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Aran V, Santos Cavalcanti A, Meohas W, Canteri B, Perini JA, Pino Minguez J, Guimarães JAM, Moura Neto V, Leite Duarte ME. Clinical insights into circulating free-DNA in patients with bone sarcomas and ewing sarcoma. Clinics (Sao Paulo) 2025; 80:100661. [PMID: 40288045 PMCID: PMC12059349 DOI: 10.1016/j.clinsp.2025.100661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 02/25/2025] [Accepted: 04/09/2025] [Indexed: 04/29/2025] Open
Abstract
BACKGROUND AND OBJECTIVES Sarcomas represent a heterogeneous group of malignancies characterized by varying clinical behaviors and treatment responses. Liquid biopsy has emerged as a promising non-invasive method for monitoring tumor dynamics by detecting actionable mutations in cancer patients. The emergence of circulating DNA as a non-invasive biomarker offers promising avenues for improving diagnostic accuracy and treatment monitoring in sarcoma patients. METHODS In this study, the authors employed mutation-specific droplet digital PCR (ddPCR) to analyze tumor-derived cell-free DNA, also known as circulating tumor DNA (ctDNA), belonging to plasma samples of sarcoma patients, aiming to characterize mutation profiles in the IDH2 and TP53 genes. Between July 2019 and June 2023, the authors collected and analyzed 38 samples from patients diagnosed with osteosarcoma, chondrosarcoma, or Ewing's sarcoma. Histopathological confirmation of diagnoses was performed, followed by ddPCR analysis on 36 valid plasma samples. RESULTS The results showed mutations in three out of thirty-six sarcoma patients. Patient 1 exhibited a 12.6 % mutant IDH2 (R172S) allele fraction, Patient 2 had a 0.27 % mutant TP53 (R175H), and Patient 3 showed a 17 % mutant IDH2 (R172K). Notably, Patients 1 and 2 were diagnosed with chondrosarcoma, while Patient 3 had osteosarcoma. CONCLUSIONS The present study provided evidence for the feasibility of ctDNA detection in sarcoma patients, where mutations were found in IDH2 and TP53 genes, including a novel IDH2 mutation in osteosarcoma. The evaluation of ctDNA has the potential to transform clinical strategies in this challenging group of malignancies and this may be further confirmed in larger cohort studies. Continued research efforts are essential to optimize ctDNA detection methods and validate its utility across diverse sarcoma subtypes.
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Affiliation(s)
- Veronica Aran
- Laboratório de Biomedicina do Cérebro, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brazil; Laboratório de Morfogênese Celular (LMC), Instituto de Ciencias Biomédicas (ICB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
| | - Amanda Santos Cavalcanti
- Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brazil
| | - Walter Meohas
- Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brazil
| | - Bruna Canteri
- Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brazil
| | - Jamila Alessandra Perini
- Laboratório de Pesquisa de Ciências Farmacêuticas (LAPESF), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Jesus Pino Minguez
- Departamento de Ortopedia, Universidade de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | | | - Vivaldo Moura Neto
- Laboratório de Biomedicina do Cérebro, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brazil
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Pietkiewicz P, Stefaniak A, Giedziun P, Calik J, Lewandowicz M, Mazur E, Cantisani C, Navarrete-Dechent C, Akay BN, Szepietowski JC, Rosendahl C. "One blade, two cuts?" A multidisciplinary survey investigating practice variability of scalpel blade change for simultaneous excision of multiple skin lesions in the same patient. Int J Dermatol 2025; 64:377-384. [PMID: 39095955 DOI: 10.1111/ijd.17416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/10/2024] [Accepted: 07/10/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Skin cancer incidence increases globally, requiring effective preventive measures and evidence-based treatment strategies. Current guidelines advocate for surgical excision as a first-line treatment for most early skin cancers. The study investigated practices regarding changing scalpel blades when excising multiple skin lesions in the same patient during the same visit (CSB) and explored how beliefs about iatrogenic seeding influence individual norms of practice. METHODS A multidisciplinary survey was conducted among 173 medical specialists involved in skin cancer care. Participants provided demographic information, years of experience, and practices regarding CSB in four clinical scenarios (first excised tumor: basal cell carcinoma, squamous cell carcinoma, melanoma suspect, and evident melanoma). Practice variations based on specialty, experience, and beliefs about seeding risk were statistically assessed. RESULTS Surgeons exhibited a significantly higher tendency to change blades compared to non-surgeons across all diagnoses. Iatrogenic seeding (56.52%) and clinical training (18.84%) were the main reasons provided for CSB. Beliefs about seeding risk did not differ significantly between specialties. CONCLUSIONS Although the practice of CSB lacks strong scientific rationale, the approach to this practice significantly varies among different medical specialties. Healthcare professionals should critically evaluate and standardize evidence-based practices to ensure optimal patient care and mitigate potential harm.
