PREOPERATIVE CORE BIOPSY OF SOFT-TISSUE TUMORS FACILITATES THEIR SURGICAL-MANAGEMENT

Background: Soft-tissue sarcomas are rare, and clinical differentiatio n of benign tumours from sarcomas is sometimes impossible. Further, th e diagnosis of soft-tissue sarcomas may be unsuspected pre-operatively , and the presenting mass enucleated. While enucleation (excisional bi opsy) is acceptable for benign lesions, it is inappropriate for sarcom as, because the opportunity for the most effective management resultin g in both adequate local control and functional Limb salvage surgery i s compromised. A high rate of wound complications following open incis ional biopsy may also compromise local treatment. Inappropriate siting of the incision for both incisional and excisional biopsies may adver sely affect subsequent surgery and radiotherapy. Methods: We therefore assessed the accuracy of core biopsy in the diagnosis of soft-tissue rumours, and planning of definitive surgery. All patients with primary soft-tissue tumours managed by two surgeons with a special interest i n soft-tissue sarcomas since 1991 were reviewed. More than half (53%) were referred from other specialists. Results: Of 45 cases, 37 (82%) w ere referred with the tumour intact, and of these 31 (84%) underwent c ore biopsy. The overall accuracy of core biopsy was 84%. The sensitivi ty was 94%, with 100% specificity. In most patients this allowed plann ing of definitive one-stage surgery (P<0.005). Of the remaining five n on-diagnostic cores, four were benign and one was a non-specific malig nancy. Conclusions: Core biopsy has a high degree of accuracy in the d iagnosis of soft-tissue tumours, particularly malignant lesions, and i s not misleading. Core biopsy avoids the complications of open biopsy, and enables planning of one-stage surgery when used in combination wi th appropriate imaging.