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Excisional biopsy of suspected benign soft tissue tumors of the upper extremity: correlation between preoperative diagnosis and actual pathology

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HAND

Abstract

Background

Tumors of the upper extremity are common and mostly benign. However, the prevalence of discordant diagnosis of a solid hand tumor is less studied. The objectives of this retrospective study were (1) to determine the proportion of patients with a different (discrepant or discordant) pathological diagnosis compared to the preoperative diagnosis, (2) to determine the prevalence of the types of pathologies encountered at excisional biopsy for suspected benign tumors, and (3) to determine the types of tumors diagnosed when the surgeon does not make a preoperative diagnosis.

Methods

One hundred and eighty-two suspected benign soft tissue tumors of the upper extremity with a preoperative diagnosis other than ganglion cyst were excised by one of three surgeons over a 10-year period. A preoperative diagnosis was applied for 125 tumors. No preoperative imaging was used.

Results

Only 26 of the 125 tumors (21 %) with a preoperative diagnosis were discrepant. The tumors that were most likely to have a discrepant diagnosis were vascular tumors (32 %) and other less common benign tumors (33 %). Among the entire cohort of 182 tumors, lipomas (19 %), giant cell tumors of tendon sheath (GCTTS; 19 %), and vascular tumors (16 %) were the most frequent pathological diagnoses. Among the 57 tumors that did not have a preoperative diagnosis, most were vascular tumors (23 %), fibromas (14 %), and GCTTS (11 %). One tumor without a preoperative diagnosis was a malignant tumor, but we consider this unusual and possibly spurious.

Conclusions

A hand surgeon’s preoperative diagnosis without imaging is usually correct prior to excision of a mass in the hand. Discrepant diagnoses are usually benign and do not alter treatment.

Level of evidence: Prognostic II

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Acknowledgments

HCES was supported by the Dutch research grant from Anna Foundation|NOREF, The Netherlands, for Scientific Research.

SJEB was supported by the Dutch research grants from Anna Foundation|NOREF, Stichting Fonds Doctor Catharine van Tussenbroek, Genootschap Noorthey, and Stichting Vreedefonds, The Netherlands, for Scientific Research.

JKJB was supported by a faculty grant for medicine students from Vrije Universiteit Amsterdam, The Netherlands.

Conflict of Interest

Heleen C.E. Sluijmer declares that he has no conflicts of interest to disclose related to this study.

Stéphanie J.E. Becker declares that she has no conflicts of interest to disclose related to this study.

Jeroen K.J. Bossen declares that he has no conflicts of interest to disclose related to this study.

David Ring declares that he has no conflicts of interest to disclose related to this study.

Statement of Human Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Statement of Informed Consent

Informed consent was waived for this study.

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Correspondence to David Ring.

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Sluijmer, H.C.E., Becker, S.J.E., Bossen, J.K.J. et al. Excisional biopsy of suspected benign soft tissue tumors of the upper extremity: correlation between preoperative diagnosis and actual pathology. HAND 9, 351–355 (2014). https://doi.org/10.1007/s11552-014-9641-y

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  • DOI: https://doi.org/10.1007/s11552-014-9641-y

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