Percutaneous core needle biopsy versus open biopsy in diagnostics of bone and soft tissue sarcoma: a retrospective study

Abstract

BackgroundBiopsy is a crucial step within the diagnostic cascade in patients with suspected bone or soft tissue sarcoma. Open biopsy is still considered the gold standard. However, recent literature suggests similar results for percutaneous biopsy techniques. Therefore, the aim of this retrospective analysis was to compare open and percutaneous core needle biopsy (CNB) regarding their accuracy in diagnosis of malignant musculoskeletal lesions.MethodsFrom January 2007 to December 2009, all patients with suspected malignant primary bone or soft tissue tumour undergoing a percutaneous CNB or open biopsy and a subsequent tumour resection at our department were identified and enrolled. Sensitivities, specificities, positive predictive values (PPV), negative predictive values (NPV) and diagnostic accuracy were calculated for both biopsy techniques and compared using Fisher’s exact test.ResultsA total of 77 patients were identified and enrolled in this study. Sensitivity, specificity, PPV, NPV and diagnostic accuracy were 100% for CNB in bone tumours. Sensitivity (95.5%), NPV (91.7%) and diagnostic accuracy (93.3%) for open biopsy in bone tumours showed slightly inferior results without statistical significance (p > 0.05). In soft tissue tumours favourable results were obtained in open biopsies compared to CNB with differences regarding sensitivity (100% vs. 81.8%, p = 0.5), NPV (100% vs. 50%, p = 0.09) and diagnostic accuracy (100% vs. 84.6%, p = 0,19) without statistical significance. The overall diagnostic accuracy was 92.9% for CNB and 98.0% for open biopsy (p = 0.55). A specific diagnosis could be obtained in 84.2% and 93.9%, respectively (p = 0.34).ConclusionIn our study we found moderately inferior results for the percutaneous biopsy technique compared to open biopsy in soft tissue tumours whereas almost equal results were obtained for both biopsy techniques for bone tumours. Thus, CNB is a safe, minimal invasive and cost-effective technique for diagnosing bony lesions. In soft tissue masses, the indication for percutaneous core needle biopsy needs to be made carefully by an experienced orthopaedic oncologist with respect to the suspected entity, size of necrosis and location of the lesion to avoid incorrect or deficient results.

Optimal Diagnostic Yield Achieved With On-site Pathology Evaluation of Fine-Needle Aspiration–Assisted Core Biopsies for Pediatric Osseous Lesions: A Single-Center Experience

“…2,3,9,11,12 A recent meta-analysis 14 of both bone and soft tissue tumors suggested that CB was more accurate than FNA, and incisional (open) biopsy appeared to be more accurate than both of those techniques; however, the differences did not reach statistical significance. Our results support the findings of the study by Pohlig et al, 15 which found percutaneous biopsy techniques (fine-needle aspiration and core needle biopsy) yielded slightly superior, but not statistically significant, results compared with OB. With the 31 lesions sampled by FNACBP as the initial diagnostic procedure in this study, 97% were diagnostic, compared with 79% and 78% for CB and OB, respectively.…”

Current Concepts in the Biopsy of Musculoskeletal Tumors

“…It might be omitted only in the case of clinically and radiologically unambiguous benign lesions, such as chondroma, osteochondroma, osteoid osteoma, simple bone cyst, fibrous dysplasia, or nonossifying fibroma. The different procedures such as fine-needle aspiration, core needle, and incisional biopsy have the objective to gain a representative tissue sample with minimal trauma [14]. The shortest distance to the lesion is not necessarily the optimal route [4].…”

“…This procedure has to be performed by an expert orthopaedic oncologist in line with the planned resection and according to sarcoma principles [14]. The samples are taken from the periphery of the tumor due to the frequent presence of central necrosis [14]. It is reasonable to assume that the risk of local contamination is higher in comparison to needle biopsy, and this is related to the width of the biopsy tract and adequacy of hemostasis.…”

“…This procedure has to be performed by an expert orthopaedic oncologist in line with the planned resection and according to sarcoma principles [14]. The samples are taken from the periphery of the tumor due to the frequent presence of central necrosis [14].…”

Biopsy of Musculoskeletal Tumors; Current Concepts Review

“…It is useful for deep-seated lesions like pelvis and spine and performed under CT guidance (11). Less morbidity and fewer complication rates have been reported for percutaneous biopsy ranging between 0% and 17%, most commonly hematoma, bleeding and infection (2,5,10). …”