Division of Surgical Oncology.
UCLA Jonsson Comprehensive Cancer Center Sarcoma Program, University of California, Los Angeles, Medical Center, Los Angeles, CA.
Am J Clin Oncol. 2019 Oct;42(10):739-743. doi: 10.1097/COC.0000000000000591.
Peripheral nerve sheath tumors (PNSTs) are clinically heterogenous, comprising benign (BPNST) and malignant (MPNST) variants. BPNSTs can be managed with nerve-sparing excision or observation. MPNSTs require radical resection and multidisciplinary oncologic management (1, 15). Image-guided core-needle biopsy (IGCNBx) is the well-established standard to obtain preoperative tissue diagnosis of soft tissue tumors. However, there has been resistance to performing IGCNBx of PNSTs because of the presumed risk of nerve injury and unknown accuracy in determining malignancy. We sought to define the accuracy and safety of IGCNBx in PNSTs.
All patients that underwent both IGCNBx and surgical resection of a PNST at our institution between 2002 and 2016 were analyzed. The accuracy of IGCNBx in determining malignancy was calculated, including subgroup analyses by histologic subtype and neurofibromatosis 1 status. Complication data were collected and analyzed.
Among the 78 PNSTs with IGCNBx and postresection surgical pathology, 76% (n=59) had BPNST and 24% (n=19) had MPNST on postresection surgical pathology. IGCNBx accurately determined malignancy in 94% of cases. IGCNBx demonstrating schwannoma or MPNST were 100% accurate in determining malignancy. IGCNBx demonstrating neurofibroma or indeterminate results were 33% and 57% malignant on postresection surgical pathology, respectively. There were no long-term complications, including sensory or motor deficits, from IGCNBx.
Percutaneous IGCNBx demonstrates 94% accuracy in differentiating benign from malignant PNSTs. IGCNBx demonstrating neurofibroma or indeterminate pathology should be interpreted with caution because of risk of malignant reclassification on surgical pathology. Our results reaffirm the safety of IGCNBx, as no patients experienced long-term complications.
周围神经鞘瘤（PNST）在临床上表现出明显的异质性，包括良性（BPNST）和恶性（MPNST）两种变体。BPNST 可通过保留神经的切除或观察来治疗。MPNST 需要根治性切除和多学科肿瘤管理（1，15）。影像引导的核心针活检（IGCNBx）是获得软组织肿瘤术前组织诊断的既定标准。然而，由于担心神经损伤以及确定恶性肿瘤的准确性未知，人们一直抵制对 PNST 进行 IGCNBx。我们旨在确定 IGCNBx 在 PNST 中的准确性和安全性。
对 2002 年至 2016 年期间在我院接受 IGCNBx 和 PNST 手术切除的所有患者进行了分析。计算了 IGCNBx 确定恶性肿瘤的准确性，包括根据组织学亚型和神经纤维瘤 1 状态的亚组分析。收集并分析了并发症数据。
在 78 例接受 IGCNBx 和术后病理检查的 PNST 中，59%（n=59）为 BPNST，24%（n=19）为 MPNST。IGCNBx 在 94%的病例中准确地确定了恶性肿瘤。IGCNBx 显示为神经鞘瘤或 MPNST 时，在术后病理检查中确定恶性肿瘤的准确率为 100%。IGCNBx 显示为神经纤维瘤或不确定结果时，分别有 33%和 57%在术后病理检查中为恶性。IGCNBx 没有导致任何长期并发症，包括感觉或运动功能障碍。
经皮 IGCNBx 在区分良性和恶性 PNST 方面具有 94%的准确性。IGCNBx 显示为神经纤维瘤或不确定的病理时，由于在术后病理检查中可能重新分类为恶性，因此应谨慎解读。我们的结果再次证实了 IGCNBx 的安全性，因为没有患者出现长期并发症。
