Accurate diagnosis of musculoskeletal lesions by core needle biopsy

Abstract

Background: Percutaneous needle biopsy has many advantages over open biopsy in the treatment of neoplasms. However, the accuracy of needle biopsy in the diagnosis of musculoskeletal lesions has not yet been established. Here, we evaluate the accuracy and limitations of the procedure for musculoskeletal lesions. Methods: The diagnoses of 163 needle biopsies (bone, 91; soft tissue, 72) performed on 157 consecutive patients using a Jamshidi needle or an Ostycut needle for bone lesions, or a Tru-cut needle for soft tissue lesions were compared with the final diagnoses made by open biopsy and/or a definitive operation. Results: One hundred forty-three specimens (88%) were determined to be adequate for histological examination. Obtaining undamaged cores from very hard bony lesions or sclerotic cyst walls proved difficult. A pathologist with experience in musculoskeletal lesions was able to differentiate malignant tumors from benign lesions in 97% of the cases (bone, 100%; soft tissue, 94%) and arrive at a specific diagnosis in 88% (bone, 96%; soft tissue, 78%) when adequate cores were obtained. Differentiating a well-differentiated liposarcoma from a benign lipoma and inflammatory lesions from benign tumorous conditions, was difficult. The overall accuracy was 77% (bone, 85%; soft tissue, 68%). There was no morbidity related to the procedure. Conclusion:The results indicate that needle biopsy is safe and accurate for diagnosing musculoskeletal lesions.

Analysis of Nondiagnostic Results after Image-guided Needle Biopsies of Musculoskeletal Lesions

“…Our study included FNA and core biopsies as we think this allows the highest chance of diagnosis. Known factors that predispose to a ND result include necrotic or sclerotic lesions [3,7,8,14] with one study reporting soft tissue lesions [17]. The bone lesions in our series had a higher ND rate than soft tissue lesions.…”

“…The bone lesions in our series had a higher ND rate than soft tissue lesions. Liposarcoma, hemangioma, and osteomyelitis are mentioned as specific diagnoses that lead to ND results [9,14,15]. The most common diagnoses of our patients (metastatic disease, myeloma, giant cell tumor) have predictably low ND rates.…”

“…Published series have documented that overall ND rates for image-guided needle biopsies range between 5% and 29% [1,8,15,17]. Specific diagnoses rarely are reported to have an effect on the ND rates [14,15], although sclerotic or necrotic lesions are more difficult to diagnose [3,7,8,14]. The literature suggests a range in accuracy from 74% to 99% with factors such as tissue type, lesion location, and type of biopsy affecting the result [19,23,24].…”

Prognostic factors in soft-tissue sarcomas: what have we learnt?

“…The movement towards needle biopsy, while pursued in the interest of reducing patient morbidity [62][63][64], may result in procurement of tissue from nonrepresentative areas. This potential hazard, however, has not impeded the progression towards needle biopsy.…”

A Comparison of Fine-needle Aspiration, Core Biopsy, and Surgical Biopsy in the Diagnosis of Extremity Soft Tissue Masses

“…A block of tissue allows the pathologist to examine tumor architecture and cellular interrelation, improving the diagnosis of histologic subtype and grade compared to FNA [13,19,56]. Other advantages of core biopsy, as with FNA, include speed, convenience, decreased cost (average $1106 per case), minimal morbidity, minimal contamination, and a 0.1% to 1.1% complication rate; disadvantages are also similar to FNA and include limited sampling and inaccessibility of some masses (secondary to size, depth, density, or location) [8,24,25,40,50,53,56]. Improved from FNA, core biopsy's soft tissue mass sensitivity ranges from 81.8% to 100%, specificity from 91% to 100%, and diagnostic accuracy from 72.7% to 100% [6-9, 12, 19, 23-26, 31, 36, 40, 42, 43, 50, 53, 57-59].…”