The Non-Diagnostic Needle Core Biopsy in Musculoskeletal Pathology.
Colin D Elliot, Brian Chow, David DJ Howarth, Rita A Kandel, Brendan C Dickson. Mount Sinai Hospital, Toronto, ON, Canada
Background: Needle core biopsy represents a safe, efficient and accurate technique in the diagnosis of tumors arising in the bone and soft tissues. While much has been published on this topic, guidelines on re-sampling in the event of a non-diagnostic sample are lacking.
Design: We performed a retrospective review of our pathology archives for all needle core biopsies performed on lesions arising in the bone or soft tissues (2005-2009).
Results: A total of 1004 needle core biopsies of the bone and soft tissue were identified. Of these cases a total of 56 (5.6%) were deemed to be diagnostically insufficient (9 bone, 8 joint and 39 soft tissue). 32 patients underwent a second biopsy in the form of either a repeat needle core biopsy (7) or an open biopsy (25) as part of their management. All of the cases followed by an open biopsy (100%) resulted in a diagnosis. Five of the repeat needle core biopsies were diagnostic (71.4%), while two were not (28.6%). For those with a diagnosis, the cases included: 6 malignant and 5 benign soft tissue neoplasms, 5 vascular lesions, 5 lymphoid neoplasms, 3 giant cell tumors, 2 osteosarcomas, 1 osteomyelitis, 1 ganglion cyst and a case each of metastatic melanoma and carcinoma.
Conclusions: This study reaffirms the utility of the needle core biopsy in the diagnosis of musculoskeletal lesions. Our percentage of non-diagnostic cases is similar to that of published reports. In the majority of instances inadequate sampling appears to be the cause of diagnostic insufficiency; however, in retrospect, potential diagnostic clues could be identified in a minority of cases. It is interesting that a greater percentage of non-diagnostic cases appear to occur with lymphoid and vascular lesions. It is possible that lymphoid proliferations are over-represented in our sample population; as well, a greater amount of lesional tissue may be necessary for ancillary studies to facilitate a diagnosis. Vascular lesions were less common in our dataset and it is unclear if lesion heterogeneity contributed to a greater percentage of insufficient cases. In the event of a negative core biopsy an open biopsy remains the most reliable means of securing a diagnosis. Nevertheless, a repeat needle core often yields a diagnostic specimen and may have a role in some clinical situations.
Category: Bone & Soft Tissue
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 14, Tuesday Morning