Core needle biopsy diagnosis of musculoskeletal tumors at a small regional treatment center and at sarcoma referral centers are equally effective and accurate: a retrospective case series

Abstract

Background: Although incisional biopsy (IB) is the gold standard for diagnosing musculoskeletal tumors, core needle biopsy (CNB) is becoming common. Many large sarcoma referral centers have evaluated the accuracy of CNB, but its accuracy at smaller centers is unknown. Methods: After IRB approval, a retrospective study of patients undergoing CNB and IB for musculoskeletal tumor diagnosis at Texas Tech University Health Sciences Center from 2006 to 2018 was performed. All patients underwent surgical excision of their tumor. Final pathology was the gold standard for analysis. Biopsy effectiveness and accuracy for determining malignancy and pathology was determined. Complications from biopsies and diagnostic errors were evaluated. Results: Efficacy of CNB was 83.1% for bone and 97.7% for soft-tissue tumors; IB was 100% effective. Accuracy of determining malignancy of bone tumors was 89.8% for CNB and 100% for IB, while that for soft-tissue tumors was 92.9% with CNB and 100% with IB. Accuracy of CNB determining pathology of bone tumors was 73.1% for malignant and 42.4% for benign tumors, while IB determined pathology of 100% of malignant and 75% of benign tumors. For soft-tissue tumors, CNB accurately diagnosed 88.9% of malignant and 52% of benign tumors while IB accurately diagnosed 100% of malignant and benign soft-tissue tumors. There were no procedural complications related to biopsy. Conclusions: The data in this study show that CNB and IB performed at a small treatment center are effective and accurate for diagnosis of musculoskeletal tumors. Level of Evidence: Level IV.