Accuracy of core needle biopsy for histologic diagnosis of soft tissue sarcoma

J. Kiefer,Ph. Kurz,F. Simunovic,M. Mutschler,G. B. Stark,H. Bannasch

doi:10.1038/s41598-022-05752-4

Abstract

The biopsy technique of choice in soft tissue sarcoma (STS) diagnosis is controversial. We examined the diagnostic accuracy of percutaneous core needle biopsy (CNB) and compared it to open incisional biopsy. A retrospective study included 91 incisional biopsies and 102 CNBs. A pair-match investigation was conducted on 19 patient pairs, comparing sensitivity, specificity, and diagnostic accuracy. Furthermore, we investigated the role of molecular pathology in sarcoma diagnostics. In 81/91 (89%) patients with incisional biopsy, the entity was confirmed by definitive pathology, whereas this was the case in 89/102 (87%) CNB patients (p = 0.52). Grading remained unchanged in 46/55 (84%) of incisional and 54/62 (87%) of CNBs (p = 0.61). The pair matched analysis showed that the correct entity was determined in 96% of incisional and 97.6% of core needle biopsies. The time between the initial consultation and the interdisciplinary tumor board's treatment recommendation was shorter in core needle biopsies (8.37 vs. 15.63 days; p < 0.002). Incisional biopsies led to two wound infections and one hematoma, whereas wound infection occurred in one patient after CNB. CNB leads to faster diagnosis while reaching the same histological accuracy and is less burdensome for patients. Still, surgeons need to remain aware of the possibility of biopsy failure.

Highlights

The biopsy technique of choice in soft tissue sarcoma (STS) diagnosis is controversial
In the core needle biopsy (CNB) group, we biopsied significantly more undifferentiated sarcomas and soft tissue metastases of other adenocarcinoma or non-solid tumors, whereas we found more sarcomas arising from vascular tissue in the incisional biopsy group
There was no need for new biopsy and primary surgery has been suggested, so that there was no delay in treatment. This retrospective analysis provides evidence that core needle biopsy is as accurate as incisional biopsy in diagnosing soft tissue sarcoma

Summary

Introduction

The biopsy technique of choice in soft tissue sarcoma (STS) diagnosis is controversial. Open incisional biopsy delivered the best quality tissue for an accurate diagnosis with the lowest rate of false biopsies This procedure requires general anesthesia, and complications such as hematoma and wound infection occur in up to 16% of c ases[6]. Less-invasive soft tissue tumor biopsy methods, such as percutaneous core needle biopsy (CNB) and fineneedle aspiration biopsy, have emerged as alternatives These procedures are performed in the office under local anesthesia. Newer studies, including a comprehensive 2020 meta-analysis, have reported comparable accuracy of percutaneous CNB and incisional biopsy, and an increasing number of centers have cited CNB as the method of the first choice in diagnosing soft tissue tumors[13,14,15,16,17,18,19,20,21,22,23]. We analyze the role of molecular pathology in sarcoma diagnostics in our institution

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