assessment of 828 primary soft tissue and bone lesions, and proposal for a system for reporting soft tissue cytopathology. Cytopathology 2020; 32:7-19. [PMID: 32926591 PMCID: PMC7821273 DOI: 10.1111/cyt.12914] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/06/2020] [Accepted: 09/07/2020] [Indexed: 12/13/2022]
Abstract
Introduction The aim of the study was to evaluate the diagnostic utility of fine needle aspiration (FNA) cytology and core needle biopsies (CNBs) in a series of primary soft tissue and bone lesions and to test a possible system for reporting results of FNA cytology of soft tissue lesion. Methods This retrospective study encompassed 828 primary soft tissue and bone lesions, analysed with FNA, CNB and/or surgical specimen in order to perform sensitivity/specificity as well as accuracy analyses. The series was then used to test a system for reporting soft tissue cytopathology with six categories and the risk of malignancy in each category was calculated. Results With a malignant diagnosis defined as positive test result, FNA and CNB analysis showed sensitivity of 87% and 94%, respectively, and specificity of 89% and 95%, respectively. FNA and CNB analyses identified the correct histopathological entity of the examined lesion in 55% and 66%, respectively. The risk of malignancy within the tested categories was non‐diagnostic 42%, non‐neoplastic 0%, atypia of unknown significance 46%, neoplasm benign 3%, neoplasm of unknown malignant potential 27%, suspicious for malignancy 72% and malignant 97%. Conclusion FNA cytology is a suitable tool to determine the malignant potential of a sampled soft tissue/bone lesion but is inferior to CNB in defining the correct entity. A standardised reporting system might improve the clinical management of patients with soft tissue tumours examined primarily by FNA cytology. The study evaluated the diagnostic utility of fine needle aspiration cytology and core needle biopsies in 828 primary soft tissue and bone lesions. In a second step, a possible system for reporting results of fine needle aspiration cytology of soft tissue lesion was tested.
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Affiliation(s)
- Jan Köster
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden.,Division of Laboratory Medicine, Department of Clinical Genetics and Pathology, Skåne University Hospital, Lund, Sweden
| | - Iman Ghanei
- Department of Orthopedics, Skåne University Hospital, Lund, Sweden
| | - Henryk A Domanski
- Division of Laboratory Medicine, Department of Clinical Genetics and Pathology, Skåne University Hospital, Lund, Sweden
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Domanski HA. Role of fine needle aspiration cytology in the diagnosis of soft tissue tumours. Cytopathology 2020; 31:271-279. [PMID: 32298511 DOI: 10.1111/cyt.12836] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/02/2020] [Accepted: 04/10/2020] [Indexed: 01/22/2023]
Abstract
Fine needle aspiration cytology (FNAC) is a widely accepted safe, simple and rapid diagnostic procedure used in the examination of neoplastic and non-neoplastic lesions of various locations. Since its introduction, FNAC has developed into an effective diagnostic tool practiced in a large majority of medical centres evaluating and treating oncological patients. The role of FNAC has been limited in the examination of primary soft tissue lesions, however, as many physicians working in this area recommended against using FNAC. An increasing use of minimally invasive diagnostic procedures in the last decade has resulted in a better acceptance of FNAC as a first-line approach or as a complementary tool to core needle biopsy in the diagnosis of musculoskeletal lesions. This review discusses the role and value of FNAC in the evaluation and treatment of soft tissue tumours based on the experience gathered over the course of 48 years at the Sarcoma Center in Lund, Sweden. FNAC reports most often provide diagnostic information allowing the initiation of treatment or, when definitive diagnosis cannot be rendered from a cytological examination, guiding the continued diagnostic investigation. The main advantages of soft tissue FNAC are good sensitivity and specificity, low morbidity, speed of diagnosis, and low cost/benefit ratio. The most important disadvantages stem from limited experience in cytological diagnosis of soft tissue tumours and a lack of standardised and uniform reporting system for soft tissue FNAC.
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Affiliation(s)
- Henryk A Domanski
- Division of Laboratory Medicine, Department of Clinical Genetics and Pathology, Lund University Hospital,, Lund, Sweden.,Department of Tumor Pathology and Prevention, Poznan University of Medical Sciences, Poznań, Poland
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25
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Tøttrup M, Eriksen JD, Hellfritzsch MB, Sørensen FB, Baad-Hansen T. Diagnostic accuracy of ultrasound-guided core biopsy of peripheral nerve sheath tumors. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:134-138. [PMID: 31441068 DOI: 10.1002/jcu.22769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/15/2019] [Accepted: 07/31/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE To retrospectively evaluate the diagnostic accuracy of and complications from ultrasound-guided core needle biopsy (UGCNB) of suspected peripheral nerve sheath tumors (PNSTs). METHODS Patients undergoing UGCNB from January 2004 to December 2016, based on the suspicion of PNST, were included in the study. Age, gender, anatomical location, dates of relevant events, and histopathological reports of the UGCNB cores and the resected tumors were retrieved from the patients' medical records. RESULTS A total of 154 UGCNBs were identified. One hundred and forty (90.9%) of these resulted in a conclusive histopathological report, while 14 were unsuited for histopathological analysis due to insufficient amount of tissue and/or nonrepresentative tissue. The overall diagnostic accuracy of UGCNB with respect to discriminate malignant from benign tumors was 99.3%, while correct specific UGCNB diagnoses were confirmed in 95.1% of the cases. Sensitivity and specificity were 90.9% (95% CI: 58.7-99.8%) and 100% (95% CI: 97.2-100%), respectively. The positive predictive value was 100%, and the negative predictive value was 99.2%. Except for one patient, who reported mild dysesthesia, which resolved 2 days after the UGCNB, no complications were reported. CONCLUSION This study suggests that UGCNB is accurate and safe in patients suspected for PNST.
