Summary
Tumour cells may be dispersed into the wound when diagnostic or excisional biopsy is undertaken. This risk is reduced by using fine needle aspiration biopsy. The definitive excision of a soft tissue sarcoma may then be carried out in a more limited manner. In selected cases diagnostic and definitive operation may be combined, accepting the risk of excision of a benign lesion with unnecessarily broad margins. Aspiration cytology could possibly help the surgeon to decide on the extent of the excision.
One hundred and nine consecutive patients with soft tissue lesions were referred to the Orthopaedic Oncology Group at Lund in Southern Sweden because of suspected malignancy. Biopsy had not been carried out. Further diagnostic and therapeutic procedures were planned as if aspiration cytology was not going to be used. The procedure was then performed with a fine needle and the cytodiagnosis was used to modify the plan. Sixty-seven tumours were examined histologically. Ten were sarcomas, two metastatic carcinomas and one a malignant lymphoma. The surgical plan was changed after the cytology was known in 33 of the 109 cases. Compartmental or wide excisions which had been planned became unnecessary in 20 patients. No operation was done in 6 patients and in 14 others a more limited excision was carried out. It was possible to avoid planned incisional biopsy in 3 patients with sarcoma.
Résumé
La biopsie chirurgicale peut être responsable d'une extension de la tumeur dans l'hématome opératoire. Pour limiter l'exérèse et conserver la fonction au maximum, on peut, dans certains cas, enlever d'emblée la tumeur en totalité, en prenant le risque de l'excision trop large d'une tumeur bénigne. Aussi la cytologie par aspiration peut-elle guider le chirurgien sur l'étendue à donner à l'éxérèse.
Cette technique a été utilisée dans cent neuf cas consécutifs de tumeurs des parties molles adressées à l'«Orthopaedic Oncology Club» de Suède méridionale à Lund. Dans chaque cas, après l'examen clinique, la plan était fait des mesures diagnostiques et thérapeutiques à prévoir. Puis la cytologie était pratiquée, et le plan éventuellement modifié. Ce fut le cas dans 33 des 109 cas: l'éxérèse prévue a été abandonnée dans 6 cas, réduite dans 14 cas: la biopsie a pu être évitée dans 3 cas de sarcome. Dans 4 cas l'aspiration a donné un résultat inexact: dans deux cas la malignité fut reconnue par la biopsie; les deux cas faussement malins furent traités par excision limitée.
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Rydholm, A., Akerman, M., Idvall, I. et al. Aspiration cytology of soft tissue tumours. International Orthopaedics 6, 209–214 (1983). https://doi.org/10.1007/BF00267141
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DOI: https://doi.org/10.1007/BF00267141