Fine-Needle Aspiration Biopsy of Soft Tissue Sarcomas: A Cytomorphologic Analysis With Emphasis on Histologic Subtyping, Grading, and Therapeutic Significance

Abstract

A b s t r a c tAlthough fine-needle aspiration biopsy (FNAB) of soft tissue sarcomas has been used effectively for preoperative evaluation and documentation of local recurrences and metastases, its role in the initial diagnosis of primary soft tissue sarcomas is still not accepted widely. 12 In experienced hands, sensitivity and specificity rates exceed 90% for the determination of malignancy and approach the rates obtained with frozen section interpretation.3 -4 Nevertheless, the accuracy and therapeutic significance of FNAB for histologic subtyping of soft tissue sarcomas is less clear. 5 Furthermore, establishing a specific histologic subtype seems easier for some cytomorphologic groups of sarcomas (eg, small round cell) than for others (eg, pleomorphic cell) and often influences initial therapy.2 -6 We describe our experience with the use of FNAB as the initial diagnostic procedure to guide therapy for 67 primary soft tissue sarcomas, emphasizing the accuracy of histologic subtyping among specific cytomorphologic groups. It is not our purpose to provide detailed cytomorphologic descriptions of various sarcoma subtypes; for such information, the reader is referred to other publications that more adequately address these topics. -2 Materials and MethodsWe retrospectively reviewed 73 consecutive FNAB soft tissue sarcoma specimens (63 primary tumors, 9 metastases, and 1 local recurrence) from 67 patients, none of whom had a previously established sarcoma diagnosis. All cytologic samples were obtained without general anesthesia using 23-and 25-gauge needles by the standard manual method (62 aspirates) and computed tomographic-guided or ultrasoundguided needle placement (11 aspirates) at Wake Forest

Concordance of histopathologic and cytologic grading in musculoskeletal sarcomas

“…Most important, a needle biopsy should be used to establish the presence of malignancy and to determine whether a lesion is mesenchymal. From our data and that published within the literature, [3][4][5][6][7][8][9][10][11][12] FNA appears to perform many of the same functions as core needle biopsy.…”

“…[3][4][5][6][7][8][9][10][11] Some of these studies have addressed the accuracy of FNA in histologic subtyping of mesenchymal tumors. [3][4][5][6][7][8][9][10][11] The success of subtyping tumors of the musculoskeletal system has varied among studies but generally has been between 50% and 70% accurate. 6 -10, 12 Some authors have demonstrated greater accuracy of subclassification for bone neoplasms, 12 whereas others have shown significantly less success with subclassification of soft tissue neoplasms.…”

“…4 Needle aspiration cytology is more successful at separating benign from malignant musculoskeletal lesions with diagnostic accuracy ranging between 80% and 95%. [3][4][5][6][7][8][9][10][11][12] This rate of diagnostic accuracy compares favorably with that achievable by cutting needle biopsy. 13 In the study by Mankin et al, 13 major diagnostic errors were found in up to 18.2% of surgical biopsies of musculoskeletal lesions.…”

Zytologische Sarkomdiagnostik

“…4). Die Anwendung der Zusatzuntersuchungen bei den überwiegend aus runden Zellen bestehenden Weichteitumoren führt im höchsten Prozentsatz (bis zu 83%) der Fälle im Vergleich mit anderen Grundmustern zu definitiver Subtypisierung [17].…”

“…offene Biopsien beurteilt. Bis auf einige technische Einzelheiten stehen ihm grundsätzlich die gleichen Zusatzuntersuchungen zur Verfü-gung [10,11,15,17]. Insbesondere der Einsatz der Zellblocktechnik lässt den scheinbaren Widerspruch zwischen einer FNP und einer Stanzbiopsie in vielen Fällen schwinden -die Bearbeitung, die diagnostischen Kriterien und die zur Verfügung stehenden Methoden sind identisch [30,32].…”