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Affiliation(s)
- Mikkel Tøttrup
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob D Eriksen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Flemming B Sørensen
- University Institute of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Baad-Hansen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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Birgin E, Yang C, Hetjens S, Reissfelder C, Hohenberger P, Rahbari NN. Core needle biopsy versus incisional biopsy for differentiation of soft-tissue sarcomas: A systematic review and meta-analysis. Cancer 2020; 126:1917-1928. [PMID: 32022262 DOI: 10.1002/cncr.32735] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/11/2019] [Accepted: 01/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Controversies exist regarding the biopsy technique of choice for the accurate diagnosis of soft-tissue sarcoma (STS). The objective of this systematic review and meta-analysis was to compare the diagnostic accuracy of core needle biopsy (CNB) versus incisional biopsy (IB) in STS with reference to the final histopathological result. METHODS Studies regarding the diagnostic accuracy of CNB and IB in detecting STS were searched systematically in the MEDLINE and EMBASE databases. Estimates of sensitivity and specificity with associated 95% CIs for diagnostic accuracy were calculated. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS-2). RESULTS A total of 17 studies comprising 2680 patients who underwent 1582 CNBs and 241 IBs with subsequent tumor resection met the inclusion criteria. The sensitivity and specificity of CNB and IB to detect the dignity of lesions were 97% (95% CI, 95%-98%) and 99% (95% CI, 97%-99%), respectively, and 96% (95% CI, 92%-99%) and 100% (95% CI, 94%-100%), respectively. Estimates of the sensitivity and specificity of CNB and IB to detect the STS histotype were 88% (95% CI, 86%-90%) and 77% (95% CI, 72%-81%), respectively, and 93% (95% CI, 87%-97%) and 65% (95% CI, 49%-78%), respectively. Patients who underwent CNB had a significantly reduced risk of complications compared with patients who underwent IB (risk ratio, 0.14; 95% CI, 0.03-0.56 [P ≤ .01). Quality assessment of studies revealed a high risk of bias. CONCLUSIONS CNB has high accuracy in diagnosing the dignity of lesions and STS histotype in patients with suspected STS with fewer complications compared with IB. Therefore, CNB should be regarded as the primary biopsy technique.
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Affiliation(s)
- Emrullah Birgin
- Department of Surgery, Medical Faculty Mannheim, Mannheim School of Medicine, Heidelberg University, Mannheim, Germany
| | - Cui Yang
- Department of Surgery, Medical Faculty Mannheim, Mannheim School of Medicine, Heidelberg University, Mannheim, Germany
| | - Svetlana Hetjens
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Reissfelder
- Department of Surgery, Medical Faculty Mannheim, Mannheim School of Medicine, Heidelberg University, Mannheim, Germany
| | - Peter Hohenberger
- Department of Surgery, Medical Faculty Mannheim, Mannheim School of Medicine, Heidelberg University, Mannheim, Germany
| | - Nuh N Rahbari
- Department of Surgery, Medical Faculty Mannheim, Mannheim School of Medicine, Heidelberg University, Mannheim, Germany
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Alagic Z, Alagic H, Bujila R, Srivastava S, Jasim S, Lindqvist M, Wick MC. First experiences of a low-dose protocol for CT-guided musculoskeletal biopsies combining different radiation dose reduction techniques. Acta Radiol 2020; 61:28-36. [PMID: 31091966 DOI: 10.1177/0284185119847676] [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] [Indexed: 11/15/2022]
Abstract
Background The use of computed tomography (CT) for image guidance during biopsies is a powerful approach. The method is, however, often associated with a significant level of radiation exposure to the patient and operator. Purpose To investigate if a low-dose protocol for CT-guided musculoskeletal (MSK) biopsies, including a combination of different radiation dose (RD) techniques, is feasible in a clinical setting. Material and Methods Fifty-seven patients underwent CT-guided fine-needle aspiration cytology (FNAC) utilizing the low-dose protocol (group A). A similar number of patients underwent CT-guided FNAC using the reference protocol (group B). Between-group comparisons comprised radiation dose, success rate, image quality parameters, and workflow. Results In group A, the mean total dose-length product (DLP) was 41.2 ± 2.9 mGy*cm, which was statistically significantly lower than of group B (257.4 ± 22.0 mGy*cm), corresponding to a mean dose reduction of 84% ( P<0.001). The mean CTDIvol for the control scans were 1.88 ± 0.09 mGy and 13.16 ± 0.40 mGy for groups A and B, respectively ( P < 0.001). The success rate in group A was 91.2% and 87.9% in group B ( P = 0.56). No negative effect on image-quality parameters, time of FNAC, and number of control scans were found. Conclusion We successfully developed a low-dose protocol for CT-guided MSK biopsies that maintains diagnostic accuracy and image quality at a fraction of the RD compared to the reference biopsy protocol at our clinic.
