Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Ann Surg Oncol. 2020 Oct;27(11):4574-4581. doi: 10.1245/s10434-020-08519-1. Epub 2020 May 4.
Biopsy sensitivity in retroperitoneal dedifferentiated liposarcoma (DDLPS) is variable. Patients with grade 3 DDLPS face a significant risk of metastatic disease and may potentially benefit from neoadjuvant therapy, making highly accurate pretherapy diagnosis essential. Our study aimed to establish whether diagnostic sensitivity could be improved by targeting solid areas of tumor on percutaneous biopsy.
Between 2016 and 2019, data on patients with suspected primary retroperitoneal sarcoma who underwent a biopsy were collected, and diagnostic accuracy was calculated. These data were compared with our previously reported series from 2005 to 2016. For DDLPS tumors, comparisons were then made between biopsies that targeted the solid component and those that did not.
Data were available for 121 patients in the current series and 238 from the previous study. The proportion of biopsies returning a histological subtype concordant with postoperative pathology was 83% in the current series, marking a significant improvement over our previous study (67%, p = 0.001). For diagnosis of DDLPS, biopsy sensitivity improved from 40 to 74% (p < 0.001), with an increase from 13 to 50% (p = 0.006) where grade 3 DDLPS was treated as a separate disease. Within the current series, targeted biopsy yielded a sensitivity of 100% for identifying DDLPS, compared with 10% in nontargeted biopsy (p < 0.001).
Systematic targeting of solid areas of tumor within suspected retroperitoneal liposarcoma has improved sensitivity for detection of both DDLPS and grade 3 DDLPS on biopsy. This approach minimizes the risk of underdiagnosis of patients with DDLPS who could benefit from neoadjuvant chemotherapy.
腹膜后去分化脂肪肉瘤（DDLPS）的活检敏感性存在差异。患有 3 级 DDLPS 的患者面临转移疾病的重大风险，可能受益于新辅助治疗，因此术前诊断的准确性至关重要。我们的研究旨在确定通过靶向经皮活检的肿瘤实性区域是否可以提高诊断敏感性。
在 2016 年至 2019 年期间，收集了疑似原发性腹膜后肉瘤患者接受活检的数据，并计算了诊断准确性。将这些数据与我们 2005 年至 2016 年之前报告的系列数据进行比较。对于 DDLPS 肿瘤，然后比较了靶向实性成分的活检和未靶向的活检。
本系列研究中共有 121 例患者的数据，之前的研究中有 238 例患者的数据。当前系列中活检结果与术后病理一致的组织学亚型比例为 83%，与之前的研究相比有显著提高（67%，p=0.001）。对于 DDLPS 的诊断，活检敏感性从 40%提高到 74%（p<0.001），其中 3 级 DDLPS 作为单独的疾病治疗，敏感性从 13%提高到 50%（p=0.006）。在当前系列中，靶向活检识别 DDLPS 的敏感性为 100%，而非靶向活检的敏感性为 10%（p<0.001）。
系统地靶向疑似腹膜后脂肪肉瘤中的实性区域，提高了活检对 DDLPS 和 3 级 DDLPS 的检测敏感性。这种方法最大限度地降低了可能受益于新辅助化疗的 DDLPS 患者漏诊的风险。
