Heslin M J, Lewis J J, Woodruff J M, Brennan M F
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Ann Surg Oncol. 1997 Jul-Aug;4(5):425-31. doi: 10.1007/BF02305557.
Classic teaching has advocated the use of open biopsy to diagnose and grade extremity soft-tissue sarcoma. Reported advantages of core needle biopsy include the minimal morbidity, cost, and time. The perceived disadvantage has been diagnostic inaccuracy. The objective of this study was to compare the diagnostic accuracy of core needle biopsy to incisional or frozen section biopsy for primary extremity masses suspicious for soft-tissue sarcoma.
Patients presenting with extremity masses were identified from our prospective soft-tissue sarcoma database (malignant) and from the clinical information center (benign) between January 1, 1990, and December 31, 1995. Biopsy and subsequent resection data were collected from the pathologic records.
During this time, 164 primary extremity soft-tissue masses were evaluated before any biopsy. As the initial diagnostic approach, there were 60 core needle, 44 incisional, 36 frozen section, and 26 excisional biopsies. Two patients underwent two biopsy procedures. Ninety-three percent of the specimens obtained at core needle biopsy were adequate to make a diagnosis. Of the adequate core needle biopsy specimens, 95%, 88% and 75% correlated with the final resection diagnosis for malignancy, grade, and histologic subtype, respectively. Of the frozen section biopsy specimens, 94% were adequate, and accurate diagnostic results of malignancy were obtained with 88%. However, only 62% and 47% were correct for grade and histologic subtype, respectively, which was significantly different than the results obtained with incisional biopsy. The false-negative and false-positive rates for core needle biopsy were 5% and 0% for malignancy. Two core needle biopsy specimens graded low were found to be high, and one core needle biopsy specimen graded high was subsequently found to be low on final resection.
When read by an experienced pathologist, the results of core needle biopsy provide accurate diagnostic information for malignancy and grade. Adequate core needle biopsy obviates the need for open biopsy and can be used for rational treatment planning. In the absence of adequate tissue, open biopsy is required.
传统教学主张采用切开活检来诊断和分级肢体软组织肉瘤。据报道，粗针活检的优点包括发病率低、成本低和时间短。其被认为的缺点是诊断不准确。本研究的目的是比较粗针活检与切开活检或冰冻切片活检对疑似软组织肉瘤的原发性肢体肿块的诊断准确性。
从我们前瞻性的软组织肉瘤数据库（恶性）以及临床信息中心（良性）中识别出1990年1月1日至1995年12月31日期间出现肢体肿块的患者。从病理记录中收集活检及随后切除的数据。
在此期间，在进行任何活检之前，对164例原发性肢体软组织肿块进行了评估。作为初始诊断方法，有60例粗针活检、44例切开活检、36例冰冻切片活检和26例切除活检。两名患者接受了两次活检程序。粗针活检获得的标本中有93%足以做出诊断。在足够的粗针活检标本中，分别有95%、88%和75%与最终切除诊断的恶性程度、分级和组织学亚型相关。在冰冻切片活检标本中，94%是足够的，恶性程度的准确诊断率为88%。然而，分级和组织学亚型的正确诊断率分别仅为62%和47%，这与切开活检的结果有显著差异。粗针活检的恶性程度假阴性率和假阳性率分别为5%和0%。发现2例粗针活检标本分级低的最终切除时为高分级，1例粗针活检标本分级高的最终切除时为低分级。
由经验丰富的病理学家解读时，粗针活检的结果可为恶性程度和分级提供准确的诊断信息。足够的粗针活检无需进行切开活检，可用于合理的治疗规划。在没有足够组织的情况下，则需要进行切开活检。