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Affiliation(s)
- Zlatan Alagic
- Functional Unit for Musculoskeletal Radiology, Function Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
- Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Haris Alagic
- Diagnostic Radiology, Institute for molecular medicine and surgery (MMK), Karolinska Institutet, Stockholm, Sweden
| | - Robert Bujila
- Functional Unit for Medical Radiation Physics and Nuclear Medicine, Function Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Physics, Royal Institute of Technology, Stockholm, Sweden
| | - Subhash Srivastava
- Functional Unit for Musculoskeletal Radiology, Function Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Saif Jasim
- Functional Unit for Musculoskeletal Radiology, Function Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Lindqvist
- Functional Unit for Musculoskeletal Radiology, Function Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Marius C Wick
- Functional Unit for Musculoskeletal Radiology, Function Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
- Diagnostic Radiology, Institute for molecular medicine and surgery (MMK), Karolinska Institutet, Stockholm, Sweden
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Layfield LJ. Soft tissue tumor diagnosis: A three prong approach utilizing pattern analysis, immunocytochemistry, and molecular diagnostics. Diagn Cytopathol 2019; 48:265-284. [PMID: 31868988 DOI: 10.1002/dc.24355] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 12/28/2022]
Abstract
Tissue diagnosis of a soft tissue neoplasm is of paramount importance for the development of an appropriate treatment plan. Biopsy technique including approach and biopsy method is important to the success of diagnosis and subsequent treatment. Histologic and cytologic diagnoses are difficult and complicated by the large number of soft tissue lesions described, distinctly different biopotential for morphologically similar lesions, often small biopsy specimen size, and the generally limited experience many pathologists have in the diagnosis of soft tissue neoplasms. While utilized less frequently than core-needle biopsies, fine-needle aspiration is a valuable initial approach for the classification of soft tissue neoplasms. The combination of pattern based morphologic analysis, immunohistochemistry, and molecular diagnostics represents a utilitarian and generally successful approach for the diagnosis of soft tissue lesions.
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Affiliation(s)
- Lester J Layfield
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri
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Comparison of the diagnostic performances of core needle biopsy in myxoid versus non-myxoid tumors. Eur J Surg Oncol 2019; 45:1293-1298. [DOI: 10.1016/j.ejso.2019.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/07/2019] [Accepted: 05/01/2019] [Indexed: 01/09/2023] Open
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Turkoz KH, Erol B, Seven IE. Tumor cell seeding in the biopsy tract and its clinical significance in osteosarcomas. J Surg Oncol 2018; 118:1335-1340. [PMID: 30399199 DOI: 10.1002/jso.25282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/09/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The reasons behind the removal of the biopsy tract in osteosarcomas are not well known, and studies about tumor seeding in the biopsy tract have generated conflicting results. This study is designed to evaluate the presence and possible clinical significance of tumor cell seeding in the biopsy tract of osteosarcomas. METHODS We prospectively evaluated 55 cases of osteosarcomas for tumor cell seeding and other clinical and pathologic prognostic parameters. RESULTS Eleven cases (20%) involved microscopic tumor foci in the biopsy tract. The higher local recurrence rates (P = 0.005) and worse recurrence-free survivals ( P = 0.009) were observed in patients with tumor cell foci in the biopsy tract. Mitotic rate, tumor cell pleomorphism, and matrix production in main tumor foci were higher in cases with tumor seeding ( P = 0.047, P = 0.012, and P = 0.005, respectively) CONCLUSIONS: Tumor seeding in the biopsy tract is a fact in osteosarcomas. The higher local recurrence rates are more likely to occur in cases with tumor seeding.
