Pediatric Core Needle Biopsy: Strengths and Limitations in Evaluation of Masses

Abstract

Needle core biopsies (NCB) are widely used in adults but are less often used for the evaluation of pediatric tumors. To determine the diagnostic utility of NCB for pediatric tumors, we performed a retrospective analysis. Fifty NCB of masses from 1992 to 1998, subsequent pathologic specimens, and medical records were reviewed. All patients were less than 21 years of age. Of the NCB 78% (39/50) were diagnostic of a neoplasm, 8% (4/50) were nondiagnostic in cases where a tumor was subsequently diagnosed, and 14% (7/50) revealed inflammatory or reactive lesions, with no subsequent diagnosis of a neoplasm according to medical record review. In cases in which a neoplasm was present, NCB was diagnostic in 91% (39/43). For cases in which there was a previous diagnosis of a tumor, 100% (9/9) of NCB were diagnostic of a recurrence or metastasis. In cases of NCB for primary tumor diagnosis, 88% (30/34) were diagnostic. The most common problems encountered were related to specimen adequacy, such as insufficient tissue, crush artifact, and tumor necrosis. Tumor diagnoses were as follows: primitive neuroectodermal tumor (PNET)/Ewing sarcoma (12), malignant lymphoma/Hodgkin's disease (8), rhabdomyosarcoma (4), germ cell tumor (3), Wilms' tumor (3), neuroblastoma (1), sarcoma, not otherwise specified (4), and other neoplasms (8). There were no complications of the procedure. NCB of pediatric tumors is an effective diagnostic tool and can be used to obtain diagnostic material quickly and safely. NCB was diagnostic in 90% of cases in this series. When NCB provide sufficient material for immunohistochemical, cytogenetic, flow cytometric, and other ancillary studies, the diagnostic efficacy is enhanced. The major limitations in this series were related to sampling problems and specimen adequacy for comprehensive pathologic evaluation.

Indications and results of diagnostic biopsy in pediatric renal tumors: A retrospective analysis of 317 patients with critical review of SIOP guidelines

“…When required, both FNA and CNB techniques provide adequate samples. The cellularity was judged satisfactory in 82% to 85% of our cases, in agreement with the literature (i.e., 76% to 93% for FNA and 80% to 95% for CNB) . However, our data confirm a significantly higher diagnostic accuracy of CNB, as previously reported .…”

Needle core vs open biopsy for diagnosis of intermediate- and high-risk neuroblastoma in children

“…Furthermore, we did not observe any increased morbidity associated with taking multiple cores (15)(16)(17)(18)(19)(20) as opposed to few core samples (3)(4)(5) to ensure adequate diagnosis and adequate tissue for cytogenetic studies and for enrollment into Children's Oncology Group clinical trials. In addition, needle core biopsy may be advantageous in diagnosing metastatic tumors in patients with known neuroblastoma.…”

“…On the other hand, the primary criticism of needle core biopsies has been the possibility of inadequate tissue sampling, which can delay diagnosis and subsequent treatment. As a result, the National Cancer Institute and Children's Oncology Group recommend obtaining tissue samples by open surgical biopsy technique rather than needle core biopsy [9,13,16]. However, in the absence of prospective randomized studies to compare the safety and efficacy of these 2 techniques, this recommendation is largely based on anecdotal experience rather than unbiased data [9,10,12].…”

“…Needle core biopsies were performed by surgeons or interventional radiologists at Texas Children's Hospital using ultrasound guidance to localize the tumor. A Tru-cut biopsy needle or Bard core biopsy needle (both 14 gauge) was used by surgeons, and the Cook Medical Co-axial needle (16,18, and 20 gauge) was used by interventional radiologists to obtain several core biopsies (range 3-12 cores). The incision was closed with a single absorbable suture and Steri-Strips (3M Health Care, St. Paul, MN).…”

Optimal Management Strategies for Rhabdomyosarcoma in Children

“…When in doubt, it biopsies versus open biopsies to obtain appropriate material to is important to recognize any unfavorable site that is involved and definitively establish the diagnosis in patients with unresectable classify the tumor according to the most unfavorable site so that tumors. [11] Sometimes the diagnosis is made from a tumor that has appropriately aggressive therapy can be administered. been resected; for staging purposes care should be taken by the The most common metastatic sites include the lungs, bone, pathologist and surgeon to clearly establish the size of the mass bone marrow, liver, and distant lymph nodes.…”