Needle tract seeding after percutaneous biopsy of sarcoma: Risk/benefit considerations

Abstract

To evaluate histologic subtype and grade, which in turn guide the decision making for multimodality therapy, the workup of suspected sarcoma requires more material than can be obtained from a fine-needle aspiration. Either open or percutaneous core needle biopsy is indicated before a management decision is made. Percutaneous biopsy of a potentially malignant lesion is controversial, given the perceived potential for tumor seeding along the needle tract. However, the evidence that the latter is a significant risk is weak at best. To the authors' knowledge, among cases of patients with extremity sarcoma who have undergone core needle biopsy, only a few cases of needle tract seeding have been reported to date. Although en bloc excision of the needle tract with the primary tumor is often performed, this practice is not associated with improved oncologic outcomes; the evidence for excision of the needle tract is poor. For patients with gastrointestinal stromal tumors, there is a theoretical risk of peritoneal dissemination after percutaneous biopsy, but to the authors' knowledge this remains unproven. Although endoscopic ultrasound is the preferred route for biopsy among patients with gastrointestinal stromal tumors, percutaneous biopsy is indicated if endoscopic ultrasound is unsuitable or unavailable. In the setting of retroperitoneal sarcoma, a review of pooled data from 4 large tertiary care referral centers demonstrated a risk of needle tract seeding of 0.37%. The authors concluded that the benefits of pretreatment biopsy in patients with mesenchymal tumors outweigh the potential risks of needle tract seeding. Cancer 2017;123:560-567. © 2016 American Cancer Society.

Clinical Implications of Transbronchial Biopsy for Surgically-resected Non-small Cell Lung Cancer

“…The concept is similar to needle biopsy seeding. Despite a report describing the rarity of tumor seeding during needle biopsy procedures (10), needle tract seeding is one of the risks of needle biopsy, particularly in breast cancer and prostate cancer (3).…”

“…The concept that biopsies might cause metastasis and/or dissemination of tumor cells has been known since the late 1970s and is referred to as needle tract seeding (3). This has been shown both in ex vivo resected lung, and through tumor cell dislodgement by TBB resulting in circulating tumor cells (4).…”

Behandlung retroperitonealer Sarkome in Deutschland

“…erhöhtem Rezidivrisiko mögen der Auslassung von Biopsien zugrunde liegen. In der Literatur finden sich diesbezüglich jedoch mehrere Studien, die keine relevante Erhöhung des Lokalrezidivrisikos durch Stanzbiopsien von Sarkomen nachweisen -explizit bei retroperitonealenSarkomen-, auchohne Ausschneiden des Biopsiekanals [15,16]. Die Verwendung von Koaxialnadeln zur Führung der Biopsienadel wird jedoch empfohlen.…”

Ensuring a Safe and Qualitative Diagnostic Biopsy for Retroperitoneal Sarcomas

“…Following imaging, the common practice, and now standard of care, is to proceed with percutaneous biopsy of the mass [11,15]. This diagnostic approach is particularly important in suspected retroperitoneal sarcoma as although imaging can sometimes distinguish between a benign or malignant neoplasm, a histological diagnosis is important in dictating treatment plan [13].…”

“…This has been shown in case reports pertaining to other types of cancers; however, relatively little data has been available with regards to risk of recurrence along the needle tract for retroperitoneal sarcoma [15]. Within the last five years, retrospective studies have demonstrated minimal risk of seeding, indicating this is not a reason to avoid biopsy [19][20][21].…”