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Affiliation(s)
- Kemal H Turkoz
- Department of Pathology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Bulent Erol
- Department of Orthopedics and Traumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Ipek E Seven
- Department of Pathology, Marmara University, School of Medicine, Istanbul, Turkey
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31
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Lau HD, Kong CS, Kao CS. Evaluation of diagnostic accuracy and a practical algorithmic approach for the diagnosis of renal masses by FNA. Cancer Cytopathol 2018; 126:782-796. [PMID: 30193011 DOI: 10.1002/cncy.22037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/21/2018] [Accepted: 06/15/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The classification of renal neoplasms is essential for oncologic risk stratification and clinical management, and an accurate pretreatment pathologic diagnosis can provide useful guidance for active surveillance, minimally invasive ablative therapy, or surgical resection and can reduce the incidence of overtreatment. Previous studies evaluating the diagnostic accuracy of fine-needle aspiration (FNA) and core-needle biopsy (CNB) for renal masses are limited and show variable results. METHODS Two hundred forty-seven renal FNA cases with or without concurrent CNB performed and/or reviewed at the Stanford University School of Medicine over the course of 20 years were identified. Cytohistopathologic correlation was performed for 77 cases with subsequent resection specimens. All available case materials were reviewed, and select cases were worked up further and reclassified as necessary. RESULTS Cytohistopathologic correlation showed 96% diagnostic specificity and 83% sensitivity for renal FNA with or without concurrent CNB. Discordant cases were mostly attributed to sampling errors or suboptimal specimens (79%) and also included 2 non-renal cell carcinoma entities (1 case of angiomyolipoma and 1 case of a benign peripheral nerve sheath tumor) and 1 case involving misclassification of the renal cell carcinoma subtype. CONCLUSIONS There is considerable value in FNA/CNB for the initial diagnosis of renal masses because of the high diagnostic specificity and sensitivity. Sensitivity is predominantly dependent on sufficient sampling, and additional potential diagnostic pitfalls include nonepithelial and rare entities. Judicious use of ancillary techniques is encouraged, especially when one is presented with a limited specimen, and this article presents a practical algorithmic approach to the diagnosis of renal masses using salient morphologic features and results from ancillary studies. Fine-needle aspiration is an accurate method for the diagnosis of renal masses. A practical diagnostic algorithm, based on salient morphologic and ancillary findings, is presented.
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Affiliation(s)
- Hubert D Lau
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Christina S Kong
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Chia-Sui Kao
- Department of Pathology, Stanford University School of Medicine, Stanford, California
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Kubo T, Furuta T, Johan MP, Sakuda T, Ochi M, Adachi N. A meta-analysis supports core needle biopsy by radiologists for better histological diagnosis in soft tissue and bone sarcomas. Medicine (Baltimore) 2018; 97:e11567. [PMID: 30024558 PMCID: PMC6086481 DOI: 10.1097/md.0000000000011567] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although surgical biopsy has historically been considered to be the standard diagnostic biopsy for soft tissue and bone sarcomas, recent literature suggests that percutaneous core needle biopsy yields similar results. Therefore, an evaluation of the exact diagnostic accuracy and associated influential variables of core needle biopsy that is based on a large data set would be useful. METHODS We searched MEDLINE, Web of Science, and EMBASE to identify core needle biopsy studies for predicting final histological subtypes of musculoskeletal lesions. The diagnostic accuracies of core needle biopsy and of surgical biopsy were assessed and compared by using random-effect meta-analyses. The factors relevant to diagnostic accuracy were evaluated by meta-regression and subgroup analyses. RESULTS We selected 32 studies comprising 7209 musculoskeletal lesions. The pooled proportion estimate for the diagnostic accuracy of core needle biopsy was 0.84 (95% confidential interval, CI: 0.81-0.87), which indicated an approximate 84% concordance between core needle biopsy results and final histological diagnoses. The findings of meta-regression and subgroup analyses suggested that radiologists were better core needle biopsy operators than surgeons. An additional meta-analysis for direct comparison between core needle biopsy and surgical biopsy demonstrated that diagnostic accuracy was significantly lower for core needle biopsy than for surgical (pooled odds ratio: 0.39, 95% CI: 0.20-0.76). CONCLUSION Our results suggested that core needle biopsy should be performed by expert radiologists and that surgical biopsy should be performed if diagnosis following core needle biopsy does not match the clinical presentation and radiographic findings.
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Walker JB, Stockwell E, Worhacz K, Kang P, Decomas A. Safety and Accuracy of Core Needle Biopsy for Soft Tissue Masses in an Ambulatory Setting. Sarcoma 2018; 2018:1657864. [PMID: 30008580 PMCID: PMC6020496 DOI: 10.1155/2018/1657864] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/17/2018] [Accepted: 04/16/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Percutaneous needle biopsy has been found to be a safe and accurate method for the initial investigation of soft tissue masses. The notion exists that needle biopsies should be performed in specialized sarcoma centers, which can place a financial burden on patients without a sarcoma center near their place of residence. There is no consensus in the current literature regarding the diagnostic accuracy and clinical utility of clinic-based percutaneous core needle biopsy performed by community orthopedic surgeons with fellowship training in musculoskeletal oncology. QUESTIONS/PURPOSES Our primary goal was to determine if office-based core needle biopsy of soft tissue masses could safely yield accurate diagnoses when performed by a community orthopedic surgeon with fellowship training in musculoskeletal oncology. PATIENTS AND METHODS We retrospectively reviewed the charts of 105 patients who underwent percutaneous core needle biopsy of soft tissue masses in a community clinic. All procedures were performed by one fellowship-trained musculoskeletal oncologist. Accuracy of the initial clinic-based needle biopsy was determined through comparison to the results of pathological analysis of the surgically excised masses. Final data analysis included 69 patients who underwent both clinic-based biopsy and subsequent surgical excision of their masses. RESULTS We found clinic-based biopsies to be 87.0% accurate for exact diagnosis and 94.2% accurate in determining whether the mass was benign or malignant (p < 0.0001). Minor complications related to the clinic-based biopsy occurred in 5.80% of cases, with no documentation of major complications. CONCLUSIONS Our results provide evidence that office-based percutaneous biopsy can be administered safely and yield accurate, clinically useful results when performed by a fellowship-trained musculoskeletal oncologist.
