Division of Pediatric Surgery, Department of Surgery, C. S. Mott Children's Hospital, The University of Michigan, Ann Arbor, Michigan.
Department of Surgery, Division of Pediatric Surgery, Oregon Health and Science University, Portland, Oregon.
Pediatr Blood Cancer. 2020 May;67(5):e28153. doi: 10.1002/pbc.28153. Epub 2020 Feb 19.
Image-guided percutaneous core needle biopsy (PCNB) is increasingly utilized to diagnose solid tumors. The objective of this study is to determine whether PCNB is adequate for modern biologic characterization of neuroblastoma.
A multi-institutional retrospective study was performed by the Pediatric Surgical Oncology Research Collaborative on children with neuroblastoma at 12 institutions over a 3-year period. Data collected included demographics, clinical details, biopsy technique, complications, and adequacy of biopsies for cytogenetic markers utilized by the Children's Oncology Group for risk stratification.
A total of 243 children were identified with a diagnosis of neuroblastoma: 79 (32.5%) tumor excision at diagnosis, 94 (38.7%) open incisional biopsy (IB), and 70 (28.8%) PCNB. Compared to IB, there was no significant difference in ability to accurately obtain a primary diagnosis by PCNB (95.7% vs 98.9%, P = .314) or determine MYCN copy number (92.4% vs 97.8%, P = .111). The yield for loss of heterozygosity and tumor ploidy was lower with PCNB versus IB (56.1% vs 90.9%, P < .05; and 58.0% vs. 88.5%, P < .05). Complications did not differ between groups (2.9 % vs 3.3%, P = 1.000), though the PCNB group had fewer blood transfusions and lower opioid usage. Efficacy of PCNB was improved for loss of heterozygosity when a pediatric pathologist evaluated the fresh specimen for adequacy.
PCNB is a less invasive alternative to open biopsy for primary diagnosis and MYCN oncogene status in patients with neuroblastoma. Our data suggest that PCNB could be optimized for complete genetic analysis by standardized protocols and real-time pathology assessment of specimen quality.
影像引导经皮核心针活检（PCNB）越来越多地用于诊断实体肿瘤。本研究的目的是确定 PCNB 是否足以用于神经母细胞瘤的现代生物学特征分析。
由小儿外科肿瘤研究协作组（Pediatric Surgical Oncology Research Collaborative）对 12 家机构的 3 年内患有神经母细胞瘤的儿童进行了一项多机构回顾性研究。收集的数据包括人口统计学、临床细节、活检技术、并发症以及活检对儿童肿瘤组（Children's Oncology Group）用于风险分层的细胞遗传学标志物的充分性。
共确定 243 例神经母细胞瘤患儿：79 例（32.5%）诊断时肿瘤切除，94 例（38.7%）开放式切开活检（IB），70 例（28.8%）PCNB。与 IB 相比，PCNB 准确获得原发性诊断的能力没有差异（95.7% vs 98.9%，P=0.314）或确定 MYCN 拷贝数（92.4% vs 97.8%，P=0.111）。PCNB 检测杂合性丢失和肿瘤倍性的检出率低于 IB（56.1% vs 90.9%，P<0.05；58.0% vs 88.5%，P<0.05）。两组之间的并发症没有差异（2.9% vs 3.3%，P=1.000），尽管 PCNB 组输血和阿片类药物使用量较少。当儿科病理学家评估新鲜标本的充分性时，PCNB 对杂合性丢失的效果得到改善。
PCNB 是一种比开放性活检侵入性更小的方法，可用于神经母细胞瘤患者的初步诊断和 MYCN 原癌基因状态。我们的数据表明，通过标准化的方案和实时评估标本质量的病理检查，PCNB 可以优化用于全面的基因分析。
