H. Lee Moffitt Cancer Center & Research Institute, Sarcoma Program, 12902 Magnolia Drive, Tampa, FL 33612, USA.
Clin Orthop Relat Res. 2013 Mar;471(3):891-8. doi: 10.1007/s11999-012-2569-z.
Core needle biopsies of sarcomas allow a diagnosis in a high percentage of patients with few complications. However, it is unclear whether the tract needs to be excised to prevent recurrences.
QUESTIONS/PURPOSES: We therefore determined the rates of recurrence and metastases in patients with Stage III extremity sarcomas, who underwent wide local resection without excision of the needle tract and also received adjuvant treatment.
We retrospectively reviewed 59 adult patients with deep, larger than 5 cm, high-grade soft tissue sarcomas of the upper or lower extremity treated between January 1999 and April 2009. All the patients underwent a core needle biopsy. Resection was performed with wide margins. The biopsy tract was not resected during the definitive surgery. Fifty-seven patients (97%) received preoperative and/or postoperative radiation, whereas 49 patients (83%) received chemotherapy. Local recurrence and distant recurrence rates were determined. The minimum followup was 24 months (median, 56 months; range, 24-122 months).
The local recurrence rate was 9%. Fifteen patients (25%) developed metastasis after diagnosis. Seven of the 59 patients (12%) had microscopic positive margins at resection.
Our data demonstrate no increase in local recurrence rates or rates of metastatic disease compared with previously published studies when resection of the core biopsy tract was not performed.
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
肉瘤的核心针活检在少数并发症的情况下，能够使很大比例的患者得到确诊。然而，目前尚不清楚是否需要切除活检通道以防止复发。
问题/目的：因此，我们确定了未切除活检通道且接受辅助治疗的 III 期肢体肉瘤患者的复发和转移率，这些患者接受了广泛局部切除术。
我们回顾性分析了 1999 年 1 月至 2009 年 4 月期间治疗的 59 例成人肢体深部、大于 5cm、高级别的软组织肉瘤患者，这些患者的软组织肉瘤位于上下肢。所有患者均接受了核心针活检。切除时采用广泛的边缘。在确定性手术中，未切除活检通道。57 例患者（97%）接受了术前和/或术后放疗，而 49 例患者（83%）接受了化疗。确定了局部复发和远处复发的发生率。最小随访时间为 24 个月（中位数为 56 个月；范围为 24-122 个月）。
局部复发率为 9%。诊断后 15 例患者（25%）发生转移。59 例患者中有 7 例（12%）在切除时边缘有显微镜下阳性。
与之前发表的研究相比，当未切除核心活检通道时，我们的数据并未显示局部复发率或转移性疾病发生率增加。
IV 级，治疗研究。欲了解完整的证据水平描述，请参见作者指南。