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Affiliation(s)
| | - Erin Stockwell
- University of Arizona College of Medicine, Phoenix, AZ, USA
| | | | - Paul Kang
- University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Amalia Decomas
- University of Arizona College of Medicine, Phoenix, AZ, USA
- The CORE Institute, Phoenix, AZ, USA
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Fairweather M, Gonzalez RJ, Strauss D, Raut CP. Current principles of surgery for retroperitoneal sarcomas. J Surg Oncol 2018; 117:33-41. [PMID: 29315649 DOI: 10.1002/jso.24919] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/21/2017] [Indexed: 12/17/2022]
Abstract
Surgery for primary retroperitoneal sarcomas (RPS) often requires a technically challenging, en bloc multivisceral resection to optimize outcomes. Surgery may also be appropriate for patients with localized recurrent RPS. Anatomic considerations and tumor biology driven by histologic subtype may guide the extent of resection in patients with RPS. This review provides an overview of the current surgical principles for primary and recurrent RPS.
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Affiliation(s)
- Mark Fairweather
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute; Harvard Medical School, Boston, Massachusetts
| | | | - Dirk Strauss
- Department of Surgery, Royal Marsden Hospital, NHS Foundation Trust, London, UK
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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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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Ní Mhuircheartaigh J, McMahon C, Lin YC, Wu J. Diagnostic yield of percutaneous biopsy for sclerotic bone lesions: Influence of mean Hounsfield units. Clin Imaging 2017; 46:53-56. [DOI: 10.1016/j.clinimag.2017.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 06/15/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
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Song Y, Kwon JW. Percutaneous CT-guided sternal biopsy: factors affecting the diagnostic yield. Acta Radiol 2017; 58:825-833. [PMID: 27852642 DOI: 10.1177/0284185116676652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Sternal lesions are occasionally seen in clinical practice and their diagnosis can be important, especially for oncologic patients. However, percutaneous computed tomography (CT)-guided biopsy of sternal lesions is rarely performed. Purpose To assess the diagnostic yield of percutaneous CT-guided sternal biopsies and to analyze the factors that affect diagnostic yield. Material and Methods A retrospective review of 34 patients who underwent CT-guided sternal biopsy was carried out at a single institution. Pre-biopsy CT density, location, penetration length of biopsy needle, number of biopsy attempts, angle of needle approach, final diagnosis, and operator experience level were recorded. A biopsy was considered as diagnostic if it provided a confident pathologic result. All variables were compared using Chi-square tests. Results Twenty-two of the 34 (64.7%) biopsy procedures yielded a diagnostic sample and 12 (35.3%) were non-diagnostic. Eight participants in the non-diagnostic group were clinically diagnosed with inflammatory arthritis of the manubriosternal or costosternal joints. Longer penetration distance of the tumor by the biopsy needle showed higher diagnostic yield ( P = 0.031). Osteoblastic lesions ( P < 0.001), lesions in the manubriosternal joint ( P = 0.018) and approaches using more obtuse angles ( P = 0.009) were associated with significantly lower diagnostic yields. Malignancy in the final diagnosis led to a higher diagnostic yield than benign lesions ( P < 0.001). Conclusion CT-guided percutaneous sternal biopsy has a relatively lower diagnostic yield. However, acute angle of needle approach may help increase biopsy success rate. Osteoblastic lesions and lesions in the manubriosternal joint tend to have lower diagnostic yield.
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Affiliation(s)
- Yoonah Song
- Department of Radiology, Hanyang University Hospital, Seoul, Republic of Korea
| | - Jong Won Kwon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
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Cardoso P, Rosa J, Esteves J, Oliveira V, Rodrigues-Pinto R. Fine needle aspiration for the diagnosis and treatment of musculoskleletal tumours. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:278-283. [PMID: 28739192 PMCID: PMC6197158 DOI: 10.1016/j.aott.2017.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 12/22/2016] [Accepted: 03/13/2017] [Indexed: 12/03/2022]
Abstract
Objective The aim of this study was to evaluate the diagnostic accuracy of FNA and analyse its efficacy in enabling the initiation of treatment in musculoskeletal tumours. Methods A total of 130 FNA were performed (94 bone and 36 soft tissue lesions) guided by CT scan (n = 64), ultrasonography (n = 36) and radioscopy (n = 30). Diagnostic yield and accuracy were evaluated. A diagnosis was considered accurate when confirmed by histology or ulterior clinical/imaging evaluation. Exclusion of malignancy or infection was considered as diagnoses. Results Ninety diagnoses (69.2%) were obtained: 87 (96.7%) were accurate and 3 were wrong. FNA was non-diagnostic in 40 cases (30.8%) but in 15 (11.5%) it has been possible to conclude if the lesion was malignant (n = 6) or benign (n = 9). This method was completely inconclusive in 25 cases (19.2%). Conclusion Despite the low diagnostic yield, accuracy was high. FNA allowed the initiation of treatment in all 87 patients with a correct diagnosis and in 9 in which malignancy was excluded. Two of the 6 biopsies with the information of malignancy were soft tissue lesions. Even here, treatment could be done, as the majority of soft tissue sarcoma protocols begin with surgery. This study validates FNA as a method with a high diagnostic accuracy.
