Cytological Diagnosis of Bone Tumours

Abstract

We evaluated the diagnostic accuracy of fine-needle aspiration biopsy in a prospective study of 300 patients with previously undiagnosed bone lesions. Patients with suspected local recurrence of a primary bone tumour or a metastatic lesion of a previously diagnosed malignancy were excluded. Fine-needle aspiration biopsy was performed under radiological control as an outpatient procedure.The series was grouped into three major categories: 1) benign bone lesions including infections; 2) primary malignant bone tumours; and 3) metastases including lymphomas and myelomas. We compared the cytological diagnosis with the final diagnosis as assessed by histological examination and/or the clinical and radiological features.Material considered conclusive for cytological diagnosis was obtained from 251 of the 300 patients. Of the 49 failures, there were 24 aspirates with insufficient cellular yield and 25 in which a diagnosis could not be made although the cytological material was adequate in quantity. Most of the inconclusive aspirates (36/49) were obtained from benign bone lesions.The diagnosis was correct in 239 (95%) of the 251 cases providing adequate cytological material. There were eight (3%) falsely benign diagnoses, one (0.3%) falsely malignant, and three cases in which we were unable to differentiate between sarcoma and a metastasis. Chondrosarcoma (2/12) gave the greatest diagnostic difficulty and Ewing's sarcoma the least (0/9). There were no decisive errors of treatment. All falsely benign or malignant diagnoses were questioned, and led to open biopsy since they did not correlate with the clinical and radiological features.Our study suggests that fine-needle aspiration biopsy is a valid option for the diagnosis of bone tumours. It is a simple outpatient procedure which gives sufficient cytological material for the correct diagnosis in 80% of cases. As with histological analysis of material from open biopsy, the cytological assessment must agree with the clinical and radiological findings.

Cytological diagnosis of skeletal lesions

“…In a study of 300 patients, we reported correct discrimination between benign, primary malignant and secondary malignant bone lesions in 95% of adequate fine-needle aspirates. 4 Similar figures were found by Bommer, Ramzy and Mody 5 in a study of 427 patients with skeletal lesions. Ruhs, El-Khoury and Chrischilles 6 found FNAB to be more cost-effective than open biopsy.…”

Primary Musculoskeletal Neoplasms: Effectiveness of Core-Needle Biopsy

“…The accuracy of core-needle biopsy in terms of correct histologic features in another combined series (2) of soft-tissue and bone tumors was 84% (52 of 62). Some authors (2,3) have suggested that core-needle biopsy may be more effective for evaluation of primary tumors of bone than for evaluation of tumors of the soft tissue. In one early series (4), however, the success rate of large-gauge trephine core biopsy of 16 primary bone tumors was only 44%.…”

Diagnostic procedures and surgical treatment of bone sarcomasExperience from the Scandinavian Sarcoma Group and Karolinska hospital

“…This fast, nontraumatic, outpatient procedure has during the last 20 years been utilized in both soft-and bone lesions. The reliable results in clinical practice have been shown in several studies (Kreicbergs et al 1996, Åkerman 1997, Wedin et al 2000. FNAB is generally accepted at most Scandinavian centers for the diagnosis of soft tissue tumors.…”