We reviewed the clinicopathologic features of 145 consecutive fine-needle aspiration biopsy (FNAB) specimens from 140 patients without a previous diagnosis of sarcoma. Among 138 adequate specimens, 42 bone sarcomas and 80 soft tissue sarcomas were recognized as sarcomas; histologic subtyping was easier in bone than in soft tissue sarcomas and in pediatric than in adult cases. There was no correlation in accuracy of subtyping in low- vs high-grade sarcomas. FNAB was most accurate for subtyping of skeletal osteosarcoma, pediatric small round cell bone/soft tissue sarcomas, synovial sarcoma, skeletal chondrosarcoma, and adult myxoid soft tissue sarcomas. Although almost always recognized as sarcoma, subtyping of adult pleomorphic soft tissue sarcomas generally was not possible but did not influence therapy; all were considered high-grade sarcomas for treatment purposes. There were 4 misinterpretations of subtype in soft tissue sarcomas; none resulted in a change in therapy. Cytogenetic analysis on aspirated material confirmed t(11;22) in 2 Ewing and t(X;18) in 3 synovial sarcomas. No procedure-related complications occurred. Among bone and soft tissue sarcomas, FNAB was sufficient for initiation of definitive therapy in 87% and 83% of patients, respectively. Most FNAB specimens from bone and soft tissue sarcomas are recognized easily as sarcoma, but subtyping seems more accurate in bone sarcomas. Although histologic subtyping of adult soft tissue sarcomas is often impossible, no influence on initial therapy is usually observed. In contrast, subtyping of pediatric sarcomas by FNAB seems highly accurate and is necessary for appropriate therapy.

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The role of histocompatibility matching in bone allografting was studied in two canine bone graft models. In a cancellous ulnar segmental replacement model, frozen bone allografts exchanged between closely matched dogs were significantly better incorporated by radiographic and histologic criteria than were strongly incompatible grafts. Frozen allografts from disparate donors in recipients receiving immunosuppression appeared indistinguishable 6 months later from those in the untreated closely matched groups and from fresh autografts. Fresh vascularized orthotopically placed fibular bone grafts were evaluated by quantitative blood flow assessment, microangiography, and fluorochrome histomorphometry. Revascularized grafts exchanged between untreated closely matched dogs demonstrated preservation of blood flow and a pattern of repair that was delayed but not otherwise different than vascularized autografts. These results suggest that fresh vascularized grafts in the judiciously matched or immunosuppressed recipient offer attractive clinical possibilities.

A b s t r a c tAlthough fine-needle aspiration biopsy (FNAB) of soft tissue sarcomas has been used effectively for preoperative evaluation and documentation of local recurrences and metastases, its role in the initial diagnosis of primary soft tissue sarcomas is still not accepted widely. 12 In experienced hands, sensitivity and specificity rates exceed 90% for the determination of malignancy and approach the rates obtained with frozen section interpretation.3 -4 Nevertheless, the accuracy and therapeutic significance of FNAB for histologic subtyping of soft tissue sarcomas is less clear. 5 Furthermore, establishing a specific histologic subtype seems easier for some cytomorphologic groups of sarcomas (eg, small round cell) than for others (eg, pleomorphic cell) and often influences initial therapy.2 -6 We describe our experience with the use of FNAB as the initial diagnostic procedure to guide therapy for 67 primary soft tissue sarcomas, emphasizing the accuracy of histologic subtyping among specific cytomorphologic groups. It is not our purpose to provide detailed cytomorphologic descriptions of various sarcoma subtypes; for such information, the reader is referred to other publications that more adequately address these topics. -2 Materials and MethodsWe retrospectively reviewed 73 consecutive FNAB soft tissue sarcoma specimens (63 primary tumors, 9 metastases, and 1 local recurrence) from 67 patients, none of whom had a previously established sarcoma diagnosis. All cytologic samples were obtained without general anesthesia using 23-and 25-gauge needles by the standard manual method (62 aspirates) and computed tomographic-guided or ultrasoundguided needle placement (11 aspirates) at Wake Forest

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