Effectiveness of histology and cytology on musculoskeletal tumor diagnosis

Abstract

OBJECTIVE: To compare cytology and histology on the diagnosis of musculoskeletal neoplasms. METHOD: Fifty eight cases available to evaluation were analyzed both by cytology and histology. The results of the biopsies studied by histology and cytology were compared to the results obtained on the surgical specimen or immunohistochemistry. We determined the percentage of correct results, sensitivity, specificity, positive and negative predictive values and accuracy of each method. RESULTS: Twelve per cent of biopsies were inconclusive by cytology. The percentage of correct diagnosis was 70.7% and 81% (p=.179), the ability to differentiate benign lesions from malignant ones was 84.5% and 93.1% (p=0.18) respectively, for cytology and histology. Cytology showed sensitivity of 87.8%, specificity of 76.5%, positive predictive value of 90%, negative predictive value of 72% and accuracy 84.5%. Histology showed sensitivity of 90.2%, specificity of 100%, positive predictive value of 100%, negative predictive value of 81% and accuracy of 93.1%. The Youden index for cytology was 64.3% and for histology it was 90.2%. CONCLUSION: Despite promising, cytology obtained by thin needle aspiration is less accurate and reliable than the histological evaluation on musculoskeletal tumors diagnosis. Level of Evidence II, Diagnostic Studies.

Core needle biopsy diagnosis of musculoskeletal tumors at a small regional treatment center and at sarcoma referral centers are equally effective and accurate: a retrospective case series

“…The accuracy of CNB for determining malignancy was 89.8% for bone tumors and 92.9% for soft-tissue tumors, compared with the accuracy of IB which was 100% for both bone and soft-tissue tumors. The results at the authors’ institution are equivalent to CNB accuracy in diagnosing malignancy at many larger referral centers, which ranges from 84% to 96% for bone and soft-tissue tumors, respectively 1,6–13. These results show that even at smaller regional treatment centers, CNB can be effectively used as an initial diagnostic tool for diagnosing the malignancy of musculoskeletal lesions, and that CNB performed at a small regional treatment center is equivalent to the accuracies published by many larger centers that have the added expertise of musculoskeletal-trained radiologists and pathologists.…”

“…The results at the authors' institution are equivalent to CNB accuracy in diagnosing malignancy at many larger referral centers, which ranges from 84% to 96% for bone and soft-tissue tumors, respectively. 1,[6][7][8][9][10][11][12][13] These results show that even at smaller regional treatment centers, CNB can be effectively used as an initial diagnostic tool for diagnosing the malignancy of musculoskeletal lesions, and that CNB performed at a small regional treatment center is equivalent to the accuracies published by many larger centers that have the added expertise of musculoskeletaltrained radiologists and pathologists. Besides determining tumor malignancy, biopsies need to be able to provide a reliable diagnosis of the exact tumor pathology to guide patient treatment.…”

“…1 A literature review showed that most recent studies have reported CNB accuracy rates of 84% to 96% for determining whether soft-tissue and bone tumors were malignant versus benign. 1,[6][7][8][9][10][11][12][13][14] However, the accuracy rates for CNB determining specific pathology was less accurate and ranged from 45.6% and 57% in two studies to 72.7%, 75%, and 80% in others. [3][4][5][15][16][17] Although these retrospective studies indicated CNB is accurate enough to guide the diagnosis and treatment of musculoskeletal tumors, most of these studies were performed at large sarcoma referral centers where musculoskeletal pathologists and musculoskeletal radiologists are abundant and review of all patients by a musculoskeletal tumor board is routine.…”

“…Retrospective analysis from a study at Sloan-Kettering Cancer center showed CNB diagnostic accuracy of 95% for determining benign versus malignant status and 75% for determining specific pathology, with these authors noting an important interpretational caveat that, “when read by an experienced pathologist, the results of core needle biopsy provide accurate diagnostic information for malignancy and grade.”5 A recent meta-analysis of such retrospective studies showed that CNB had a pooled diagnostic accuracy of 84% 1. A literature review showed that most recent studies have reported CNB accuracy rates of 84% to 96% for determining whether soft-tissue and bone tumors were malignant versus benign 1,6–14. However, the accuracy rates for CNB determining specific pathology was less accurate and ranged from 45.6% and 57% in two studies to 72.7%, 75%, and 80% in others 3–5,15–17…”

Does histopathological examination still have value in detecting and preventing cancer?

“…In addition, the cytological examination has also played an important role in the diagnosis of cancer 4 , and its results could be helpful for confirming of the histological examination 13,22 . Although the cytological analysis has many disadvantages [23][24] , it also has several benefits compared with the pathological analysis, including cost-effectiveness, rapid turnaround time, providing a minimal risk for the patient, and giving the results when other techniques failed 1,4 .…”