Therapeutic Accuracy and Diagnostic Utility for Open Biopsy, Core Needle Biopsy and Fine-Needle Aspiration in a Series of 282 Biopsy Procedures: Comparison with Resection Diagnoses
Nikhil A Sangle, Lester J Layfield. University of Utah School of Medicine, Salt Lake City, UT
Background: Interpretation of musculoskeletal biopsies is challenging with reported diagnostic accuracy for open (OB) and core needle (CNB) biopsies being as low as 82%. Diagnostic accuracies of 76-98% and 74-99% have been reported for CNB and fine-needle aspiration (FNA) respectively. Most studies of CNB and FNA have reported accuracy for the separation of benign from malignant lesions. This does not represent true therapeutic accuracy as therapy for malignancies often depends on specific histologic type. Clinical utility is lower than therapeutic accuracy because some FNA and CNB are followed by confirmatory open biopsy. This diminishes the clinical utility of the initial FNA or CNB.
Design: We compared the therapeutic accuracy and clinical utility of OB, CNB and FNA in a series of 282 patients (121 OB, 132 CNB, 65 FNA) who had subsequent definitive therapeutic resections at a single medical center. Biopsy results were categorized as therapeutically correct, minor error, major error, insufficient or confirmation by open biopsy needed. We also calculated the therapeutic accuracy and clinical utility for the combination of CNB and FNA when both were performed at the same time.
Results: Therapeutic accuracy was 86% for OB, 81% for CNB and 64% for FNA. Therapeutic accuracy for the combination of CNB and FNA was 80%. Clinical utility was 86% for OB, 76% for CNB and 38% for FNA. The clinical utility for the combination of CNB and FNA was 75%. Percentage of biopsies insufficient were 0%, 17%, 15% and 0% for OB, CNB, FNA and combined FNA and CNB respectively.
Conclusions: The reduced clinical utility of CNB and FNA was due to confirmatory open biopsies performed before definitive therapy in some cases. FNAs clinical utility was significantly less than that of CNB because of clinician's discomfort with purely cytologic diagnoses. The therapeutic accuracy of FNA was closer to that of CNB (64% vs. 81%) than was its clinical utility (38% vs. 76%). Therapeutic accuracy and clinical utility were not improved by combining CNB and FNA when compared to CNB alone.
Category: Bone & Soft Tissue
Monday, March 19, 2012 1:00 PM
Poster Session II # 20, Monday Afternoon