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39
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Yu GH, Maisel J, Frank R, Pukenas BA, Sebro R, Weber K. Diagnostic utility of fine-needle aspiration cytology of lesions involving bone. Diagn Cytopathol 2017; 45:608-613. [PMID: 28470965 DOI: 10.1002/dc.23735] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/29/2017] [Accepted: 04/06/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) is utilized in the diagnostic work-up of bone lesions in a number of institutions, either in isolation or in conjunction with core biopsy. We report our experience with FNA of bone-based lesions, including comparison of this approach with concurrent core biopsy specimens. METHODS Retrospective review over a 5-year period (2011-2015) revealed 233 cases of bone FNAs. RESULTS The most commonly encountered diagnosis was malignant neoplasm (160 cases, 68.7%); within this group of malignancies, 103 cases (64.4%) represented metastatic carcinoma. Benign lesions were encountered infrequently (9 cases, 3.9%). While 37 cases (15.9%) revealed "no evidence of malignancy," 12 cases (5.2%) showed atypical findings, 3 cases (1.3%) demonstrated inflammatory conditions, and 12 aspiration biopsies were deemed nondiagnostic (5.2%). In 202 cases, concurrent core biopsies were performed following FNA and rapid on-site evaluation (ROSE). Comparison of the FNA and core biopsy diagnoses among malignant neoplasms revealed 19 diagnostic discrepancies, including 16 cases with a false-negative FNA (7.9% of all FNAs with concurrent core biopsy) and 3 cases with a false-negative core biopsy (1.5% of all cases with corresponding FNA). CONCLUSION Our findings indicate that FNA of bone lesions is a useful diagnostic technique with high sensitivity, particularly when the cytologic findings are interpreted in conjunction with the core biopsy and pertinent clinical and radiologic findings. In addition, ROSE followed by open, dynamic communication with the performing radiologist leads to an extremely low rate of inadequate core biopsy specimens, resulting in optimal patient diagnosis and management. Diagn. Cytopathol. 2017;45:608-613. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Gordon H Yu
- Department of Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Julia Maisel
- Department of Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Renee Frank
- Department of Pathology & Laboratory Medicine, Geisinger Medical Laboratories, Danville, Pennsylvania
| | - Bryan A Pukenas
- Department of Radiology, Neuroradiology Division, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Ronnie Sebro
- Department of Radiology, Musculoskeletal Radiology Division, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Kristy Weber
- Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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Abstract
The treatment of musculoskeletal neoplasms and infection is usually based on an initial diagnostic biopsy. Prior to biopsy, a hypothesis should be formed about the most likely diagnosis and a differential diagnosis. These deliberations should consider whether the lesion is a primary benign or malignant tumour, a metastasis, a haematological problem or an infection. A tactical plan should be developed which evaluates the necessity, the risk, the approach and finally defines the technique of biopsy most likely to achieve a representative result in the clinical case. In developing this technical approach, the pitfalls should be anticipated, i.e. inadequate sampling, difficulty of pathological interpretation and contamination. The tactical approach should be developed in conjunction with a multi-disciplinary team together with appropriate pre-biopsy imaging.
