The percutaneous needle biopsy is safe and recommended in the diagnosis ofmusculoskeletal masses - Outcomes analysis of 155 patients at a sarcoma referral center

BACKGROUND. The purpose of this study was to analyze the role of percutaneo us core needle biopsy in the diagnosis of musculoskeletal sarcomas. METHODS. One hundred eighty-five biopsy procedures were performed on 161 mu sculoskeletal tissue masses suspected of being a sarcoma in 155 patients wh o underwent subsequent tumor resection. A percutaneous core needle biopsy w as performed on all masses either in the clinic or under radiologic guidanc e. If an adequate diagnosis could not be made on the basis of this biopsy s pecimen, an open incisional biopsy was performed. RESULTS. One hundred seventy-three core needle biopsy procedures were perfo rmed: 90 without radiologic guidance, 55 computed tomography guided, and 28 fluoroscopically guided. Twelve open incisional biopsies were performed. E ighty-three sarcomas, 67 benign mesenchymal tumors, and 11 metastatic epith elial tumors were identified. Analysis of the data reveals that only 7.4% o f the masses required open biopsy. In 88.2% of the masses, a single percuta neous biopsy procedure was adequate, and no additional biopsy was necessary . There was a 1.1% rate of complications; none caused a change in the patie nt's treatment plan. There was a 1.1% rate of major diagnostic errors, none of which ultimately impacted on the patient's outcome. There were no unnec essary amputations. Per cutaneous needle biopsy showed a positive predictiv e value of 100%, a negative predictive value of 82%, a sensitivity of 81.8% , and a specificity of 100%. The accuracy of a single-needle biopsy procedu re to identify benign versus malignant lesions, exact grade, and exact path ology was 92.4%, 88.6%, and 72.7%, respectively. CONCLUSIONS. The percutaneous needle biopsy was found to be extremely effec tive and safe for the diagnosis of musculoskeletal masses. This method allo wed 88% of patients with suspected sarcomas to undergo a single-needle biop sy procedure before the initiation of definitive treatment. Patients underg oing percutaneous needle biopsy had lower rates of major diagnostic errors and complications than previously described for open biopsy. Open biopsy of fered limited additional information when preceded by a needle biopsy, give n that these tumors were difficult to identify even after final resection. Cancer 2000;89:2677-86. (C) 2000 American Cancer Society.