Open Versus Core Needle Biopsy in Lower-Extremity Sarcoma

Abstract

Background: Historically, open biopsy (OB) was the gold standard for sarcoma diagnosis. Core needle biopsy (CNB) has become increasingly common. There are limited data evaluating how the type of biopsy impacts definitive surgical resection or postoperative outcomes. The aims of this study were to (1) characterize current international biopsy practice patterns, and (2) evaluate how the type of biopsy performed impacts the resection surgery, infection risk, oncological complications, and patient-reported functional outcome scores. Methods: This study was a preplanned secondary analysis of the prospective, multicenter PARITY (Prophylactic Antibiotic Regimens in Tumor Surgery) study. Patients with a benign diagnosis, metastatic disease, or no biopsy prior to surgery were excluded. Prospectively collected demographic, biopsy, surgical, and outcome variables were analyzed, and differences between patients undergoing OB and CNB were assessed. Parametric and nonparametric tests were used to compare variables between groups, and the Cox proportional hazards method was used to compare infection-related and oncological outcomes at 1 year. Median functional outcome scores at 1 year were compared. Results: Four hundred and sixty-four patients met the inclusion criteria. Data were collected from 48 sarcoma centers in 12 countries. CNB was the more utilized biopsy modality overall (57.5%). OB was more common in the U.S. and Canada. The median operative time was significantly longer for patients who underwent OB (324 versus 260 minutes; p < 0.001). Significantly more skin (p < 0.001) and fascial tissue (p < 0.001) were excised in the OB group, which also had a lower rate of primary closure (86.3% versus 92.9%; p = 0.03). There were no differences in surgical site infection or oncological outcomes between the groups at 1-year follow-up. Conclusions: CNB was the more common biopsy modality in the PARITY study in most countries. However, OB was more common in the U.S. and Canada. Patients undergoing OB had longer operative times, more excised tissue, and lower rates of primary closure, but this did not translate to differences in infection rates or oncological outcomes, including local recurrence. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Oncology

“…In this study from Toronto (Canada) , the team has looked to characterize biopsy patterns across countries and understand how the biopsy technique influences subsequent treatment and outcomes. 6 The team drew a large multicentre study together with participation from 48 centres which, between them, contributed 464 patients to the study cohort. Core needle biopsy was the more common technique employed outside of the USA and Canada.…”

What’s New in Musculoskeletal Tumor Surgery

“…The Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) Randomized Controlled Trial Secondary Analysis Supplement The PARITY trial was published online in January 2022, and the data set was opened to all investigators to perform secondary analyses 70 . A total of 13 PARITY secondary analyses were recently published in a JBJS Supplement [71][72][73][74][75][76][77][78][79][80][81][82][83] . These important studies address several exploratory questions, including, among others, the risk factors for surgical site infection and reoperations following lower-extremity endo-prosthetic reconstruction, functional outcomes in pediatric patients compared with adult patients, the use of opioids in the orthopaedic oncology population, the use of negative-pressure wound therapy and postoperative drains and the risk for surgical site infection, the risk of thromboembolism following lower-extremity endoprosthetic reconstruction, and biopsy types and their effect on surgical variables and outcomes.…”

Proximal Humerus Reconstruction for Bone Sarcomas

“…Image-guided core needle biopsies are often sufficient to obtain a diagnosis and should be planned through collaboration between the radiologist performing the procedure and also the orthopaedic oncologist who will be treating the patient because an unplanned and poorly performed biopsy can have substantial implications in the care of the patient [5][6][7] . Rarely, open biopsies are necessary 8 and should only be performed by the treating orthopaedic oncologist. In the proximal humerus, the biopsy tract should be just lateral to the deltopectoral interval, through the anterior deltoid to avoid contamination of the subscapularis and pectoralis muscle bellies because this could lead to contamination of the underlying neurovascular structures 3 .…”