Orthopaedic Service, Istituti Ortopedici Rizzoli, Via Pupilli 1, Bologna 40136, Italy. E-mail address for F. Traina:
J Bone Joint Surg Am. 2015 Jan 21;97(2):e7. doi: 10.2106/JBJS.N.00661.
A musculoskeletal tumor biopsy can involve fine needle aspiration, core needle biopsy, or incisional biopsy. Controversy regarding the diagnostic yield of these biopsy techniques continues. The purpose of this article is to summarize the current concepts in the biopsy of musculoskeletal tumors.
We performed a literature review of clinical articles reporting on the biopsy of bone and soft-tissue primary tumors. Clinical articles were excluded on the basis on abstract content if they represented case reports, review or opinion articles, or technique descriptions. Eighteen of the thirty-nine articles that remained were excluded because the results did not indicate the diagnostic accuracy of the various biopsy techniques. Thus, twenty-one articles with diagnostic data on the biopsy of bone and soft-tissue tumors were included in this review.
Core needle biopsy appeared to be more accurate than fine needle aspiration, and incisional biopsy appeared to be more accurate than both of these techniques, but the differences did not reach significance. Incisional biopsy was more expensive than the percutaneous biopsy methods. In deep musculoskeletal tumors, incorporation of ultrasonography or computed tomography for guidance is easy and safe and can be useful for increasing the accuracy of the biopsy. Advantages of a percutaneous technique compared with an incisional one are the low risk of contamination and the minimally invasive nature. Certain anatomic locations and histologic types were associated with diagnostic difficulty. Vertebral tumors had the lowest diagnostic accuracy regardless of the biopsy technique. Myxoid, infection, and round cell histologies were associated with the lowest diagnostic accuracy.
The current literature has not clarified the optimal biopsy technique for the diagnosis of bone and soft-tissue tumors. However, core needle biopsy is usually preferable to incisional biopsy because of the low risk of contamination and the low cost. In addition, the use of imaging guidance increases the diagnostic accuracy of musculoskeletal biopsies and reduces the risk of complications. If the result of a percutaneous biopsy is nondiagnostic, a small incisional biopsy should be performed.
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
肌肉骨骼肿瘤活检可包括细针抽吸、核心针活检或切开活检。这些活检技术的诊断效果仍存在争议。本文旨在总结肌肉骨骼肿瘤活检的当前概念。
我们对报道骨和软组织原发性肿瘤活检的临床文章进行了文献回顾。根据摘要内容排除了临床文章，如果它们是病例报告、综述或观点文章或技术描述。在剩余的 39 篇文章中，有 18 篇因结果未表明各种活检技术的诊断准确性而被排除。因此，在这项综述中纳入了 21 篇关于骨和软组织肿瘤活检的具有诊断数据的文章。
与细针抽吸相比，核心针活检似乎更准确，与这两种技术相比，切开活检似乎更准确，但差异无统计学意义。切开活检比经皮活检方法更昂贵。在深部肌肉骨骼肿瘤中，结合超声或计算机断层扫描引导很容易且安全，有助于提高活检的准确性。与切开活检相比，经皮技术的优势在于污染风险低且微创。某些解剖位置和组织学类型与诊断困难有关。无论采用何种活检技术，椎体肿瘤的诊断准确性最低。黏液样、感染和圆形细胞组织学与最低的诊断准确性相关。
目前的文献尚未阐明诊断骨和软组织肿瘤的最佳活检技术。然而，由于污染风险低且成本低，核心针活检通常优于切开活检。此外，使用影像学引导可提高肌肉骨骼活检的诊断准确性并降低并发症风险。如果经皮活检的结果不可诊断，则应进行小的切开活检。
诊断 IV 级。有关证据水平的完整描述，请参见作者说明。
