Clayer Mark
Department of Orthopaedic Surgery and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
ANZ J Surg. 2010 Nov;80(11):786-8. doi: 10.1111/j.1445-2197.2010.05340.x.
Accurate diagnosis of musculoskeletal tumours is important for successful treatment. Studies have reported a high risk of complications following open biopsy and have advocated core biopsy as a safer alternative; however, accuracy may be reduced with the smaller sample. The aims of this study were to determine the accuracy of open incisional biopsy, the complications (overall and those that affected subsequent management) including local recurrence and the need for further surgery.
This study was a retrospective audit of 135 consecutive open incisional biopsies of soft tissue tumours. The complications, including changes to surgical management as a direct result of complications of the biopsy, were recorded for all 135 cases. The accuracy of the open biopsy was determined by comparing the histology of the biopsy with the final histology of the 88 cases that proceeded to definitive surgical resection.
There were two complications attributable to the biopsy (complication rate 1.5%). No complication affected the definitive management. There were three cases where the biopsy incorrectly reported a benign condition when it was malignant (benign versus malignant accuracy 96%). There were no cases of benign initially being reported as malignant. The tissue diagnosis was correct in 72 of the excised specimens (accuracy 82%). The false positive rate for malignant versus benign was 0%, sensitivity 93%, specificity 100% and positive predictor value 100%.
Open incisional biopsy remains a safe and accurate method of obtaining a tissue diagnosis when the principles of biopsy are adhered to.
准确诊断肌肉骨骼肿瘤对于成功治疗至关重要。研究报告称，切开活检后并发症风险较高，并主张采用粗针活检作为更安全的替代方法；然而，样本较小可能会降低准确性。本研究的目的是确定切开活检的准确性、并发症（总体并发症以及影响后续治疗的并发症），包括局部复发情况以及进一步手术的必要性。
本研究是对135例连续的软组织肿瘤切开活检进行的回顾性审计。记录了所有135例病例的并发症，包括因活检并发症而直接导致的手术治疗变更情况。通过将活检组织学与88例行确定性手术切除病例的最终组织学进行比较，确定切开活检的准确性。
活检导致的并发症有2例（并发症发生率1.5%）。没有并发症影响确定性治疗。有3例活检将恶性病变错误报告为良性病变（良性与恶性诊断准确性为96%）。没有最初将良性病变报告为恶性病变的情况。72例切除标本的组织诊断正确（准确性82%）。恶性与良性的假阳性率为0%，敏感性为93%，特异性为100%，阳性预测值为100%。
当遵循活检原则时，切开活检仍然是一种安全、准确的获取组织诊断的方法。
