|
|
|
 |
 |
 Many
patients with musculoskeletal tumors will undergo a biopsy. In order
to develop an effective treatment plan, it is critical to obtain the
correct diagnosis of the tumor. An improperly performed biopsy can
spread tumor cells and make limb-sparing surgery difficult or even
impossible.
At our institution, we specialize in performing "minimally invasive"
needle biopsies. Oftentimes, they can be obtained directly in clinic.
For other tumors, our radiologists are experienced at performing computed
tomography (CT) guided biopsies (see picture at right). From even
small portions of tumor tissue, our pathologists can arrive at accurate
diagnoses. Our diagnostic success rate with this method is 97%.
|
|
Related
Publications |
|
|
Jelinek JS, Murphey MD, Welker JA, Henshaw RM, Kransdorf MJ,
Shmookler BM, Malawer MM. Diagnosis of Primary Bone Tumors
with Image-guided Percutaneous Biopsy: Experience with 110 Tumors.
Radiology; 223:731–737, 2002. |
PURPOSE:
To determine the diagnostic accuracy of image-guided percutaneous
biopsy in 110 primary bone tumors of varying internal
compositions.
MATERIALS AND METHODS: One hundred ten consecutive patients
with primary
bone tumors underwent biopsy with computed tomography
(CT) or fluoroscopy.
Ninety-one patients underwent surgical follow-up and 19
received medical treatment
and underwent subsequent imaging studies. Final analysis
of bone biopsy
results included tumor type, malignancy, final tumor grade,
biopsy complications,
and effect on eventual treatment outcome.
RESULTS: Seventy-seven tumors were malignant and 33 were
benign. Most common
tumors at biopsy were osteosarcoma (n=20), lymphoma (n=18),
chondrosarcoma
(n=16), and giant cell tumor (n=16). Correct final diagnosis
was
attained in 97 (88%) patients. Sixty-three lesions were
solid nonsclerotic; 26,
sclerotic; and 21, lytic with cystic centers containing
internal areas of fluid, hemorrhage,
or necrosis. In six of 21 lesions with a predominant cystic
internal composition,
problems occurred in determining a final diagnosis. In
13 patients, definite
correct diagnosis was not obtained with initial percutaneous
bone biopsy. Of these
patients, benign bone tumors were better defined with
surgical specimens in seven,
a diagnosis of malignancy was changed to that of another
malignancy in four, and
the diagnosis was changed from benign to malignant in
two. Nine patients underwent
open surgical biopsy. Seven of the difficult cases were
of cystic tumors with
hemorrhagic fluid levels visible at CT or magnetic resonance
imaging. The only
complication was a small hematoma.
CONCLUSION: Percutaneous biopsy of primary bone tumors
is safe and accurate
for diagnosis and grade of specific tumor. In cases with
nondiagnostic biopsy,
open-procedure biopsy is likely to be associated with
similar diagnostic difficulties.
 DOWNLOAD
ARTICLE (requires Acrobat Reader)
|
|
|
Welker J, Henshaw RM, Jelinek JS et al. The Percutaneous
Needle Biopsy is Safe and Recommended in the Diagnosis of Musculoskeletal
Masses. Cancer, 89(12): 2677-2686, 2000.
|
| BACKGROUND:
The purpose of this study was to analyze the role of
percutaneous core needle biopsy in the diagnosis of
musculoskeletal sarcomas.
METHODS: One hundred eighty-five biopsy procedures were
performed on 161 musculoskeletal tissue masses suspected
of being a sarcoma in 155 patients who underwent subsequent
tumor resection. A percutaneous core needle biopsy was
performed on all masses either in the clinic or under
radiologic guidance. If an adequate diagnosis could
not be made on the basis of this biopsy specimen, an
open incisional biopsy was performed.
RESULTS: One hundred seventy-three core needle biopsy
procedures were performed: 90 without radiologic guidance,
55 computed tomography guided, and 28 fluoroscopically
guided. Twelve open incisional biopsies were performed.
Eighty-three sarcomas, 67 benign mesenchymal tumors,
and 11 metastatic epithelial tumors were identified.
Analysis of the data reveals that only 7.4% of the masses
required open biopsy. In 88.2% of the masses, a single
percutaneous biopsy procedure was adequate, and no additional
biopsy was necessary. There was a 1.1% rate of complications;
none caused a change in the patient's treatment plan.
There was a 1.1% rate of major diagnostic errors, none
of which ultimately impacted on the patient's outcome.
There were no unnecessary amputations. Percutaneous
needle biopsy showed a positive predictive value of
100%, a negative predictive value of 82%, a sensitivity
of 81.8%, and a specificity of 100%. The accuracy of
a single-needle biopsy procedure to identify benign
versus malignant lesions, exact grade, and exact pathology
was 92.4%, 88.6%, and 72.7%,r espectively.
CONCLUSIONS: The percutaneous needle biopsy was found
to be extremely effective and safe for the diagnosis
of musculoskeletal masses. This method allowed 88% of
patients with suspected sarcomas to undergo a single-needle
biopsy procedure before the initiation of definitive
treatment. Patients undergoing percutaneous needle biopsy
had lower rates of major diagnostic errors and complications
than previously described for open biopsy. Open biopsy
offered limited additional information when preceded
by a needle biopsy, given that these tumors were difficult
to identify even after final resection.
Copyright 2000 American Cancer Society.
DOWNLOAD
ARTICLE (requires Acrobat Reader)
|
|
|
Bickels J, Jelinek J, Shmookler B, Malawer M. Biopsy of Musculoskeletal
Tumors from Musculoskeletal
Cancer Surgery (2001). ed. Malawer M, Sugarbaker P.
|
| Biopsy
is a key step in the diagnosis of bone and soft-tissue
tumors. An inadequately performed biopsy may fail to
allow proper diagnosis, have a negative impact on survival,
and ultimately necessitate an amputation to accomplish
adequate margins of resection. Poorly performed biopsy
remains a common finding in patients with musculoskeletal
tumors who are referred to orthopedic oncology centers.
The principles by which an adequate and safe biopsy
of musculoskeletal tumors should be planned and executed
are reviewed and a surgical approach to different anatomic
locations is emphasized.
DOWNLOAD
CHAPTER (requires Acrobat Reader) |
|
|
|
|
