Department of Neurosurgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Acta Neurochir (Wien). 2020 Jun;162(6):1425-1429. doi: 10.1007/s00701-020-04257-1. Epub 2020 Feb 10.
Usual management of peripheral nerve tumors is to avoid biopsy in those that are likely benign; the risk of biopsy outweighs the benefit of definitive tissue diagnosis. Biopsy of presumed malignant lesions is performed widely. There is a subset of peripheral nerve tumors that are not easily categorized as benign or malignant based on the clinical and/or radiological features alone. The role of biopsy in peripheral nerve tumors of uncertain character remains controversial and the risk of biopsy (and the potential risk/benefit ratio) for these lesions is not known.
Following approval by our institutional review board, we reviewed all notes of a single peripheral nerve surgeon from 2000 to 2018 with respect to image-guided percutaneous biopsy of nerve tumors. We divided these patients into 3 groups based on clinicoradiologic features. We determined the risk of complications and the "hit rate" for patients with peripheral nerve tumors of uncertain behavior, defined as the percentage of patients sent for percutaneous biopsy who had a malignancy on their final pathology.
Of 82 patients with tumors of uncertain behavior, 9 had complications, and 23 had malignant final pathology (a "hit rate" of 27.7%). Neurosurgical referral for biopsy of tumors of uncertain behavior was made in 60 patients. Twenty-two had malignant final pathology ("hit rate"= 36.7%). Non-neurosurgical referral for biopsy was made in 22 patients with tumors of uncertain behavior. Two had malignant final pathology ("hit rate"= 4.55%). There was a statistically significant difference between the "hit rate" for the two groups (p = 0.021).
The decision to biopsy a peripheral nerve tumor is largely based on the presumed behavior and prognosis, determined via clinicoradiologic characteristics. Patient care might be improved by delaying percutaneous biopsy of peripheral nerve lesions until after a neurosurgical evaluation.
对于那些可能是良性的周围神经肿瘤，通常的治疗方法是避免活检；活检的风险超过了明确组织诊断的获益。广泛进行疑似恶性病变的活检。有一部分周围神经肿瘤仅根据临床和/或影像学特征不易归类为良性或恶性。对于特征不确定的周围神经肿瘤，活检的作用仍存在争议，这些病变的活检风险（以及潜在的风险/获益比）尚不清楚。
在获得我们机构审查委员会的批准后，我们回顾了 2000 年至 2018 年期间一位外周神经外科医生的所有记录，内容涉及神经肿瘤的影像引导经皮活检。我们根据临床影像学特征将这些患者分为 3 组。我们确定了特征不确定的周围神经肿瘤患者发生并发症的风险和“命中率”，定义为接受经皮活检的患者中最终病理为恶性的百分比。
82 例行为不确定的肿瘤患者中，有 9 例出现并发症，23 例最终病理为恶性（“命中率”为 27.7%）。有 60 例行为不确定的肿瘤患者被转诊进行神经外科活检。22 例最终病理为恶性（“命中率”=36.7%）。有 22 例行为不确定的肿瘤患者被转诊进行非神经外科活检。其中 2 例最终病理为恶性（“命中率”=4.55%）。两组的“命中率”存在统计学差异（p=0.021）。
活检周围神经肿瘤的决定主要基于通过临床影像学特征确定的假定行为和预后。通过神经外科评估后再进行周围神经病变的经皮活检，可能会改善患者的治疗效果。
