Departments of Neurosurgery and Radiology, Mayo Clinic, 200 First Street SW, Gonda 8-214, Rochester, MN, 55905, USA.
Acta Neurochir (Wien). 2021 Feb;163(2):515-519. doi: 10.1007/s00701-020-04556-7. Epub 2020 Sep 8.
The decision to biopsy a peripheral nerve tumor is largely based on its presumed behavior and prognosis, determined by patient history, clinical exam, and radiologic characteristics. Percutaneous image-guided biopsy is not without risk in patients with malignant peripheral nerve sheath tumors (MPNSTs); in particular, there may be concern regarding worsening neurologic function, increasing neuropathic pain, and incorrect or absent diagnosis.
Following approval by our institutional review board, we reviewed records from 1990 to 2019 at our institution's three main sites ("our institution"). Patients with pathology-proven MPNST were selected. Further inclusion criteria included image-guided percutaneous biopsy performed at our institution, pathology report available for review, and follow-up documentation to determine post-biopsy complications.
Three hundred thirty-one patients with MPNST were reviewed. In total, 73 patients undergoing image-guided percutaneous biopsies were included. Twenty-two (30.1%) had biopsy-related complications. This included ten patients with misdiagnosis (13.7%) and six patients with non-diagnostic biopsies (8.2%). Six patients had new or worsened pain that resolved with time and neuropathic pain medication (8.2%), and one patient had subjectively worsened proximal weakness (1.3%) which resolved.
We found nearly a third of patients undergoing biopsy had a biopsy-related complication. The single largest complication was the inability to obtain an accurate diagnosis (21.9%) with the first biopsy. This may lead to the need for repeat percutaneous or open biopsies, or a non-oncologic initial surgery with implications for disease-free and overall survival. Neurologic complications including exacerbation of pain or a deficit were rare and transient. It remains important that clinicians balance the potential risks and benefits based on individual patient characteristics when determining the necessity of an image-guided percutaneous biopsy.
对外周神经肿瘤进行活检的决定主要基于其推测的行为和预后，这取决于患者的病史、临床检查和影像学特征。在患有恶性外周神经鞘瘤（MPNST）的患者中，经皮影像引导下活检并非没有风险；特别是，可能会担心神经功能恶化、增加神经病理性疼痛以及诊断错误或缺失。
在获得我们机构审查委员会的批准后，我们在我们机构的三个主要地点回顾了 1990 年至 2019 年的记录（“我们的机构”）。选择了经病理证实为 MPNST 的患者。进一步的纳入标准包括在我们机构进行的影像引导经皮活检、可用于审查的病理报告以及随访文件，以确定活检后的并发症。
共回顾了 331 例 MPNST 患者。共有 73 例接受影像引导经皮活检的患者入组。共有 22 例（30.1%）出现与活检相关的并发症。这包括 10 例误诊患者（13.7%）和 6 例非诊断性活检患者（8.2%）。6 例患者新出现或加重的疼痛随时间和神经病理性疼痛药物缓解（8.2%），1 例患者出现主观上近端无力加重（1.3%），随后缓解。
我们发现近三分之一接受活检的患者出现了与活检相关的并发症。最大的单一并发症是第一次活检无法获得准确的诊断（21.9%）。这可能导致需要重复进行经皮或开放性活检，或进行非肿瘤性的初始手术，这对无病生存期和总生存期都有影响。神经并发症，包括疼痛加剧或功能缺失，较为罕见且短暂。在确定是否需要影像引导经皮活检时，临床医生根据患者的个体特征权衡潜在的风险和收益仍然非常重要。
