Excisional Biopsy of Suspected Benign Soft Tissue Tumors of the Upper Extremity: Correlation between Preoperative Diagnosis and Actual Pathology

Abstract

Background Tumors of the upper extremity are common and mostly benign. However, the prevalence of discordant diagnosis of a solid hand tumor is less studied. The objectives of this retrospective study were (1) to determine the proportion of patients with a different (discrepant or discordant) pathological diagnosis compared to the preoperative diagnosis, (2) to determine the prevalence of the types of pathologies encountered at excisional biopsy for suspected benign tumors, and (3) to determine the types of tumors diagnosed when the surgeon does not make a preoperative diagnosis. Methods One hundred and eighty-two suspected benign soft tissue tumors of the upper extremity with a preoperative diagnosis other than ganglion cyst were excised by one of three surgeons over a 10-year period. A preoperative diagnosis was applied for 125 tumors. No preoperative imaging was used. Results Only 26 of the 125 tumors (21 %) with a preoperative diagnosis were discrepant. The tumors that were most likely to have a discrepant diagnosis were vascular tumors (32 %) and other less common benign tumors (33 %). Among the entire cohort of 182 tumors, lipomas (19 %), giant cell tumors of tendon sheath (GCTTS; 19 %), and vascular tumors (16 %) were the most frequent pathological diagnoses. Among the 57 tumors that did not have a preoperative diagnosis, most were vascular tumors (23 %), fibromas (14 %), and GCTTS (11 %).

Statistical and histological analysis of tumors of the upper extremity

“…The most common pathology in our series was giant cell tumor of the tendon sheath. This finding is consistent with results reported in the literature [ 1 – 3 ]. Giant cell tumors of the tendon sheath usually present as slow-growing lesions localized mostly on the digits, adjacent to the interphalangeal joints (in our series more common on the dorsal side of the digits).…”

“…Sluijmer et al suggested that the hand surgeon’s preoperative diagnosis without imaging is usually correct prior to excision of a mass in the hand. Discrepant diagnoses are usually benign and do not alter treatment [ 3 ]. These findings support observation as a reasonable option in innocent-looking, slow-growing tumors of the hand; however, this approach is not commonly accepted.…”

“…Ganglion cysts are typically located around the wrist and their diagnosis is usually establishedclinically. The reported incidence of particular types of tumors in the hand varies, but giant cell tumors of the tendon sheath, enchondromas, and lipomas are the most frequently mentioned [ 1 – 3 ]. Malignant tumors are relatively rare.…”

Use of Routine Pathologic Evaluation of Nonmalignant Lesions in Hand Surgery: A National Study

“…Lesions of the upper extremity are common with an estimated 15% of all soft tissue tumors found in the human body localized to the hand. 13,14 Among all benign upper extremity tumors, ganglions are noted to be the most prevalent (50–70%), followed by giant cell tumor of tendon sheath (14%), and mucous cysts (11%). 15 The risk of an upper extremity lesion being malignant is very low at 1–2% 16,17 for both soft tissue tumors 18 and bony tumors.…”

“…Routine pathologic evaluation of excised specimen has been questioned in many surgical fields including plastic surgery, orthopedic surgery, urology, otolaryngology, and general surgery. 1–4,6,7,13,21–27 Previous works have uniformly found that routine surgical pathology diagnosis did not change the treatment plan and thus concluded the practice neither cost-effective 25 nor cost-beneficial. 1–4,6,7,13,21–27 In the field of hand surgery, the value of pathology examination of benign tumors of the upper extremity has been investigated in a few case series demonstrating minimal clinical benefit.…”