CORE NEEDLE-BIOPSY IN THE DIAGNOSIS OF MUSCULOSKELETAL TUMORS GUIDED BY COLOR-CODED DUPLEX SONOGRAPHY

In a prospective study we investigated 168 patients with musculoskelet al tumors, including 71 sarcomas, by core needle biopsy using the high -speed device Autovac. Monitoring with colour-coded duplex sonography allowed a well-aimed puncture of smaller or deeply localized lesions a nd also permitted the discrimination of necrotic and viable parts of t he tumor. Adequate material for histologic diagnosis including grading and determination of tumor subtype was obtained from soft tissue sarc omas, soft tissue metastases, malignant lymphomas,plasmacytomas, and o steolytic skeletal secondaries. In contrast, in benign soft tissue and bone tumors the diagnosis could be established in only 66% of cases. Although skeletal sarcomas were identified as malignant mesenchymal le sions, a complete histologic classification of tumor subtype frequentl y was not possible due to an insufficient tissue specimen. With an acc uracy of 97% for the diagnosis of malignancy and of 94% for the diagno sis of soft tissue sarcoma the results of core needle biopsies were co mparable to those of incisional biopsies, the reference standard in th e diagnosis of musculoskeletal tumors. Regarding the known disadvantag es and the oncological risks of incisional biopsies, needle biopsy sho uld replace the open procedure as the primary means of diagnosis in so ft tissue and osteolytic bone tumors.