The hazards of biopsy in patients with malignant primary bone and soft-tissue tumors.

Mankin, Henry J.; Lange, Thomas; Spanier, Suzanne S.

doi:10.2106/00004623-198264080-00002

Cited by 611 publications

(356 citation statements)

References 5 publications

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“…Cases of low-grade osteosarcoma are therefore often misdiagnosed as benign lesions. 13,14 An experienced team can diagnose parosteal osteosarcoma on typical radiological features, that is, a heavily mineralized mass attached to the cortex of the distal posterior femur. In some cases, primary surgical resection without previous biopsy can then be proposed.…”

Section: Discussionmentioning

confidence: 99%

“…In two reviews of the literature, low-grade osteosarcomas were initially misdiagnosed as benign tumors in 32-60% of cases. 13,14 In the Mankin series, the rate of misdiagnosis reached 50% in specialist centers. 14 The differential diagnosis may include diverse entities such as fibrous dysplasia, non-ossifying fibroma, myositis ossificans, fracture callus, ossifying hematoma, osteochondroma, desmoplastic fibroma, osteoma and giant bone island.…”

mentioning

confidence: 99%

“…13,14 In the Mankin series, the rate of misdiagnosis reached 50% in specialist centers. 14 The differential diagnosis may include diverse entities such as fibrous dysplasia, non-ossifying fibroma, myositis ossificans, fracture callus, ossifying hematoma, osteochondroma, desmoplastic fibroma, osteoma and giant bone island. [2][3][4]6,12,15 Little information on low-grade osteosarcoma genetics is available in the literature.…”

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confidence: 99%

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MDM2 and CDK4 immunohistochemistry is a valuable tool in the differential diagnosis of low-grade osteosarcomas and other primary fibro-osseous lesions of the bone

Dujardin

Binh²,

Bouvier³

et al. 2011

Modern Pathology

202

122

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Low-grade osteosarcoma is a rare malignancy that may be subdivided into two main subgroups on the basis of location in relation to the bone cortex, that is, parosteal osteosarcoma and low-grade central osteosarcoma. Their histological appearance is quite similar and characterized by spindle cell stroma with low-to-moderate cellularity and well-differentiated anastomosing bone trabeculae. Low-grade osteosarcomas have a simple genetic profile with supernumerary ring chromosomes comprising amplification of chromosome 12q13-15, including the cyclindependent kinase 4 (CDK4) and murine double-minute type 2 (MDM2) gene region. Low-grade osteosarcoma can be confused with fibrous and fibro-osseous lesions such as fibromatosis and fibrous dysplasia on radiological and histological findings. We investigated MDM2-CDK4 immunohistochemical expression in a series of 72 low-grade osteosarcomas and 107 fibrous or fibro-osseous lesions of the bone or paraosseous soft tissue. The MDM2-CDK4 amplification status of low-grade osteosarcoma was also evaluated by comparative genomic hybridization array in 18 cases, and the MDM2 amplification status was evaluated by fluorescence in situ hybridization or quantitative real-time polymerase chain reaction in 31 cases of benign fibrous and fibro-osseous lesions. MDM2-CDK4 immunostaining and MDM2 amplification by fluorescence in situ hybridization or quantitative real-time polymerase chain reaction were investigated in a control group of 23 cases of primary high-grade bone sarcoma, including 20 conventional high-grade osteosarcomas, two pleomorphic spindle cell sarcomas/malignant fibrous histiocytomas and one leiomyosarcoma. The results showed that MDM2 and/or CDK4 immunoreactivity was present in 89% of lowgrade osteosarcoma specimens. All benign fibrous and fibro-osseous lesions and the tumors of the control group were negative for MDM2 and CDK4. These results were consistent with the MDM2 and CDK4 amplification results. In conclusion, immunohistochemical expression of MDM2 and CDK4 is specific and provides sensitive markers for the diagnosis of low-grade osteosarcomas, helping to differentiate them from benign fibrous and fibro-osseous lesions, particularly in cases with atypical radio-clinical presentation and/or limited biopsy samples.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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MDM2 and CDK4 immunohistochemistry is a valuable tool in the differential diagnosis of low-grade osteosarcomas and other primary fibro-osseous lesions of the bone

Dujardin

Binh²,

Bouvier³

et al. 2011

Modern Pathology

202

122

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“…Traditionally, open biopsy has been the gold standard for musculoskeletal lesions, providing adequate material for histological and immunohistochemical studies in most cases, resulting in a highly diagnostic procedure. However, in vertebral neoplasm, performing an open biopsy can be a difficult procedure with significant risk of complications [13,14].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous CT-guided biopsy of the spine: results of 430 biopsies

et al. 2008

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Biopsies of lesions in the spine are often challenging procedures with significant risk of complications. CT-guided needle biopsies could lower these risks but uncertainties still exist about the diagnostic accuracy. Aim of this retrospective study was to evaluate the diagnostic accuracy of CT-guided needle biopsies for bone lesions of the spine. We retrieved the results of 430 core needle biopsies carried out over the past fifteen years at the authors' institute and examined the results obtained. Of the 430 biopsies performed, in 401 cases the right diagnosis was made with the first CT-guided needle biopsy (93.3% accuracy rate). Highest accuracy rates were obtained in primary and secondary malignant lesions. Most false negative results were found in cervical lesions and in benign, pseudotumoral, inflammatory, and systemic pathologies. There were only 9 complications (5 transient paresis, 4 haematomas that resolved spontaneously) that had no influence on the treatment strategy, nor on the patient's outcome. In conclusion we can assert that this technique is reliable and safe and should be considered the gold standard in biopsies of the spine.

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“…The key to education is information. In the 1980s [1], and again in the 1990s [2], Drs. Mankin and Simon led members of the Musculoskeletal Tumor Society to decry prereferral biopsy of malignant bone neoplasms.…”

Section: How Do We Get There?mentioning

confidence: 99%

CORR Insights®: What Is the Use of Imaging Before Referral to an Orthopaedic Oncologist? A Prospective, Multicenter Investigation

Jones

2015

Clinical Orthopaedics &Amp; Related Research

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The hazards of biopsy in patients with malignant primary bone and soft-tissue tumors.

Cited by 611 publications

References 5 publications

MDM2 and CDK4 immunohistochemistry is a valuable tool in the differential diagnosis of low-grade osteosarcomas and other primary fibro-osseous lesions of the bone

MDM2 and CDK4 immunohistochemistry is a valuable tool in the differential diagnosis of low-grade osteosarcomas and other primary fibro-osseous lesions of the bone

Percutaneous CT-guided biopsy of the spine: results of 430 biopsies

CORR Insights®: What Is the Use of Imaging Before Referral to an Orthopaedic Oncologist? A Prospective, Multicenter Investigation

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