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Biopsie von Knochen- und Weichteilsarkomen

Eine deutschlandweite Umfrage

Biopsies from bone and soft tissue sarcoma

A nationwide survey in Germany

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Zusammenfassung

Studienziel

Die Biopsie stellt in der Diagnostik maligner Tumoren des Bewegungsapparats einen wesentlichen Schritt dar. Ziel ist immer die Gewinnung einer repräsentativen Gewebeprobe unter Beachtung des späteren Zugangswegs für die definitive Operation. Ziel dieser Studie war es daher, die Vorgehensweisen der tumororthopädischen Kliniken in Deutschland im Rahmen einer anonymisierten Umfrage zu erfassen und so die aktuellen Versorgungsmöglichkeiten aufzuzeigen.

Material und Methoden

Insgesamt wurden 60 tumororthopädische Zentren kontaktiert. Jedem Zentrum wurde ein Exemplar eines neuentwickelten Fragebogens mit 13 Items zu Biopsietechnik, Indikationskriterien, Indikationsstellung, Durchführung, unterstützender Bildgebung und histopathologischen Ergebnissen zugesandt. Die Auswertung erfolgte mittels Binärsystem und prozentualer Zustimmung zu jeder Antwortmöglichkeit.

Ergebnisse

In allen Zentren werden offene Biopsien durchgeführt. Perkutane Verfahren finden zusätzlich an 72 % der Kliniken Anwendung. Wichtigstes Kriterium für die Indikation zum offenen oder perkutanen Vorgehen stellt die Lage des Tumors dar (80 %). Die Indikationsstellung erfolgt in 68 % der Fälle durch den tumororthopädischen Oberarzt. Spezielle bildgebende Verfahren kommen in 36 % der Institutionen zum Einsatz. Der Zugangsweg für die Biopsie wird in 88 % durch den Orthopäden festgelegt. In 60 % der Kliniken werden perkutane Biopsien von interventionellen Radiologen durchgeführt. Offene Biopsien erfolgen in 88 % durch einen Assistenzarzt unter Aufsicht des tumororthopädischen Oberarztes. Die histopathologischen Ergebnisse werden in 88 % der Kliniken in einer interdisziplinären Tumorkonferenz diskutiert und in 64 % in einer ambulanten Sprechstunde mitgeteilt.

Schlussfolgerungen

Insgesamt zeigt sich ein weitestgehend leitliniengerechtes Vorgehen der befragten Institutionen bei Biopsien von Tumoren des Bewegungsapparats. Lediglich hinsichtlich der Festlegung des Zugangswegs für die Biopsie und der Anwendung bildgebender Verfahren während der Biopsie waren geringe Abweichungen zu verzeichnen.

Abstract

Aim of the study

A biopsy is an essential step in the diagnostic cascade of malignant bone and soft tissue tumors. The objective is always the extraction of a representative tissue specimen in line with the approach for the definitive operation. The aim of this study therefore was to assess the diagnostic approaches regarding the biopsy of tumors in orthopedic centers in Germany.

Material and methods

In total 60 hospitals with an orthopedic focus on tumors were contacted and provided with a newly developed questionnaire with 13 items regarding biopsy technique, indication criteria, execution, supportive imaging and histopathological results. Evaluation of the responses was performed by means of binary systems and proportional consent to every answer possibility was calculated.

Results

The results of the questionnaire showed that open biopsies are performed in all centers and in 72 % of the hospitals percutaneous techniques are additionally applied. The most important criterion for an open or percutaneous procedure was the tumor location (80 %). The indications for either technique are assessed by a tumor orthopedic consultant in 68 % of the centers and special imaging is applied in 36 % of the institutions. The approach for the biopsy is defined by the orthopedic surgeon in 88 %. Percutanous biopsies are carried out by interventional radiologists in 60 % of the centers. Open biopsies are performed by residents under supervision by a tumor orthopedic consultant in 88 %. The histopathological results are discussed in 88 % of the hospitals in an interdisciplinary tumor board and in 64 % patients are informed about the diagnosis in an outpatient clinic.

Conclusions

Overall, biopsy of musculoskeletal tumors is performed according to the guidelines in most institutions. Only small differences were identified regarding the definition of the surgical approach and the application of imaging techniques during biopsy.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. F. Pohlig, U. Lenze, F.W. Lenze, H. Mühlhofer, J. Schauwecker, H. Rechl, R. von Eisenhart-Rothe geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    F. Pohlig, U. Lenze, F.W. Lenze, H. Mühlhofer, J. Schauwecker, H. Rechl & R. von Eisenhart-Rothe

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  1. F. Pohlig
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  2. U. Lenze
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  3. F.W. Lenze
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  4. H. Mühlhofer
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  5. J. Schauwecker
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  6. H. Rechl
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  7. R. von Eisenhart-Rothe
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Correspondence to F. Pohlig.

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Pohlig, F., Lenze, U., Lenze, F. et al. Biopsie von Knochen- und Weichteilsarkomen. Orthopäde 42, 934–940 (2013). https://doi.org/10.1007/s00132-013-2175-0

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  • DOI: https://doi.org/10.1007/s00132-013-2175-0

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