Initial diagnostic management of pediatric bone tumors

Abstract

Background Osteosarcoma (OS) and the Ewing sarcoma family of tumors (ESFT) are the most common primary pediatric bone malignancies. We sought to assess the diagnostic accuracy of initial tumor biopsies in patients with OS or ESFT at a pediatric cancer center. Methods All biopsies performed at initial presentation of patients with OS or ESFT at our institution from 2003 to 2012 were retrospectively reviewed. Diagnostic accuracy and incidence of complications were correlated with study variables using logistic regression analysis. Results One hundred forty-two biopsies were performed in 105 patients (median age 13.4 years, range: 1.8-23.0), 104 (73.2%) OS and 38 (27.8%) ESFT. Thirty-one (21.8%) were performed on metastatic sites. Eighty-five (76.6%) of 111 primary site biopsies were open procedures, and 26 were percutaneous (23.4%). Primary site biopsies were successful in 94.1% of open and 73.1% of percutaneous procedures. Odds of obtaining a successful diagnostic specimen were 7.8 times higher with open approach (CI: 1.6-36.8). Metastatic site biopsies were successful in 66.7% of percutaneous and 100% of open and thoracoscopic procedures. Conclusion Biopsy of metastatic sites was equal to primary site in obtaining diagnostic material with the added benefit of accurate staging, with few adverse events and high diagnostic yield.

Ewing Sarcoma—Diagnosis, Treatment, Clinical Challenges and Future Perspectives

“…The accuracy of open biopsies is close to 100% in some reported publications [ 43 , 44 , 45 ]. CNB-reported biopsy success rates in sarcoma patients vary from 50% to 98% [ 46 , 47 , 48 , 49 , 50 , 51 ]. The success rate for needle biopsy may be inferior compared to open biopsy, specifically in EwS patients [ 51 ].…”

Generation of patient‐derived tumor xenografts from percutaneous tumor biopsies in children with bone sarcomas

“…Historically, an incisional (open) biopsy has been the preferred method for tumor tissue sampling in bone sarcomas. However, a percutaneous (needle) biopsy can also provide adequate tumor material to effectively establish the diagnosis of either OS or EWS . Historically, the small amount of tumor material obtained for research purposes has been one of the limitations to performing percutaneous biopsies in patients with bone sarcomas.…”

“…However, a percutaneous (needle) biopsy can also provide adequate tumor material to effectively establish the diagnosis of either OS or EWS. [2][3][4][5] Historically, the small amount of tumor material obtained for research purposes has been one of the limitations to performing percutaneous biopsies in patients with bone sarcomas. We have developed a multi-Abbreviations: EWS, Ewing sarcoma; IRB, institutional review board; OS, osteosarcoma; PDX, patient-derived tumor xenograft; TTF, time to tumor formation; US, ultrasound disciplinary team approach to establish an adequate cancer diagnosis and to develop patient-derived tumor xenografts (PDXs) using percutaneous biopsies in patients with bone sarcomas.…”

Skeletal Scintigraphy

“…Primary bone tumors are rare neoplasms that can occur in children and young adults, accounting for 5% and 0.2% of malignancies, respectively. 15 A role may exist for sodium fluoride F 18 PET/CT with regard to grading, staging, and evaluating response to therapy in such primary skeletal malignancies. 16 Osteosarcoma is the most common malignant primary bone tumor, accounting for 35% of bone tumors; its incidence peaks in the second decade of life.…”

“…16 Osteosarcoma is the most common malignant primary bone tumor, accounting for 35% of bone tumors; its incidence peaks in the second decade of life. 15 The literature is limited regarding the use of sodium fluoride F 18 PET/CT for the management of osteosarcomas. However, preliminary findings have been reported in small studies.…”