From the Department of Surgery, Orthopaedic Service Memorial Sloan Kettering Cancer Center, New York, NY (Chapman and Athanasian), the Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY (Chapman and Athanasian), and the Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (Lavery).
J Am Acad Orthop Surg. 2024 Jan 1;32(1):e44-e52. doi: 10.5435/JAAOS-D-23-00372. Epub 2023 Aug 1.
Excisional biopsies for soft-tissue sarcoma (STS) of the hand are commonly done outside of sarcoma centers and can compromise incorporation of the biopsy site into standard limb salvage or amputation flaps. We sought to identify risk factors for these suboptimal biopsies.
We analyzed prospective data on all patients (N = 109) who underwent definitive resection of primary STS of the hand between 1995 and 2019 at our institution. Biopsies were classified by type (excisional vs. incisional/needle), whether they were done before referral, and whether the incision could be incorporated into standard limb salvage or amputation flaps (ILS biopsies) or not (NILS biopsies). Analyses examined potential predictors of NILS biopsies and whether outcomes differed by biopsy type.
Biopsies done before referral (N = 91) were more likely to be excisional (79% vs. 17%). Excisional biopsies were associated with smaller tumor size (median, 2.0 vs. 3.15 cm; P = 0.025) and longer time to first intervention (1.88 vs. 1.17 months; P = 0.001). Forty-eight percent of excisional and 29% of incisional biopsy sites required soft-tissue coverage at the time of definitive surgery ( P = 0.07). Biopsy type was not associated with Musculoskeletal Tumor Society score or need for amputation. Risk factors for NILS biopsies included larger tumor size, deep tumor, and excisional biopsy. High-risk areas for NILS biopsies included the carpal tunnel, volar wrist, first webspace, radial palm, and proximal thumb. NILS biopsies were associated with positive margins, need for soft-tissue coverage, and lower Musculoskeletal Tumor Society scores.
This study informs referral guidelines for patients with STS of the hand. Patients with tumors that are deep, large, or in high-risk locations should be referred to a sarcoma center before biopsy. If that is not possible, incisional biopsy in line with standard resection incisions or radiology-guided core needle biopsy is preferable to excisional biopsy.
Prognostic study.
Level II.
手部软组织肉瘤（STS）的切除活检通常在肉瘤中心外进行，可能会影响活检部位纳入标准保肢或截肢皮瓣。我们旨在确定这些不理想活检的危险因素。
我们分析了 1995 年至 2019 年期间在我院接受手部原发性 STS 确定性切除的所有患者（N=109）的前瞻性数据。活检按类型（切除与切开/针刺）、是否在转诊前进行以及切口是否可纳入标准保肢或截肢皮瓣（ILS 活检）或不可纳入（NILS 活检）进行分类。分析检查了 NILS 活检的潜在预测因素，以及活检类型是否存在差异。
转诊前进行的活检（N=91）更可能是切除性（79%比 17%）。切除性活检与肿瘤较小（中位数，2.0 厘米比 3.15 厘米；P=0.025）和首次干预时间较长（1.88 个月比 1.17 个月；P=0.001）相关。48%的切除活检和 29%的切开活检在确定性手术时需要软组织覆盖（P=0.07）。活检类型与肌肉骨骼肿瘤学会评分或截肢无关。NILS 活检的危险因素包括肿瘤较大、肿瘤较深和切除性活检。NILS 活检的高危区域包括腕管、掌侧腕、第一网间空间、桡侧手掌和近端拇指。NILS 活检与切缘阳性、需要软组织覆盖和肌肉骨骼肿瘤学会评分较低相关。
本研究为手部 STS 患者的转诊指南提供了信息。肿瘤深、大或位于高危部位的患者应在活检前转诊至肉瘤中心。如果无法做到这一点，则采用与标准切除切口一致的切开活检或放射引导下的核心针活检优于切除性活检。
预后研究
II 级
