Percutaneous Core Needle Biopsy Can Efficiently and Safely Diagnose Most Primary Bone Tumors

Abstract

A biopsy is a prerequisite for the diagnosis and evaluation of musculoskeletal tumors. It is considered that surgical biopsy provides a more reliable diagnosis because it can obtain more tumor material for pathological analysis. However, it is often associated with a significant complication rate. Imaging-guided percutaneous core needle biopsy (PCNB) is now widely used as an alternative to surgical biopsy; it appears to be minimally invasive, possibly with lower complication rates. This study evaluates the diagnostic yield of the preferred use of PCNB in a referral center, its accuracy, and its complication rate. The data relating to the biopsy and the histological analysis were extracted from the database of a bone tumor reference center where PCNB of bone tumors was discussed as a first-line option. 196 bone tumors were biopsied percutaneously between 2016 and 2020. They were located in the axial skeleton in 21.4% (42) of cases, in the lower limb in 58.7% (115), and in the upper limb in 19.9% (39) cases. We obtained a diagnosis yield of 84.7% and a diagnosis accuracy of 91.7%. The overall complication rate of the percutaneous biopsies observed was 1.0% (n = 2), consisting of two hematomas. PCNB performed in a referral center is a safe, precise procedure, with a very low complication rate, and which avoids the need for first-line open surgical biopsy. The consultation between pathologist, radiologist, and clinician in an expert reference center makes this technique an effective choice as a first-line diagnosis tool.

Open Versus Core Needle Biopsy in Lower-Extremity Sarcoma

“…However, we believe that, overall, patient and tumor characteristics are infrequently the primary driver in deciding biopsy modality. Much of the recent literature on biopsy supports this conclusion, with CNB showing high diagnostic accuracy for bone sarcomas, effective use in diagnosing cartilage tumors and lytic bone lesions, and use as a successful secondary diagnostic technique after an initial failed attempt 2,3,5,6,18,19 . Given this clinical equipoise, we believe that individual, institutional, and regional preferences are the primary drivers in selecting biopsy modality.…”

“…The most likely such scenario is an OB following a nondiagnostic CNB. A review of the literature shows that 1% to 4.5% of CNBs for bone sarcoma require a subsequent OB for diagnosis 5,18,19 . Therefore, we can extrapolate that up to 9 of the 197 patients undergoing OB in this study may have had a previous CNB.…”

Results of Open Incisional Biopsy and Core Needle Biopsy of Bone Tumors

“…These findings are consistent with the emerging consensus that CNB may struggle to accurately diagnose highly heterogeneous tumours like sarcomas, osteosarcoma, and synovial sarcoma. [22,23] Another drawback of CNB is that tissue is fixed in formalin rather than frozen, which limits pathologic examination to histology and immunohistochemistry but precludes the use of more modern molecular diagnostic methods like real-time polymerase chain reaction (PCR) or microarray analysis [24]. Additional tissue collection for a cryobank or research reasons is also constrained with CNB.…”

Conceptos actuales en la planeación y realización de biopsias musculoesqueléticas

“…Until recently, open biopsy has long been considered to be the gold standard for the diagnosis of malignant and uncertain tumors of the musculoskeletal system. 2,12,17,19,[22][23][24] It can be incisional in which case only a representative specimen is removed from the lesion, or excisional in which case the lesion is completely removed. 14…”