Optimal Diagnostic Yield Achieved With On-site Pathology Evaluation of Fine-Needle Aspiration–Assisted Core Biopsies for Pediatric Osseous Lesions: A Single-Center Experience

Abstract

Context.-Image-guided, fine-needle aspiration-assisted core needle biopsy with an on-site evaluation by a pathologist (FNACBP) of osseous lesions is not a common practice in pediatric institutions.Objectives.-To evaluate the diagnostic adequacy and accuracy of FNACBP for pediatric osseous lesions and to compare the adequacy with procedures that do not use fine-needle aspiration.Design.-Six-year, retrospective review of 144 consecutive children biopsied for osseous lesions with and without fine-needle aspiration assistance.Results.-Pathologic diagnosis was achieved in 79% (57 of 72) of the core biopsies without an on-site evaluation, 78% (32 of 41) of the open biopsies (9 with intraoperative consultation), and 97% (30 of 31) of the FNACBPs as the initial diagnostic procedure. Three FNACBP cases were preceded by nondiagnostic open biopsies. Among 34 lesions sampled by FNACBP, 33 (97%) succeeded with diagnostic tissue, with most (30 of 33; 91%) being neoplasms, including 16 malignant (48%), 13 benign (39%), and 1 indeterminate (3%) lesions. The mostcommon diagnoses were osteosarcoma (9 of 33; 27%) and Langerhans cell histiocytosis (7 of 33; 21%). In cases with follow-up information available, 93% (28 of 30) of the FNACBP-rendered diagnoses were clinically useful, allowing initiation of appropriate therapy. The FNACBP procedure had 100% specificity, sensitivity, and positive predictive value for all 14 malignant lesions, with the sensitivity being 88% in benign lesions. Most FNACBP procedures (32 of 34; 94%) yielded adequate material for ancillary testing. A gradual upward trend was observed for the choice of FNACBP as an initial diagnostic procedure for osseous lesions.Conclusions.-The FNACBP procedure yields sufficient material for diagnosis and ancillary studies in pediatric, osseous lesions and may be considered an initial-diagnostic procedure of choice.

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

“…A multidisciplinary team approach is paramount to ensure adequate tumor specimens for PDX generation of bone sarcomas in pediatric patients without compromising diagnostic accuracy. Our 6 year experience with percutaneous core biopsies of pediatric osseous lesions reported 100% specificity, sensitivity, and positive predictive value in accurate diagnosis of all the malignant lesions biopsied . On‐site evaluation of tumor biopsies by cytopathologists has become the standard practice at our institution for patients with suspected bone sarcomas.…”

Ultrasound‐guided core biopsy with on‐site cytology‐immediate diagnosis in pediatric oncology

“…The literature on the pediatric population is sparse. Patel et al showed an increase in the diagnostic rate of pediatric CNB in bone lesions from 79% to 97% when on‐site FNA and cytology were added 12 . Our results for a variety of tumors in the pediatric population were very promising, yet the cohort was small.…”

“…The role of cytopathology has evolved over the years from a purely diagnostic technique to an adjuvant method that guides decisions for other sampling procedures 10‐13 . On‐site cytology followed by CNB in the adult population improves diagnostic success compared to CNB alone, and it is becoming generally accepted that the two procedures together are synergistic 10‐14 . Additionally, the cytological technique was first used with FNA only and has evolved to include TI from core biopsies 15 …”

Diagnostic yield and accuracy of paediatric image-guided fine needle aspiration biopsy of deep organ tumours

“…The overall diagnostic FNAB yield was 98.0%, with a 72.0% diagnostic accuracy for a specific lesion diagnosis (overall diagnostic accuracy 95.3%) which is comparable to similar other studies. 14 , 15 , 16 , 17 , 18 A treatment plan could be initiated in most cases based on a specific diagnosis confirmed via FNAB.…”