The Risk of Peripheral Nerve Tumor Biopsy in Suspected Benign Etiologies

Abstract

BACKGROUND Peripheral nerve sheath tumors (PNSTs) are tumors with unique clinical and imaging features that present to a variety of physicians. These lesions are often referred for biopsy, which can put nerve fascicles at risk. Preoperative biopsy may cause distortion of normal anatomic planes, making definitive resection difficult. OBJECTIVE To evaluate the neurological risks of preoperative biopsy in benign PNSTs. METHODS Surgical cases collected retrospectively using a prospectively established database of PNSTs treated by a single surgeon between 1997 and 2019. Patients were dichotomized depending on preoperative biopsy. The effects of biopsy were assessed via history and physical examination both pre- and postdefinitive resection. RESULTS A total of 151 cases were included. Only 23.2% (35) of patients underwent preoperative biopsy, but 42.9% of these experienced new or worsening neurological examination immediately following biopsy. After definitive resection, the rate of neurological deficit was significantly different between the 2 groups with 60% of biopsy patients and 19% of those patients not biopsied experiencing decline in examination (F = 25.72, P < .001). Odds ratio for any postoperative deficit for biopsy was 6.40 (CI [2.8, 14.55], P < .001). Univariate logistic regression of neurological deficit with patient age, sex, tumor type, and biopsy status showed that only biopsy was associated with the occurrence of any postoperative deficit. CONCLUSION Biopsy of benign PNSTs is associated with a high rate of neurological deficit both immediately following the procedure and after definitive resection. Careful selection is imperative prior to proceeding with biopsy of nerve sheath tumors exhibiting benign features given the unacceptably high rate of neurological decline.

Analysis of the effect of intraoperative neuromonitoring during resection of benign nerve sheath tumors on gross-total resection and neurological complications

“…There was a high rate of biopsy-related complications, and they also found that having a preoperative biopsy significantly increased the risk of a postoperative neurological complication after resection. 18 We had a similar distressing rate of preoperative biopsy (28%). Biopsy, except in select cases in which there is a high suspicion for malignancy, is unnecessary and likely harmful.…”

Cervical Paraspinal Chordoma: A Literature Review with a Novel Case Report

“…Moreover, biopsy should be performed prior to surgery for cases in which diagnosis of chordoma is suspected, which is important in overall therapeutic planning. However, this was not initially considered in our patient due to the presumptive diagnosis of PNST, as it is associated with a high risk of complications, such as neurological deficits and damaging surrounding vascular anatomy [ 7 , 8 ]. Recommendations for surgical margins vary on the basis of tumor grade or stage and presence of metastases; however, in some patients, radiotherapy or palliative interventions are recommended instead of radical resection [ 18 ].…”

“…Therefore, schwannoma diagnosis was more convincing than neurofibroma or malignant peripheral nerve sheath tumor (MPNST) due to homogenous enhancement on MRI without any infiltration to nearby structures and bone remodeling rather than destruction. The patient was qualified to surgery without prior preoperative biopsy, since performing biopsy in PNST carries risks of neurological deficit post-operatively, damaging adjusting vascular structures with consequent death [ 7 , 8 ]. Surgery was performed through an anterior transcervical approach procedure with a longitudinal incision from C2 to C6, along with the sternomastoid ( Figure 2 a–c).…”

Malignant Peripheral Nerve Sheath Tumors—A Comprehensive Review of Pathophysiology, Diagnosis, and Multidisciplinary Management

“…Immunohistochemical staining may include S100, Ki67, TP53, CD34, p16, and H3K27me3 (trimethylation at lysine 27 of histone H3) [ 35 ]. The interested reader is referred to an excellent review article on the histopathological diagnosis of nerve sheath tumors in general, including MPNSTs [ 38 ], see Figure 3 .…”