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A Comparison of Fine-needle Aspiration, Core Biopsy, and Surgical Biopsy in the Diagnosis of Extremity Soft Tissue Masses

  • Symposium: Highlights of the ISOLS/MSTS 2009 Meeting
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Biopsy tissue can be obtained through a fine needle, a wider coring needle, or through an open surgical incision. Though much literature exists regarding the diagnostic yield of these techniques individually, none compare accuracy of diagnosis in the same mass.

Questions/purposes

We asked how the diagnostic accuracy of fine-needle aspiration, core biopsy, and open surgical biopsy compare in regard to identifying malignancy, establishing the exact diagnosis, and guiding the appropriate treatment of soft tissue masses.

Patients and Methods

We prospectively studied 57 patients with palpable extremity soft tissue masses, performing fine-needle aspiration, followed by core biopsy, followed by surgical biopsy of the same mass.

Results

Open surgical biopsy was 100% accurate on all accounts. With regard to determining malignancy, fine-needle aspiration and core biopsy had 79.17% and 79.2% sensitivity, 72.7% and 81.8% specificity, 67.9% and 76% positive predictive value, 82.8% and 84.4% negative predictive value, and an overall accuracy of 75.4% and 80.7%, respectively. In regard to determining exact diagnosis, fine-needle aspiration had a 33.3% accuracy and core biopsy had a 45.6% accuracy. With regard to eventual treatment, fine-needle aspiration was 38.6% accurate and core biopsy was 49.1% accurate.

Conclusions

In soft tissue mass diagnosis, core biopsy is more accurate than fine-needle aspiration on all accounts, and open biopsy is more accurate than both in determining malignancy, establishing the exact diagnosis, and the guiding appropriate treatment.

Level of Evidence

Level I, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Sarah E. Cole, MS, Adrian J. Correa, MD, and Ling Wang, PA, for their considerable efforts, which made this study possible.

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Authors and Affiliations

  1. Department of Orthopedics, University of Southern California + Los Angeles County Medical Center, 1200 N State St, Ste 3900, Los Angeles, CA, USA

    Sina Kasraeian MD, Daniel C. Allison MD, MBA & Elke R. Ahlmann MD

  2. Division of Musculoskeletal Oncology, Southern California Permanente Medical Group, 1011 Baldwin Park Boulevard, Baldwin Park, CA, 91706, USA

    Daniel C. Allison MD, MBA

  3. Department of Pathology, University of Southern California + Los Angeles County Medical Center, Los Angeles, CA, USA

    Alexander N. Fedenko MD

  4. Department of Orthopedics, University of Southern California + Los Angeles County Medical Center, USC University Hospital, Los Angeles, CA, USA

    Lawrence R. Menendez MD, FACS

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  1. Sina Kasraeian MD
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  2. Daniel C. Allison MD, MBA
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  3. Elke R. Ahlmann MD
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  4. Alexander N. Fedenko MD
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  5. Lawrence R. Menendez MD, FACS
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Correspondence to Daniel C. Allison MD, MBA.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Kasraeian, S., Allison, D.C., Ahlmann, E.R. et al. A Comparison of Fine-needle Aspiration, Core Biopsy, and Surgical Biopsy in the Diagnosis of Extremity Soft Tissue Masses. Clin Orthop Relat Res 468, 2992–3002 (2010). https://doi.org/10.1007/s11999-010-1401-x

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