Van Houdt W J, Schrijver A M, Cohen-Hallaleh R B, Memos N, Fotiadis N, Smith M J, Hayes A J, Van Coevorden F, Strauss D C
Sarcoma Unit, Department of Surgery, The Royal Marsden Hospital, London, UK; Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Eur J Surg Oncol. 2017 Sep;43(9):1740-1745. doi: 10.1016/j.ejso.2017.06.009. Epub 2017 Jun 24.
Retroperitoneal tumours often require a preoperative core needle biopsy to establish a histological diagnosis. Literature is scarce regarding the risk of biopsies in retroperitoneal sarcomas, so the aim of this study is to identify the potential risks of core needle biopsies causing needle tract recurrences or local recurrences.
Patients who underwent resection of a primary retroperitoneal sarcoma between 1990 and 2014 were identified from a prospectively maintained database from two tertiary referral centres. Patient demographics, tumour characteristics and biopsy techniques were examined. The primary endpoint was needle tract recurrence and local intra-abdominal recurrence.
498 patients were included in the analysis. The most common histological subtypes were liposarcoma (66%) and leiomyosarcoma (18%). Of the 498 patients that underwent resection, 255 patients were diagnosed with a preoperative biopsy. Five patients (2%) developed a biopsy site recurrence: 3 patients with leiomyosarcomas and 2 patients with dedifferentiated liposarcomas. All biopsy site recurrences occurred after trans-abdominal biopsies and were not performed with a co-axial technique. There was no significant difference in local recurrence rate between the patients with or without a biopsy (=0.30) or for the biopsy route (trans-abdominal or trans-retroperitoneal (p = 0.72)).
The risk of a needle tract metastasis after core needle biopsy for retroperitoneal sarcoma is very low but not zero. The safest method seems a trans-retroperitoneal approach with a co-axial technique. Local recurrence rate is not altered after doing a core needle biopsy.
腹膜后肿瘤通常需要术前进行粗针穿刺活检以确立组织学诊断。关于腹膜后肉瘤活检风险的文献较少，因此本研究的目的是确定粗针穿刺活检导致针道复发或局部复发的潜在风险。
从两个三级转诊中心前瞻性维护的数据库中识别出1990年至2014年间接受原发性腹膜后肉瘤切除术的患者。检查患者的人口统计学、肿瘤特征和活检技术。主要终点是针道复发和腹腔内局部复发。
498例患者纳入分析。最常见的组织学亚型是脂肪肉瘤（66%）和平滑肌肉瘤（18%）。在498例行切除术的患者中，255例患者术前经活检确诊。5例患者（2%）发生活检部位复发：3例平滑肌肉瘤患者和2例去分化脂肪肉瘤患者。所有活检部位复发均发生在经腹活检后，且未采用同轴技术。有或无活检患者之间的局部复发率无显著差异（P=0.30），活检途径（经腹或经腹膜后）之间也无显著差异（P=0.72）。
腹膜后肉瘤粗针穿刺活检后针道转移的风险非常低，但并非零风险。最安全的方法似乎是采用同轴技术的经腹膜后途径。粗针穿刺活检后局部复发率未改变。
