Orthopedics and Trauma Department, University Hospital of Nantes, 1, place Alexis Ricordeau, 44093, Nantes Cedex 1, France.
Orthopedic and Traumatology Surgery Department, Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris, Paris-Sud University ORSAY, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France.
Surg Oncol. 2021 Jun;37:101518. doi: 10.1016/j.suronc.2020.12.012. Epub 2021 Jan 2.
Front-line biopsy remains the rule in the management of soft tissue mass syndromes. Although open biopsy has long been considered the gold standard, it has recently been shown that a percutaneous biopsy is associated with a reduction in the rate of complications and cost, while maintaining high diagnostic accuracy. Though there is much literature regarding the diagnostic accuracy of image-guided and open biopsies for soft tissue tumors, the accuracy of percutaneous non image-guided biopsies has not been well documented. The objective of this study was to compare the failure rate of non image-guided biopsies, image-guided biopsies and open biopsies for the diagnosis of soft tissue tumors. We also attempted to identify the failure risk factors for non image-guided biopsies and we compared the diagnostic delay of the three types of biopsy.
This was a continuous, single-center retrospective study. We reviewed the results from 337 patients managed with a biopsy (percutaneous or open) for a soft tissue tumor, all carried out in our center between January 2010 and December 2015. Biopsy technique was chosen by the treating orthopedic surgeon, according to the clinical and radiological characteristics of the mass. 141 patients (41.8%) had a non-image-guided biopsy as the first-line diagnostic procedure, 81 (24.0%) had an image-guided biopsy, and 115 (34.1%) an open biopsy. Diagnostic failure was defined either by a non-contributory biopsy, the need for repeat biopsy, or a major histological discordance obtained from the resected tumor piece. The risk factors studied were tumor characteristics, patient' characteristics and sampling modalities. Diagnostic delay was defined as the period between the day of the first external consultation at the hospital and the day of the notification of the diagnosis by the physician.
We obtained a failure rate of 9.9% (14 patients) for non image-guided biopsies. Eleven were non-contributive and three were considered as errors of diagnosis. The failure rate for image-guided biopsies was 18.5% (15 patients), with no significant difference compared with non image-guided biopsies. The open biopsies were associated with a failure rate of 6.9% (eight patients). We found no failure risk factors for non image-guided biopsies. Diagnostic delay was significantly shorter for non image-guided biopsies (p = 0.001).
When performed in a referral center by the patient's surgeon, a non-image-guided core needle biopsy is a safe procedure which ensures equivalent diagnostic accuracy for soft tissue tumors, while reducing the diagnostic delay.
在软组织肿块综合征的管理中，一线活检仍然是常规方法。虽然开放性活检长期以来一直被认为是金标准，但最近的研究表明，经皮活检可降低并发症和成本的发生率，同时保持较高的诊断准确性。虽然有很多关于影像学引导和开放性活检对软组织肿瘤的诊断准确性的文献，但非影像学引导活检的准确性尚未得到很好的记录。本研究的目的是比较非影像学引导活检、影像学引导活检和开放性活检在诊断软组织肿瘤方面的失败率。我们还试图确定非影像学引导活检的失败风险因素，并比较三种活检类型的诊断延迟。
这是一项连续的、单中心的回顾性研究。我们回顾了 2010 年 1 月至 2015 年 12 月期间在我们中心接受软组织肿瘤活检（经皮或开放性）的 337 名患者的结果。活检技术由治疗骨科医生根据肿块的临床和影像学特征选择。141 名患者（41.8%）作为一线诊断程序进行了非影像学引导活检，81 名患者（24.0%）进行了影像学引导活检，115 名患者（34.1%）进行了开放性活检。诊断失败的定义是活检无明显结果、需要重复活检或从切除的肿瘤组织中获得主要组织学不一致。研究的风险因素包括肿瘤特征、患者特征和采样方式。诊断延迟定义为患者首次在医院就诊的日期与医生通知诊断的日期之间的时间间隔。
我们发现非影像学引导活检的失败率为 9.9%（14 例）。其中 11 例为无明显结果，3 例为诊断错误。影像学引导活检的失败率为 18.5%（15 例），与非影像学引导活检无显著差异。开放性活检的失败率为 6.9%（8 例）。我们没有发现非影像学引导活检的失败风险因素。非影像学引导活检的诊断延迟明显缩短（p=0.001）。
在转诊中心由患者的外科医生进行时，非影像学引导的核心针活检是一种安全的方法，可为软组织肿瘤提供等效的诊断准确性，同时缩短诊断延迟。
