Managing NON-DIAGNOSTIC biopsies in musculoskeletal tumours in a specialist centre: Deciding on the algorithm. Issue 5 (May 2021)

• Record Type: Journal Article
• Authors: Tamvakopoulos, George S.; Rose, Barry; Saifuddin, Asif; Skinner, John A.; Pollock, Robin
• Is Part Of: European journal of surgical oncology. Volume 47:Issue 5(2021)
• Page Start: 1207
• Page End: 1213
• Publication Date: 2021-05
• Subjects: Diagnosis -- Biopsy -- Non-diagnostic -- Re-biopsy -- Sarcoma -- Bone tumour; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2020.10.011
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Introduction: Core needle biopsy is an effective method of obtaining tissue diagnosis. However, a diagnostic dilemma arises when lesional tissue is non-diagnostic which obviates considering radiological guided re-biopsy (RB) or an open surgical biopsy but the question raised is which serves as a better diagnostic tool. Patient and methods: We retrospectively reviewed data from a prospectively collected database of 4516 core needle biopsies performed in our specialist musculoskeletal tumour centre over a 6-year period. Our aim was to evaluate the management of non-diagnostic biopsies (NDB) and establish a safe and accurate diagnostic strategy in the presence of a NDB. Results: Two hundred fifteen (4.8%) NDB cases with complete follow-up were identified. Of these 157 (73%) were treated definitively on the basis of imaging and 58 (27%) had a RB, 48 (83%) of which led to a positive histological diagnosis. The remaining 10 were again non-diagnostic giving a total of 167 patients being treated definitively without a tissue diagnosis. The sensitivity and specificity for multidisciplinary team (MDT) assessment as a diagnostic tool was 0.75 and 0.88 respectively while that for RB was 0.91 and 0.9. Conclusion: Re-biopsy after first non-diagnostic core needle biopsy offers high sensitivity and specificity, especially in the presence of malignancy. In the absence of tissue diagnosis, however, MDT assessment is also highly accurate and a safe strategy in managing this complex group of patients. Level of evidence: Diagnostic Level III.