Biopsy sensitivity in retroperitoneal dedifferentiated liposarcoma (DDLPS) is variable. Patients with grade 3 DDLPS face a significant risk of metastatic disease and may potentially benefit from neoadjuvant therapy, making highly accurate pretherapy diagnosis essential. Our study aimed to establish whether diagnostic sensitivity could be improved by targeting solid areas of tumor on percutaneous biopsy.
Between 2016 and 2019, data on patients with suspected primary retroperitoneal sarcoma who underwent a biopsy were collected, and diagnostic accuracy was calculated. These data were compared with our previously reported series from 2005 to 2016. For DDLPS tumors, comparisons were then made between biopsies that targeted the solid component and those that did not.
Data were available for 121 patients in the current series and 238 from the previous study. The proportion of biopsies returning a histological subtype concordant with postoperative pathology was 83% in the current series, marking a significant improvement over our previous study (67%, p = 0.001). For diagnosis of DDLPS, biopsy sensitivity improved from 40 to 74% (p < 0.001), with an increase from 13 to 50% (p = 0.006) where grade 3 DDLPS was treated as a separate disease. Within the current series, targeted biopsy yielded a sensitivity of 100% for identifying DDLPS, compared with 10% in nontargeted biopsy (p < 0.001).
Systematic targeting of solid areas of tumor within suspected retroperitoneal liposarcoma has improved sensitivity for detection of both DDLPS and grade 3 DDLPS on biopsy. This approach minimizes the risk of underdiagnosis of patients with DDLPS who could benefit from neoadjuvant chemotherapy.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Brennan MF, Antonescu CR, Moraco N, et al. Lessons learned from the study of 10,000 patients with soft tissue sarcoma. Ann Surg. 2014;260:416–21.
Trans-Atlantic RPSWG. Management of primary retroperitoneal sarcoma (RPS) in the adult: a consensus approach from the Trans-Atlantic RPS Working Group. Ann Surg Oncol. 2015;22:256–63.
Tan MC, Brennan MF, Kuk D, et al. Histology-based classification predicts pattern of recurrence and improves risk stratification in primary retroperitoneal sarcoma. Ann Surg. 2016;263:593–600.
Gronchi A, Strauss DC, Miceli R, et al. Variability in patterns of recurrence after resection of primary retroperitoneal sarcoma (RPS): a report on 1007 patients from the Multiinstitutional Collaborative RPS Working Group. Ann Surg. 2016;263:1002–9.
Dingley B, Fiore M, Gronchi A. Personalizing surgical margins in retroperitoneal sarcoma: an update. Exp Rev Anticanc Ther. 2019;19:613–31.
Gronchi A, Miceli R, Allard MA, et al. Personalizing the approach to retroperitoneal soft tissue sarcoma: histology-specific patterns of failure and postrelapse outcome after primary extended resection. Ann Surg Oncol. 2015;22:1447–54.
Morosi C, Stacchiotti S, Marchianò A, et al. Correlation between radiological assessment and histopathological diagnosis in retroperitoneal tumors: analysis of 291 consecutive patients at a tertiary reference sarcoma center. Eur J Surg Oncol. 2014;40:1662–70.
Berger-Richardson D, Burtenshaw SM, Ibrahim AM et al. Early and late complications of percutaneous core needle biopsy of retroperitoneal tumors at two tertiary sarcoma centers. Ann Surg Onc. 2019;26:4692–8.
Almond LM, Tirotta F, Tattersall H, et al. Diagnostic accuracy of percutaneous biopsy in retroperitoneal sarcoma. Br J Surg. 2019;106:395–403.
Coindre JM, Trojani M, Contesso G, et al. Reproducibility of a histopathologic grading system for adult soft tissue sarcoma. Cancer. 1986;58:306–9.
Ikoma N, Torres KE, Somaiah N et al. Accuracy of preoperative percutaneous biopsy for the diagnosis of retroperitoneal liposarcoma subtypes. Ann Surg Oncol. 2015;22:1068–72.
Lahat G, Madewell JE, Anaya DA, et al. Computed tomography scan-driven selection of treatment for retroperitoneal liposarcoma histologic subtypes. Cancer. 2009;115:1081–90.
Fiore M. Distinguishing between well-differentiated and dedifferentiated retroperitoneal liposarcomas in the preoperative setting: a work in progress in the era of precision medicine. Ann Surg Oncol. 2015;22:1055–56.
von Mehren M, Benjamin RS, Bui MM, Casper ES, Conrad EU III, DeLaney TF, et al. Soft tissue sarcoma, version 2.2012: featured updates to the NCCN guidelines. J Natl Compr Canc Netw. 2012;10:951–60.
Bonvalot S, Gronchi A, Le Pechoux C, et al. STRASS (EORTC 62092): a phase III randomized study of preoperative radiotherapy plus surgery versus surgery alone for patients with retroperitoneal sarcoma. J Clin Oncol. 2019;37(15 Suppl):11001.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Tirotta, F., Morosi, C., Hodson, J. et al. Improved Biopsy Accuracy in Retroperitoneal Dedifferentiated Liposarcoma. Ann Surg Oncol 27, 4574–4581 (2020). https://doi.org/10.1245/s10434-020-08519-1