Cite this article: EFORT Open Rev 2017;2:51–57. DOI: 10.1302/2058-5241.2.160065
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Affiliation(s)
- G Ulrich Exner
- Orthopaedie Zentrum Zuerich (ozz), Seestrasse 259, CH 8038 Zurich, Switzerland
| | - Michael O Kurrer
- Gemeinschaftspraxis fuer Pathologie, Caecilienstrasse 3, CH 8032 Zurich, Switzerland
| | - Nadja Mamisch-Saupe
- Klinik Hirslanden, Department of Musculoskeletal Radiology, Witellikerstrasse 40, 8032 Zurich, Switzerland
| | - Stephen R Cannon
- BMI The Clementine Churchill Hospital, Sudbury Hill, Harrow, Middlesex HA1 3RX, Great Britain
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41
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Pathology of Bone and Soft Tissue Sarcomas. Sarcoma 2017. [DOI: 10.1007/978-3-319-43121-5_4] [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] Open
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42
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Federation Nationale des Centers de Lutte Contre le Cancer grading of soft tissue sarcomas on needle core biopsies using surrogate markers. Hum Pathol 2016; 56:147-54. [PMID: 27346575 DOI: 10.1016/j.humpath.2016.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/02/2016] [Accepted: 06/11/2016] [Indexed: 11/23/2022]
Abstract
Needle core biopsy (NCB) of soft tissue sarcomas (STSs) presents problems for French Federation Nationale des Centers de Lutte Contre le Cancer (FNCLCC) histological grading because small sample size hinders determination of necrosis and mitotic activity. We graded 53 STSs on NCB using a modified FNCLCC grading system that substitutes Ki-67 immunoexpression for mitotic count and uses a radiological assessment of necrosis, and compared the results with those obtained by conventional FNCLCC grading of the corresponding untreated, surgically resected specimen. Forty-eight of the 53 tumors were classified as malignant on NCB (concordance = 91%). The modified FNCLCC grade correctly separated high-grade (grades II and III) from low-grade sarcomas in 70% of cases and predicted the traditional FNCLCC grade given to the resected specimen in 49% of cases. Ki-67 scores of 2 or 3 were observed in 5 tumors classified as low-grade neoplasms on NCB but upgraded to a high-grade dedifferentiated liposarcoma on resection. Underestimated NCB grades were commonly encountered with lipomatous tumors due to sampling error, whereas Ki-67 or radiologic necrosis scores higher than the corresponding histological scores were responsible for the vast majority of overestimated NCB grades. Our FNCLCC grading scheme replacing conventional mitosis counting and histologic assessment of necrosis with surrogate markers is useful in separating high- and low-grade STSs on NCB for STS treatment planning. High Ki-67 rate should raise suspicion of a higher-grade component, particularly with fatty tumors.
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Buy X, Kind M, Stoeckle E, Catena V, Gangi A, Palussiere J. Radiologie interventionnelle et tumeurs des tissus mous : du diagnostic au traitement. ONCOLOGIE 2016. [DOI: 10.1007/s10269-016-2614-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kaur I, Handa U, Kundu R, Garg SK, Mohan H. Role of fine-needle aspiration cytology and core needle biopsy in diagnosing musculoskeletal neoplasms. J Cytol 2016; 33:7-12. [PMID: 27011434 PMCID: PMC4782412 DOI: 10.4103/0970-9371.175478] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: The management of musculoskeletal neoplasms requires an accurate diagnosis, histologic type, and degree of tumor differentiation. Aim: The present study was undertaken to compare the accuracy of fine-needle aspiration cytology (FNAC) and core needle biopsy (CNB) in the diagnosis of musculoskeletal tumors and further to compare the results with histopathological examination of surgical specimens. Grading of malignant tumors was also compared on these techniques. Materials and Methods: This prospective study was conducted on 50 patients with musculoskeletal neoplasms. Detailed history, clinical examination, and radiological investigations were undertaken. FNAC followed by CNB were performed in each case. The tumors were categorized as benign and malignant with a definitive histotype diagnosis. For malignant neoplasms, cytologic and histologic gradings were done into three grades. The sensitivity and specificity of FNAC and CNB were compared. Results: Of the 50 cases with musculoskeletal neoplasms, 32 (64%) were bone tumors and 18 (36%) were soft tissue tumors. The sensitivity of FNAC and CNB for categorizing bone tumors into benign and malignant was 94.7%. For soft tissue tumors, FNAC had a sensitivity of 90.9% and CNB had a sensitivity of 100%. The specificity of both the techniques, FNA and CNB for bone and soft tissue tumors was 100%. For malignant bone tumors, cytologic grade was concordant with CNB grade in 72.2% of the cases. Cytologic grade was concordant with the grade on CNB in 81.8% cases for malignant soft tissue neoplasms. Conclusion: FNAC and CNB alleviate the need for an open biopsy in diagnosing and grading musculoskeletal neoplasms, thus facilitating appropriate therapeutic intervention.
