Core needle biopsy is highly accurate in diagnosing bone and soft tissue lesions
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CORE NEEDLE BIOPSY IS HIGHLY ACCURATE IN DIAGNOSING BONE AND SOFT-TISSUE LESIONS PowerPoint PPT Presentation


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CORE NEEDLE BIOPSY IS HIGHLY ACCURATE IN DIAGNOSING BONE AND SOFT-TISSUE LESIONS. Piya Kiatisevi 1 ,  Torsten Nielsen 2 ,  Malcolm Hayes 2 ,  Peter L Munk 3 , Amy E LaFrance 4 , Paul W Clarkson 4 ,  Bassam A Masri 4

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CORE NEEDLE BIOPSY IS HIGHLY ACCURATE IN DIAGNOSING BONE AND SOFT-TISSUE LESIONS

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Core needle biopsy is highly accurate in diagnosing bone and soft tissue lesions

CORE NEEDLE BIOPSY IS HIGHLY ACCURATE IN DIAGNOSING BONE AND SOFT-TISSUE LESIONS

Piya Kiatisevi1,  Torsten Nielsen2,  Malcolm Hayes2,  Peter L Munk3, Amy E LaFrance4, Paul W Clarkson4, 

Bassam A Masri4

1Orthopaedic Oncology Lerdsin Hospital, Institute of Orthopaedics, Lerdsin Hospital, Bangkok, Thailand

2Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada

3Department of Radiology, University of British Columbia, Vancouver, BC, Canada

4Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada

Saturday, November 15, 2008


Background

Background

  • Open biopsy is the historical gold standard for diagnosing bone and soft-tissue lesions

    • Highly accurate

    • 16% complication rate

    • 12% treatment altered

    • 1.2% unnecessary amputation

Mankin et al., J Bone Joint Surg Am. 1996;78(5):656-663


Core needle biopsy cnb

Core Needle Biopsy (CNB)

  • Increasingly accepted for the diagnosis of bone and soft-tissue lesions

    • Reduced morbidity, time and cost

    • Fewer complications

  • Concerns remain regarding accuracy of CNB


  • Objectives

    Objectives

    • To assess and compare :

      • Core Needle Biopsy (CNB)

      • Open Biopsy (OB)

      • Fine Needle Aspiration (FNA)

  • Diagnostic rate

  • Accuracy for

    • Distinguishing benign vs. malignant

    • Histological diagnosis

    • Distinguishing low vs. high grade sarcoma


  • Materials and methods

    Materials and Methods

    • Prospectively collected database

      • 286 biopsies in 282 patients

      • 2004-2007

      • 165 males, 117 females

      • Mean age 51 yrs (range 16-92 yrs)

  • Biopsy compared to final pathology

  • Included biopsies performed prior to referral but slides were re-reviewed by an experienced MSK pathologist


  • Our practice

    Our Practice

    • Patients are assessed in MSK surgical clinic

    • Site for CNB is marked with indelible marker

    • Image-guided biopsy performed by radiologist within pre-marked biopsy site

    • 10mm biopsy incision so site is identifiable for definitive resection


    Our practice1

    Our Practice

    • If core needle biopsy is non-diagnostic, then proceed with open biopsy

    • Biopsy track excised en bloc with tumour during definitive resection


    Core needle biopsy is highly accurate in diagnosing bone and soft tissue lesions

    Biopsy Types

    229 CNB

    286 biopsies

    32 OB

    25 FNA


    Core needle biopsy is highly accurate in diagnosing bone and soft tissue lesions

    Types of Lesions


    Results

    Results


    Core needle biopsy is highly accurate in diagnosing bone and soft tissue lesions

    Diagnostic Rate

    92% 100%72%


    Non diagnostic specimens

    Non-diagnostic Specimens

    CNB (18/229 = 8%)

    FNA (7/25 = 28%)


    Core needle biopsy is highly accurate in diagnosing bone and soft tissue lesions

    Accuracy for Distinguishing Benign vs. Malignant

    Accuracy89% 97%68%


    Core needle biopsy is highly accurate in diagnosing bone and soft tissue lesions

    Incorrect Diagnosis of

    Benign vs. Malignant

    • Benign (at biopsy)  Malignant (final pathology)

    • CNB (n=229)

    • 6 Benign lipomatous tumour  Well-differentiated liposarcoma (ST)

    • 1 Fracture healing  Adenocarcinoma metastasis (B)

    • OB (n=32)

    • 1 Leiomyoma  Leiomyosarcoma (ST)

    • FNA(n=25)

    • 1 Mature fat  Well-differentiated liposarcoma (ST)


    Core needle biopsy is highly accurate in diagnosing bone and soft tissue lesions

    Incorrect Diagnosis of

    Benign vs. Malignant

    • Malignant (at biopsy)  Benign (final pathology)

    • CNB (n=229)

    • 1 Lymphoma of ilium  Osteomyelitis (B)

    • OB (n=32)

    • 0

    • FNA (n=25)

    • 0


    Core needle biopsy is highly accurate in diagnosing bone and soft tissue lesions

    Accuracy for Histological Subtype

    Accuracy 70% 81% 40%


    Core needle biopsy is highly accurate in diagnosing bone and soft tissue lesions

    Accuracy for Distinguishing Low vs. High Grade Sarcoma


    Core needle biopsy is highly accurate in diagnosing bone and soft tissue lesions

    Accuracy for Distinguishing Low vs. High Grade Sarcoma

    Accuracy90% 96% 72%


    Core needle biopsy is highly accurate in diagnosing bone and soft tissue lesions

    Incorrect Diagnosis of Low vs. High Grade Sarcoma

    • Low grade (at biopsy)  High grade (final pathology)

    • CNB (n=92)

    • 3

    • OB (n=24)

    • 0

    • FNA (n=10)

    • 2

    • High grade (at biopsy)  Low grade (final pathology)

    • None

    1 Osteosarcoma (B)

    1 Liposarcoma (ST)

    1 Ossifying fibromyxoid tumour (ST)

    1 De-diff. Chondrosarcoma (B)

    1 Myofibroblastic sarcoma (ST)


    Core needle biopsy is highly accurate in diagnosing bone and soft tissue lesions

    Discussion


    Discussion

    Discussion

    • Perform CNB with care on fatty lesions


    Conclusion

    Conclusion

    • Core needle biopsy is accurate for determining:

      • Benign vs. malignant

      • Histological subtype

      • Low vs. high grade for sarcoma

    • Advantages of core needle biopsy

      • Fewer complications

      • Reduced cost of treatment

      • High diagnostic accuracy


    Recommendations

    Recommendations

    • CNB be used routinely for diagnosis, whenever possible

    • Open biopsy reserved for use when CNB is non-diagnostic

    • Given its high inaccuracy, FNA is not indicated for diagnosing musculoskeletal lesions in the extremities


    Core needle biopsy is highly accurate in diagnosing bone and soft tissue lesions

    Orthopaedic Oncology Lerdsin Hospital, Bangkok, Thailand

    Thank you

    The University of British Columbia, Vancouver, BC, Canada


    Core needle biopsy is highly accurate in diagnosing bone and soft tissue lesions

    Non-diagnostic Specimens


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