Is Fine-Needle Aspiration Biopsy a Practical Alternative to Open Biopsy for the Primary Diagnosis of Sarcoma?

Abstract

We reviewed the clinicopathologic features of 145 consecutive fine-needle aspiration biopsy (FNAB) specimens from 140 patients without a previous diagnosis of sarcoma. Among 138 adequate specimens, 42 bone sarcomas and 80 soft tissue sarcomas were recognized as sarcomas; histologic subtyping was easier in bone than in soft tissue sarcomas and in pediatric than in adult cases. There was no correlation in accuracy of subtyping in low- vs high-grade sarcomas. FNAB was most accurate for subtyping of skeletal osteosarcoma, pediatric small round cell bone/soft tissue sarcomas, synovial sarcoma, skeletal chondrosarcoma, and adult myxoid soft tissue sarcomas. Although almost always recognized as sarcoma, subtyping of adult pleomorphic soft tissue sarcomas generally was not possible but did not influence therapy; all were considered high-grade sarcomas for treatment purposes. There were 4 misinterpretations of subtype in soft tissue sarcomas; none resulted in a change in therapy. Cytogenetic analysis on aspirated material confirmed t(11;22) in 2 Ewing and t(X;18) in 3 synovial sarcomas. No procedure-related complications occurred. Among bone and soft tissue sarcomas, FNAB was sufficient for initiation of definitive therapy in 87% and 83% of patients, respectively. Most FNAB specimens from bone and soft tissue sarcomas are recognized easily as sarcoma, but subtyping seems more accurate in bone sarcomas. Although histologic subtyping of adult soft tissue sarcomas is often impossible, no influence on initial therapy is usually observed. In contrast, subtyping of pediatric sarcomas by FNAB seems highly accurate and is necessary for appropriate therapy.

Correlação do tipo de biópsia e sua validade diagnóstica nos tumores músculo-esqueléticos em distintas topografias

“…Foram estudados 140 pacientes com tumores ósseos (87% de correlação da biópsia) e tecidos moles (83% de correlação da biópsia), obtendo até 5% de falso-positivo ou falso-negativo em tumores ósseos e até 15% de discordância em tumores de partes moles (10)(11) .…”

The usefulness of cytogenetic analysis in fine needle aspirates for the histologic subtyping of sarcomas

“…1 Others have documented similar difficulties. 13,14 For the above reasons, deeply seated soft tissue lesions that appear predominantly fatty by current imaging modalities are probably best evaluated by tissue biopsy.…”

“…7 However, the literature clearly demonstrates that one or more FNAB passes may obtain adequate material for immunocytochemistry (cell block), conventional cytogenetic analysis, flow cytometry and image analysis, and even research purposes, with informed consent of the patient. 1,3,4,8,9 Other groups of investigators have successfully used polymerase chain reaction (PCR) amplification techniques on archival FNAB cytologic smears, confirming the EWS/FLI-1 fusion product of Ewing's sarcoma, the SYT/SSX fusion product of synovial sarcoma, and the detection of Herpesvirus-8 in cases of Kaposi's sarcoma. [10][11][12] For the detection of the SYT/SSX fusion transcript by reverse transcriptase PCR, Inagaki et al 11 reported a higher sensitivity among cytologic samples (91%) compared to more traditional frozen biopsy materials (75%).…”

“…For further details regarding our FNAB services and preparation of cell blocks, the reader is referred to a prior publication. 1 When available and necessary (18 cases), sections of cell block material were examined immunocytochemically utilizing the avidin-biotinperoxidase complex and employing commercially available antibodies to the following antigens: S-100 protein (polyclonal 1/2; Dakopatts, Carpinteria, CA, USA); cytokeratin (monoclonal, AE1/AE3, 1/100 Boehringer Mannheim, Indianapolis, IN, USA), vimentin (monoclonal, 1/25; BioGenex, San Ramon, CA, USA); desmin (monoclonal, D33, 1/300, Dakopatts); muscle-specific actin (monoclonal, HHF-35, 1/25 000; Enzo Diagnostics, Farmingdale, NY, USA); and CD99 (monoclonal 013, 1/40; Signet, Dedham, MA, USA). Appropriate positive and negative controls were utilized throughout these procedures.…”

“…However, its reported usefulness in fine needle aspiration biopsy specimens (FNAB) is limited to rare series and isolated case reports, usually documented in clinical settings outside of the US. [1][2][3][4][5] Not surprisingly, in our experience, many pathologists remain skeptical of the utility of FNAB for the diagnosis of sarcomas, and some appear unaware that such ancillary techniques as flow cytometry, karyotype, and fluorescence in situ hybridization (FISH) may be successfully performed in routine clinical practice. We present herein our experience with the utility of FNAB and cytogenetic analysis as the initial diagnostic procedure of 24 patients.…”