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Affiliation(s)
- Ivreet Kaur
- Department of Pathology, Government Medical College and Hospital, Chandigarh, Punjab and Haryana, India
| | - Uma Handa
- Department of Pathology, Government Medical College and Hospital, Chandigarh, Punjab and Haryana, India
| | - Reetu Kundu
- Department of Pathology, Government Medical College and Hospital, Chandigarh, Punjab and Haryana, India
| | - Sudhir Kumar Garg
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, Punjab and Haryana, India
| | - Harsh Mohan
- Department of Pathology, Government Medical College and Hospital, Chandigarh, Punjab and Haryana, India
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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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Colletti SM, Tranesh GA, Whetsell CR, Chambers LN, Nassar A. High diagnostic accuracy of core needle biopsy of soft tissue tumors: An institutional experience. Diagn Cytopathol 2016; 44:291-8. [DOI: 10.1002/dc.23440] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 11/13/2015] [Accepted: 12/02/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Shanna M. Colletti
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Jacksonville Florida
| | - Ghassan A. Tranesh
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Jacksonville Florida
| | - Chantel R. Whetsell
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Jacksonville Florida
| | - Larissa N. Chambers
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Jacksonville Florida
| | - Aziza Nassar
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Jacksonville Florida
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Yamabe A, Irisawa A, Shibukawa G, Hoshi K, Fujisawa M, Igarashi R, Abe Y, Imbe K. An experimental study to assess the best maneuver when using a reverse side-bevel histology needle for EUS-guided fine-needle biopsy. Endosc Int Open 2016; 4:E56-61. [PMID: 26793786 PMCID: PMC4713184 DOI: 10.1055/s-0041-107801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Recently, ProCore™ was developed as an endoscopy ultrasound (EUS)-guided histology needle designed to address several current limitations of EUS-guided fine-needle aspiration (FNA). Nevertheless, tissue yield with the ProCore™ is not consistent. No standard technique has been established. This experimental study was conducted to ascertain the best maneuver when using the ProCore™. PATIENTS AND METHODS We performed fine-needle aspiration and biopsy (FNAB) with a 22-gauge (G) ProCore™ using chicken tenderloin and liver. Six methods were used, with two needle movement techniques (natural speed and whipping back) and three negative pressures (no suction (NS), slow pull (SP), and 10-mL suction). RESULTS In cases using the "natural speed" technique, a significant difference in tissue yield was found with suction pressures in both tenderloin and liver (P < 0.0001, P = 0.0079). In cases using the "whipping back" technique, for the tenderloin, no significant difference in tissue yield was found for NS vs. SP (P = 0.0596), however, a significant difference was found for SP vs. 10-mL suction (P < 0.0001) and for NS vs. 10-mL suction (P < 0.0001). For the liver, a significant difference was found among suction pressures (P = 0.0079). Comparing "natural speed" with "whipping back" using the tenderloin, no significant difference in tissue yield was found with NS and 10 mL of pressure (P = 0.1126, P = 0.0718), but a significant difference was found with SP (P = 0.0028). Regarding the liver, no significant difference was found based upon suction pressure (NS P = 0.1508; SP P = 0.0873; 10 mL P = 0.6667). CONCLUSIONS EUS-FNAB using ProCore™ can be performed with negative pressure with any needling technique. Although ProCore™ has a reverse side-bevel, results in using it with a whipping-back technique were inconclusive.
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Affiliation(s)
- Akane Yamabe
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center
| | - Atsushi Irisawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center,Corresponding author Atsushi Irisawa Department of GastroenterologyFukushima Medical University Aizu Medical CenterArzuwakamazuJapan
| | - Goro Shibukawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center
| | - Koki Hoshi
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center
| | - Mariko Fujisawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center
| | - Ryo Igarashi
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center
| | - Yoko Abe
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center
| | - Koh Imbe
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center
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Natali GL, Paolantonio G, Fruhwirth R, Alvaro G, Parapatt GK, Toma' P, Rollo M. Paediatric musculoskeletal interventional radiology. Br J Radiol 2015; 89:20150369. [PMID: 26235144 DOI: 10.1259/bjr.20150369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Interventional radiology technique is now well established and widely used in the adult population. Through minimally invasive procedures, it increasingly replaces surgical interventions that involve higher percentages of invasiveness and, consequently, of morbidity and mortality. For these advantageous reasons, interventional radiology in recent years has spread to the paediatric age as well. The aim of this study was to review the literature on the development, use and perspectives of these procedures in the paediatric musculoskeletal field. Several topics are covered: osteomuscle neoplastic malignant and benign pathologies treated with invasive diagnostic and/or therapeutic procedures such as radiofrequency ablation in the osteoid osteoma; invasive and non-invasive procedures in vascular malformations; treatment of aneurysmal bone cysts; and role of interventional radiology in paediatric inflammatory and rheumatic inflammations. The positive results that have been generated with interventional radiology procedures in the paediatric field highly encourage both the development of new ad hoc materials, obviously adapted to young patients, as well as the improvement of such techniques, in consideration of the fact that childrens' pathologies do not always correspond to those of adults. In conclusion, as these interventional procedures have proven to be less invasive, with lower morbidity and mortality rates as well, they are becoming a viable and valid alternative to surgery in the paediatric population.
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Affiliation(s)
- Gian L Natali
- 1 Interventional Radiology Unit, "Bambino Gesù" Children's Hospital, Rome, Italy
| | | | - Rodolfo Fruhwirth
- 1 Interventional Radiology Unit, "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Giuseppe Alvaro
- 1 Interventional Radiology Unit, "Bambino Gesù" Children's Hospital, Rome, Italy
| | - George K Parapatt
- 1 Interventional Radiology Unit, "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Paolo Toma'
- 2 Imaging Department, "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Massimo Rollo
- 1 Interventional Radiology Unit, "Bambino Gesù" Children's Hospital, Rome, Italy
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Hua WB, Wu Q, Zhang B, Yang SH, Shao ZW, Xu WH, Wang Y, Zhang XD. Initial CT-guided percutaneous biopsy of vertebral lesions: Evaluation of its diagnostic accuracy and clinical value. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s11596-015-1472-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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50
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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: 93] [Impact Index Per Article: 10.3] [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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