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Affiliation(s)
- Paweł Pietkiewicz
- Zwierzyniecka Medical Center, Poznań, Poland
- Polish Dermatoscopy Group, Poznań, Poland
| | - Aleksandra Stefaniak
- Polish Dermatoscopy Group, Poznań, Poland
- Department of Dermatology, Venereology and Allergology, Wroclaw, Poland
| | - Piotr Giedziun
- Polish Dermatoscopy Group, Poznań, Poland
- Faculty of Information and Communication Technology, Wrocław University of Science and Technology, Wrocław, Poland
| | - Jacek Calik
- Polish Dermatoscopy Group, Poznań, Poland
- Department of Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Michał Lewandowicz
- Polish Dermatoscopy Group, Poznań, Poland
- Department of Surgical Oncology, Breast Cancer Unit, Regional Oncology Center, Łódź, Poland
| | - Ewelina Mazur
- Polish Dermatoscopy Group, Poznań, Poland
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Carmen Cantisani
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, "Sapienza Medical School" University of Rome, Rome, Italy
| | - Cristian Navarrete-Dechent
- Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bengu Nisa Akay
- Faculty of Medicine, Department of Dermatology, Ankara University, Ankara, Turkey
| | | | - Cliff Rosendahl
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Tehran University of Medical Sciences, Tehran, Iran
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Gami A, Shah A, Shankaralingappa S, Salunke AA, Gandhi J, Patel K, Bharwani N, Trivedi P, Pandya S. Does an excision of needle bone biopsy tract affect the prognosis in patients with primary bone tumor? J Orthop 2024; 48:13-19. [PMID: 38059219 PMCID: PMC10696180 DOI: 10.1016/j.jor.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
Background Opinion remains divided as to whether excision of needle biopsy tract is beneficial and affect the prognosis. The aim of the study was to compare the outcomes in patients of primary malignant bone tumor who had undergone surgery with or without biopsy tract excision. Methods From January 2017 to June 2020, 240 patients with primary malignant bone tumors who underwent percutaneous needle biopsy followed by surgery were included. We categorized patients into Biopsy tract excision (Group1:185 patients) and Non Biopsy tract excision (Group 2:55 patients). Median follow-up of patients was 58.6 months (range; 12-61.8months). Results Demographics, histopathological type, tumor location, type of surgery were similar in biopsy tract excision and non excision group. We found biopsy tract seeding in two cases out of 185 (1.1 %). Local recurrence in biopsy tract excision and non excision group was observed in 3.2 % and 1.8 % respectively with p value 0.58. The mean local recurrence free survival rate in group 1 and 2 was 60 and 44 months respectively. Limb salvage was performed in 71.6 % and in amputation in 28.3 % cases. The local recurrence in limb-salvage and amputation group was observed in 3.4 % (6/172) and 1.4 % (1/68) respectively. Conclusion There was no significant difference in the rate of local recurrence between patients who were treated by biopsy tract excision or non tract excision. Percutenous needle bone biopsy tract leads to minimal risk of tumor seeding during surgical resection of primary bone tumors.We recommend the further multi centre studies with more number of patients to reach a consensus on resection of needle biopsy tract during surgical management of primary bone tumors.
