Primary Musculoskeletal Neoplasms: Effectiveness of Core-Needle Biopsy

Abstract

PURPOSE:To analyze the effectiveness of core-needle biopsy for evaluation of possible primary musculoskeletal neoplasms, which often are evaluated with open biopsy. MATERIALS AND METHODS:Core-needle biopsy was performed at a tertiary care institution in 141 patients suspected of having a mesenchymal neoplasm. In 85 patients, the lesion was in soft tissue; in 56 patients, the lesion was in bone. Eighty-nine patients had a malignant lesion, and 52 had a benign lesion. Twentyeight patients had undergone previous surgery. RESULTS:In 105 (74%) patients, core-needle biopsy results were concordant with results from specimens subsequently obtained at surgery with respect to tumor histologic features and grade, or they provided sufficient diagnostic information to obviate surgery. In 36 (26%) patients, inaccurate core-needle biopsy results were obtained: In nine, results were imprecise about exact histologic features; in three, results were correct about histologic features but incorrect about tumor grade. In 25 (18%) patients, open biopsy was performed after core-needle biopsy. The accuracy and rate of performance of open biopsy for soft-tissue lesions were not significantly different from those for bone lesions. CONCLUSION:Percutaneous core-needle biopsy can be an effective alternative to open biopsy in the evaluation of possible mesenchymal neoplasms of either bone or soft tissue. Needle biopsy of such lesions, however, is best performed as part of a multidisciplinary team approach to tumor management.

Analysis of Nondiagnostic Results after Image-guided Needle Biopsies of Musculoskeletal Lesions

“…The literature suggests a range in accuracy from 74% to 99% with factors such as tissue type, lesion location, and type of biopsy affecting the result [19,23,24]. Some authors do not clearly state the rate of repeat needle or open biopsies, but the range is 3% to 25% [17,21,24]. We present a large series that confirms earlier studies and examines factors and specific diagnoses predisposing to ND results.…”

“…Patients with borderline soft tissue lesions (cellular intramuscular myxoma vs. lowgrade myxoid sarcoma) based on a needle biopsy diagnosis should have either an open biopsy or a surgical resection that will not compromise their oncologic outcome. The percentage of patients who required a repeat biopsy in this series was 14% which compares favorably with the 3% to 25% reported ranges [17,21,24]. The most common reason to perform a repeat biopsy was a ND result.…”

“…The information gained in our study would suggest that patients with clinical and radiographic presentations consistent with histiocytosis, lymphoma, or osteomyelitis might be better having the biopsy in the operating room. The IC rate after needle biopsy of musculoskeletal lesions ranges from 1% to 26%, and our 2% IC rate compares favorably [23,24]. Some reports suggest benign tumors have higher IC rates than malignant tumors [3,4,7,9].…”

“…Specific diagnoses rarely are reported to have an effect on the ND rates [14,15], although sclerotic or necrotic lesions are more difficult to diagnose [3,7,8,14]. The literature suggests a range in accuracy from 74% to 99% with factors such as tissue type, lesion location, and type of biopsy affecting the result [19,23,24]. Some authors do not clearly state the rate of repeat needle or open biopsies, but the range is 3% to 25% [17,21,24].…”

2011 Mid-America Orthopaedic Association Dallas B. Phemister Physician in Training Award: Can Musculoskeletal Tumors be Diagnosed with Ultrasound Fusion-Guided Biopsy?

“…The use of percutaneous biopsy techniques has been a standard practice in the evaluation of musculoskeletal lesions, and studies have proven its safety and detection power [23,25]. Various radiographic adjuncts, including US, CT, and MRI, have been used to improve detection and minimize complications.…”