Predictors of Malignant Pathology and the Role of Trans-Thoracic Needle Biopsy in Management of Solitary Fibrous Tumors of the Pleura: A 30-Year Review of a Tertiary Care Center Patient Cohort

Abstract

Background: Solitary fibrous tumors of the pleura (SFTP) are rare neoplasms with unpredictable behavior. Lack of unifying criteria for benign or malignant SFTP has resulted in reports of SFTP exhibiting malignant behavior years after complete surgical resection (despite benign initial diagnosis). Additionally, the role of transthoracic needle biopsy in initial management of SFTP is unclear. Understanding predictors of malignancy identifies patients at unacceptably high risk for non-surgical primary therapy, and for recurrence despite complete surgical resection. Objectives: The primary objectives were to identify clinicopathological predictors of malignancy & recurrence in SFTP. The secondary aim was to determine the role of trans-thoracic needle biopsy in the management decision algorithm of SFTP. Methods: Retrospective chart review was conducted (Jan. 1983-Dec. 2013 58nign in 3 (75%) with recurrence. Clinicopathologic variables analyzed did not predict recurrent disease. IHC features did not differ between malignant & benign pathology significantly. Predictors of malignant pathology included: infiltrative cellular pattern (p = 0.042), nuclear crowding (p = 0.006), tumour necrosis (p < 0.001) and >4 mitoses/ 10 high power field (p < 0.003). Conclusion: Because numerous variables analyzed did not predict recurrent disease, long-term follow-up is warranted regardless of benign or malignant initial histology. Histologic not IHC features predicted malignant pathology. Trans-thoracic needle biopsy did identify malignant SFTP; however its main use should be to differentiate SFTP from other pleural neoplasms using IHC.

Management of solitary fibrous tumours of the pleura: a systematic review and meta-analysis

“…The diagnostic yield from fine-needle aspiration was between 8% (17) and 45% (7), and from core needle biopsies between 27% (30) and 100% (17). One study reported two of three SFTP classified as malignant on biopsy were benign when resected [ 23 ], but another found lower mitotic counts in biopsy specimens compared to subsequently resected tumours [ 11 ].…”

“…Extrapolating from this statistical information, 35 out of 73 (47.9%) cases demonstrated a first recurrence within 5 years, 17 out of 73 (23.3%) cases had a first recurrence occurring after 5 years, and it was not possible to establish timings in the remaining 21 (28.8%) cases. At least 39 cases demonstrated recurrence in populations where complete (R0) resection had been achieved in 100% of the cases [ 6 , 14 , 16 , 19 , 23 , 25 , 26 , 29 ].…”

“…Preoperative percutaneous biopsy has a low sensitivity, and the results may not correlate with surgical resection specimens, especially in the diagnosis of malignancy [11,23]. Complication rates of the procedures were not reported.…”

“…Schmid (25), McGuire (23), Guo (39) Presence of symptoms Bold type: remains significant on multivariate analysis; roman type: multivariate analysis not undertaken; italic type: no longer significant on multivariate analysis. Numbers in parenthesis are the number of patients in the study.…”