Mullassery Dhanya, Sharma Videha, Salim Adeline, Jawaid Wajid B, Pizer Barry L, Abernethy Laurence J, Losty Paul D
Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK.
Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK; Division of Child Health, University of Liverpool, UK.
J Pediatr Surg. 2014 Oct;49(10):1505-7. doi: 10.1016/j.jpedsurg.2014.05.015. Epub 2014 Jul 11.
Open surgical biopsy is traditionally advocated prior to initiating therapy in UKCCLG neuroblastoma protocols. We report a single centre experience comparing the utility of open biopsy vs image guided needle biopsy in aiding the definitive diagnosis and risk stratification of neuroblastoma - (Shimada classification, MYCN expression, cytogenetics - 1p 11q, 17 q).
Medical records of all new cases of neuroblastoma presenting to a single UKCCLG centre during January 2002-July 2013 were examined.
Thirty nine patients underwent a biopsy of primary tumour for neuroblastoma during the study. Twenty one children had open biopsy and eighteen cases had a needle biopsy. Staging of neuroblastoma revealed - stage 4 (n=26), stage 3 (n=7), stage 2 (n=3) and stage 4S (n=3). Sites of primary tumour were adrenal gland (n=20), abdomen (n=12), thoracic (n=4), abdomino-thoracic (n=2) and abdomino pelvic regions (n=1). All patients (open vs needle) had adequate tissue retrieved for histological diagnosis of neuroblastoma. One needle and one open biopsy case did not have MYCN status determined despite adequate tissue sampling. Seventeen patients (7 open and 10 needle biopsies) had 1p and 17q status reported in MLPA testing (Multiplex Ligation-dependent Probe Amplification). No single patient required a repeat tumour biopsy. Morbidity in the series was minimal with only one child - open biopsy group, requiring emergent laparotomy to control bleeding from an abdominal primary tumour. No complications were recorded with needle biopsy.
Open and image guided needle biopsy appear to yield adequate tissue sampling for diagnosis, risk classification and staging of neuroblastoma. Further larger co-operative studies may usefully guide national and international protocols.
在英国儿童癌症与白血病研究组（UKCCLG）的神经母细胞瘤治疗方案中，传统上主张在开始治疗前进行开放性手术活检。我们报告了一项单中心经验，比较开放性活检与影像引导下针吸活检在辅助神经母细胞瘤的明确诊断和风险分层（Shimada分类、MYCN表达、细胞遗传学——1p、11q、17q）方面的效用。
检查了2002年1月至2013年7月期间在一个UKCCLG中心就诊的所有神经母细胞瘤新病例的病历。
在研究期间，39例患者接受了神经母细胞瘤原发肿瘤的活检。21例儿童接受了开放性活检，18例接受了针吸活检。神经母细胞瘤分期显示——4期（n = 26）、3期（n = 7）、2期（n = 3）和4S期（n = 3）。原发肿瘤部位为肾上腺（n = 20）、腹部（n = 12）、胸部（n = 4）、腹胸（n = 2）和腹盆腔区域（n = 1）。所有患者（开放性活检与针吸活检）均获取了足够的组织用于神经母细胞瘤的组织学诊断。尽管组织取样充足，但有1例针吸活检和1例开放性活检病例未确定MYCN状态。17例患者（7例开放性活检和10例针吸活检）在多重连接依赖探针扩增（MLPA）检测中有1p和17q状态报告。没有患者需要重复肿瘤活检。该系列中的发病率极低，只有1名儿童——开放性活检组，需要紧急剖腹手术以控制腹部原发肿瘤出血。针吸活检未记录到并发症。
开放性活检和影像引导下针吸活检似乎能获取足够的组织样本用于神经母细胞瘤的诊断、风险分类和分期。进一步更大规模的合作研究可能会对国家和国际治疗方案提供有益指导。
