Outpatient Core Needle Biopsy Versus Intraoperative Open Surgical Biopsy in the Diagnosis and Grading of Soft Tissue Neoplasms: Is One Method Better Than the Other?
Jennifer Kaley, Matthew Lindberg. University of Arkansas for Medical Sciences, Little Rock, AR
Background: Soft tissue neoplasms are notorious for their morphologic heterogeneity, not only from one specimen to another but also within an individual specimen. Although the open surgical biopsy (OSB) is a mainstay for diagnosis of these tumors, surgeons are more frequently utilizing the core needle biopsy in the outpatient setting (OCNB) due to its convenience and lower risk of morbidity to the patient. The aim of our study was to evaluate and compare the accuracy of OSB and OCNB in the diagnosis and grading of soft tissue neoplasms.
Design: Twenty-five (25) OCNBs and 76 OSBs of soft tissue neoplasms from 2010 to the present were collected from our archives. Each biopsy included a follow-up resection specimen. Biopsies and corresponding subsequent resections were evaluated by two pathologists (one with specific expertise in soft tissue pathology) for the determination of adequate sampling, tumor grading (benign, low grade malignant, high grade malignant), and diagnosis (if possible). The tissue of origin (e.g., adipocytic, etc) was also recorded in order to assess whether tumors of a particular origin were more or less acurately diagnosed or graded on biopsy.
Results: Twenty of twenty-five (80%) OCNBs were deemed representative of the subsequent resections. The 5 non-representative cases related to a change in grade from benign to low grade malignant (2 well differentiated liposarcomas and 1 low-grade fibromyxoid sarcoma) or a change in diagnosis (2 pleomorphic liposarcomas). Sixty-four of 76 (84%) OSBs were deemed representative. Three of the 4 non-representative cases related to a change in grade from benign to low grade malignant (all well differentiated liposarcomas), and one resulted in a change in diagnosis but no change in grade (foamy macrophages to pigmented villonodular synovitis). The difference in histologic accuracy between OCNB and OSB, 80% and 84% respectively, was not statistically significant (P=0.3099).
Conclusions: There was no significant difference in representative sampling, diagnosis, or grading between OCNB and OSB in this study. Given the convenience of the procedure and the lower risk of morbidity, OCNB appears to be a viable and favorable alternative to OSB in the diagnosis and grading of soft tissue neoplasms; however, care should be taken with adipocytic tumors, particularly well differentiated lipomatous neoplasms, as diagnostic elements of malignancy are less likely to be present in small specimens than for tumors of other origins.
Category: Bone & Soft Tissue
Tuesday, March 5, 2013 1:00 PM
Poster Session IV # 16, Tuesday Afternoon