Advertisement

Clinical Orthopaedics and Related Research®

, Volume 468, Issue 10, pp 2774–2780 | Cite as

Office-based Core Needle Biopsy of Bone and Soft Tissue Malignancies: An Accurate Alternative to Open Biopsy with Infrequent Complications

  • Sheila C. AdamsEmail author
  • Benjamin K. Potter
  • David J. Pitcher
  • H. Thomas Temple
Clinical Research

Abstract

Background

Biopsy is a critical step in the diagnosis of musculoskeletal malignancy. As an alternative to open biopsy, percutaneous core needle biopsy techniques have been developed. As many studies combine office-based, image-guided, and operative biopsies, the accuracy of office-based core needle biopsy is not well documented.

Question/purposes

We asked whether (1) office-based core needle biopsy for the diagnosis of malignant musculoskeletal neoplasms would have few complications and diagnostic and accuracy rates comparable to those cited in the literature for core needle biopsy, (2) diagnostic errors related to office-based core needle biopsy would result in surgical treatment errors, and (3) tissue core quantity and tumor type would affect accuracy.

Patients and Methods

We retrospectively reviewed 234 patients with 252 core needle biopsies of malignant bone and soft tissue neoplasms at one institution between 1999 and 2007. Biopsy accuracy and errors were determined on the basis of histologic evaluation of prior or subsequent biopsies and/or resected specimens, when available. We eliminated 19 patients who had needle biopsies: three had the core needle biopsy completed in the operating room and 16 had insufficient documentation or followup, leaving 233 for study.

Results

Of the 233 core needle biopsies, 212 (91%) were diagnostic and accurate for malignancy. Fourteen (6%) biopsies were nondiagnostic. Major errors, defined as a benign diagnosis in a malignant tumor, occurred in seven cases (3%). Minor errors, defined as errors in histopathologic diagnosis or grade, occurred in 24 biopsies (10%). All nondiagnostic and major core needle biopsy errors were identified and addressed with either a diagnostic open biopsy or definitive wide local excision, resulting in no surgical treatment errors. Accuracy was not influenced by core number; however, myxoid lesions showed a correlation with biopsy error. There were no biopsy-related complications.

Conclusions

Office-based core needle biopsy for diagnosis of malignant musculoskeletal neoplasms has high diagnostic and accuracy rates without associated complications.

Level of Evidence

Level II, diagnostic study. See the Guidelines for Authors for a complete description of the level of evidence.

Keywords

Core Needle Biopsy Wide Local Excision Open Biopsy Definitive Surgical Treatment Benign Diagnosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank Zoraida Moore and Nancy Garcia for assistance with this project.

References

  1. 1.
    Ashford RU, McCarthy SW, Scolyer RA, Bonar SF, Karim RZ, Stalley PD. Surgical biopsy with intra-operative frozen section: an accurate and cost-effective method for diagnosis of musculoskeletal sarcomas. J Bone Joint Surg Br. 2006;88:1207–1211.CrossRefPubMedGoogle Scholar
  2. 2.
    Ayala AG, Ro JY, Fanning CV, Flores JP, Yasko AW. Core needle biopsy and fine-needle aspiration in the diagnosis of bone and soft-tissue lesions. Hematol Oncol Clin North Am. 1995;9:633–651.PubMedGoogle Scholar
  3. 3.
    Ball AB, Fisher C, Pittam M, Watkins RM, Westbury G. Diagnosis of soft tissue tumours by Tru-Cut biopsy. Br J Surg. 1990;77:756–758.CrossRefPubMedGoogle Scholar
  4. 4.
    Boriani S, Ruggieri P, Sudanese A. Biopsy: considerations on surgical technique derived from a study of 749 cases of bone tumour. Ital J Orthop Traumatol. 1984;10:489–499.PubMedGoogle Scholar
  5. 5.
    Carrino JA, Khurana B, Ready JE, Silverman SG, Winalski CS. Magnetic resonance imaging-guided percutaneous biopsy of musculoskeletal lesions. J Bone Joint Surg Am. 2007;89:2179–2187.CrossRefPubMedGoogle Scholar
  6. 6.
    Clasby R, Tilling K, Smith MA, Fletcher CD. Variable management of soft tissue sarcoma: regional audit with implications for specialist care. Br J Surg. 1997;84:1692–1696.CrossRefPubMedGoogle Scholar
  7. 7.
    Heare TC, Enneking WF, Heare MM. Staging techniques and biopsy of bone tumors. Orthop Clin North Am. 1989;20:273–285.PubMedGoogle Scholar
  8. 8.
    Heslin MJ, Lewis JJ, Woodruff JM, Brennan MF. Core needle biopsy for diagnosis of extremity soft tissue sarcoma. Ann Surg Oncol. 1997;4:425–431.CrossRefPubMedGoogle Scholar
  9. 9.
    Kissin MW, Fisher C, Carter RL, Horton LW, Westbury G. Value of Tru-cut biopsy in the diagnosis of soft tissue tumours. Br J Surg. 1986;73:742–744.CrossRefPubMedGoogle Scholar
  10. 10.
    Mankin HJ, Lange TA, Spanier SS. The hazards of biopsy in patients with malignant primary bone and soft-tissue tumors. J Bone Joint Surg Am. 1982;64:1121–1127.PubMedGoogle Scholar
  11. 11.
    Mankin HJ, Mankin CJ, Simon MA. The hazards of the biopsy, revisited. Members of the Musculoskeletal Tumor Society. J Bone Joint Surg Am. 1996;78:656–663.PubMedGoogle Scholar
  12. 12.
    Mitsuyoshi G, Naito N, Kawai A, Kunisada T, Yoshida A, Yanai H, Dendo S, Yoshino T, Kanazawa S, Ozaki T. Accurate diagnosis of musculoskeletal lesions by core needle biopsy. J Surg Oncol. 2006;94:21–27.CrossRefPubMedGoogle Scholar
  13. 13.
    Moore TM, Meyers MH, Patzakis MJ, Terry R, Harvey JP Jr. Closed biopsy of musculoskeletal lesions. J Bone Joint Surg Am. 1979;61:375–380.PubMedGoogle Scholar
  14. 14.
    Oetgen ME, Grosser DM, Friedlaender GE, Lindskog DM. Core needle biopsies of musculoskeletal tumors: potential pitfalls. Orthopedics. 2008;31. pii: orthosupersite.com/view.asp?rID = 32927.Google Scholar
  15. 15.
    Ogilvie CM, Torbert JT, Finstein JL, Fox EJ, Lackman RD. Clinical utility of percutaneous biopsies of musculoskeletal tumors. Clin Orthop Relat Res. 2006;450:95–100.CrossRefPubMedGoogle Scholar
  16. 16.
    Puri A, Shingade VU, Agarwal MG, Anchan C, Juvekar S, Desai S, Jambhekar NA. CT-guided percutaneous core needle biopsy in deep seated musculoskeletal lesions: a prospective study of 128 cases. Skeletal Radiol. 2006;35:138–143.CrossRefPubMedGoogle Scholar
  17. 17.
    Ray-Coquard I, Ranchere-Vince D, Thiesse P, Ghesquieres H, Biron P, Sunyach MP, Rivoire M, Lancry L, Meeus P, Sebban C, Blay JY. Evaluation of core needle biopsy as a substitute to open biopsy in the diagnosis of soft-tissue masses. Eur J Cancer. 2003;39:2021–2025.CrossRefPubMedGoogle Scholar
  18. 18.
    Serpell JW, Pitcher ME. Pre-operative core biopsy of soft-tissue tumours facilitates their surgical management. Aust NZ J Surg. 1998;68:345–349.CrossRefGoogle Scholar
  19. 19.
    Shin HJ, Amaral JG, Armstrong D, Chait PG, Temple MJ, John P, Smith CR, Taylor G, Connolly BL. Image-guided percutaneous biopsy of musculoskeletal lesions in children. Pediatr Radiol. 2007;37:362–369.CrossRefPubMedGoogle Scholar
  20. 20.
    Skrzynski MC, Biermann JS, Montag A, Simon MA. Diagnostic accuracy and charge-savings of outpatient core needle biopsy compared with open biopsy of musculoskeletal tumors. J Bone Joint Surg Am. 1996;78:644–649.PubMedGoogle Scholar
  21. 21.
    Stoker DJ, Cobb JP, Pringle JA. Needle biopsy of musculoskeletal lesions: a review of 208 procedures. J Bone Joint Surg Br. 1991;73:498–500.PubMedGoogle Scholar
  22. 22.
    Thomas JM. Surgical biopsy techniques and differential diagnosis of soft tissue tumours. Recent Results Cancer Res. 1995;138:25–29.PubMedGoogle Scholar
  23. 23.
    van der Bijl AE, Taminiau AH, Hermans J, Beerman H, Hogendoorn PC. Accuracy of the Jamshidi trocar biopsy in the diagnosis of bone tumors. Clin Orthop Relat Res. 1997;334:233–243.PubMedGoogle Scholar
  24. 24.
    Ward WG Sr, Kilpatrick S. Fine needle aspiration biopsy of primary bone tumors. Clin Orthop Relat Res. 2000;373:80–87.CrossRefPubMedGoogle Scholar
  25. 25.
    Welker JA, Henshaw RM, Jelinek J, Shmookler BM, Malawer MM. The percutaneous needle biopsy is safe and recommended in the diagnosis of musculoskeletal masses. Cancer. 2000;89:2677–2686.CrossRefPubMedGoogle Scholar
  26. 26.
    Woon DT, Serpell JW. Preoperative core biopsy of soft tissue tumours facilitates their surgical management: a 10-year update. ANZ J Surg. 2008;78:977–981.CrossRefPubMedGoogle Scholar
  27. 27.
    Wu JS, Goldsmith JD, Horwich PJ, Shetty SK, Hochman MG. Bone and soft-tissue lesions: what factors affect diagnostic yield of image-guided core-needle biopsy? Radiology. 2008;248:962–970.CrossRefPubMedGoogle Scholar
  28. 28.
    Yao L, Nelson SD, Seeger LL, Eckardt JJ, Eilber FR. Primary musculoskeletal neoplasms: effectiveness of core-needle biopsy. Radiology. 1999;212:682–686.PubMedGoogle Scholar
  29. 29.
    Zornoza J, Bernardino ME, Ordonez NG, Thomas JL, Cohen MA. Percutaneous needle biopsy of soft tissue tumors guided by ultrasound and computed tomography. Skeletal Radiol. 1982;9:33–36.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Sheila C. Adams
    • 1
    Email author
  • Benjamin K. Potter
    • 2
    • 3
    • 4
  • David J. Pitcher
    • 1
  • H. Thomas Temple
    • 1
  1. 1.Department of Orthopaedics and RehabilitationUniversity of Miami Miller School of Medicine, University of Miami HospitalMiamiUSA
  2. 2.Integrated Department of Orthopaedics and RehabilitationWalter Reed National Military Medical CenterWashingtonUSA
  3. 3.Integrated Department of Orthopaedics and RehabilitationWalter Reed National Military Medical CenterBethesdaUSA
  4. 4.Department of SurgeryUniformed Service University of Health SciencesBethesdaUSA

Personalised recommendations