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Affiliation(s)
- Amisha Gami
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Ashini Shah
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | | | - Abhijeet Ashok Salunke
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Jahnavi Gandhi
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Keval Patel
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Nandlal Bharwani
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Priti Trivedi
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
- Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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Kawai M, Miwa S, Yamamoto N, Hayashi K, Takeuchi A, Igarashi K, Taniguchi Y, Araki Y, Yonezawa H, Nojima T, Tsuchiya H. Needle tract seeding of a sclerosing epithelioid fibrosarcoma in a biopsy tract: a case report. BMC Musculoskelet Disord 2023; 24:454. [PMID: 37270505 DOI: 10.1186/s12891-023-06553-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 05/18/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND A sclerosing epithelioid fibrosarcoma (SEF) is an uncommon tumor of the deep soft tissue. An SEF has been described as a low-grade tumor with high local recurrence and metastatic rates. Generally, in bone and soft tissue tumors, a resection of the biopsy route is recommended; however, there is limited evidence with respect to the dissemination of the tumor tissue during a needle biopsy. CASE PRESENTATION A mass in the right pelvic cavity, with no symptoms, was observed in a 45-year-old woman during a gynecological examination. Computed tomography (CT) revealed a multilocular mass with calcification in the pelvic cavity. The magnetic resonance imaging (MRI) showed an iso-signal intensity on T1 weighted images and hypo- and iso-signal intensity on T2 weighted images. The CT-guided core needle biopsy was performed using a dorsal approach, and the biopsy diagnosis was a low-grade spindle cell tumor. The tumor was excised using an anterior approach. The tumor tissue comprised spindle cells and epithelioid cells with irregular nuclei, and the immunohistological analysis was positive for vimentin and epithelial membrane antigen, which was consistent with a diagnosis of sclerosing epithelioid fibrosarcoma. Five years after the surgery, the MRI showed a tumor recurrence in the subcutaneous tissue of the right buttock, which was consistent with the needle biopsy tract. The patient underwent a tumor excision, and the resected tumor was similar to the primary tumor. CONCLUSIONS The recurrent tumor was excised with a surgical margin, and the tumor specimen had the histological features of a sclerosing epithelioid fibrosarcoma. It was difficult to investigate the association of the core needle biopsy with the tumor recurrence because the approach of the biopsy tract is usually same as that used in a tumor excision. However, the present case indicated the tumor may recur in the biopsy tract of a soft tissue sarcoma. Surgeons should be aware of the possibility of disseminating tumor tissues in a needle biopsy.
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Affiliation(s)
- Masafumi Kawai
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Shinji Miwa
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Norio Yamamoto
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8640, Japan.
| | - Katsuhiro Hayashi
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Akihiko Takeuchi
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Kentaro Igarashi
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Yuta Taniguchi
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Yoshihiro Araki
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Hirotaka Yonezawa
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Takayuki Nojima
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
- Department of Pathology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
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de Vries ISA, van Ewijk R, Adriaansen LME, Bohte AE, Braat AJAT, Fajardo RD, Hiemcke-Jiwa LS, Hol MLF, Ter Horst SAJ, de Keizer B, Knops RRG, Meister MT, Schoot RA, Smeele LE, van Scheltinga ST, Vaarwerk B, Merks JHM, van Rijn RR. Imaging in rhabdomyosarcoma: a patient journey. Pediatr Radiol 2023; 53:788-812. [PMID: 36843091 PMCID: PMC10027795 DOI: 10.1007/s00247-023-05596-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/06/2022] [Accepted: 01/10/2023] [Indexed: 02/28/2023]
Abstract
Rhabdomyosarcoma, although rare, is the most frequent soft tissue sarcoma in children and adolescents. It can present as a mass at nearly any site in the body, with most common presentations in the head and neck, genitourinary tract and extremities. The optimal diagnostic approach and management of rhabdomyosarcoma require a multidisciplinary team with multimodal treatment, including chemotherapy and local therapy. Survival has improved over the last decades; however, further improvement in management is essential with current 5-year overall survival ranging from 35% to 100%, depending on disease and patient characteristics. In the full patient journey, from diagnosis, staging, management to follow-up after therapy, the paediatric radiologist and nuclear physician are essential members of the multidisciplinary team. Recently, guidelines of the European paediatric Soft tissue sarcoma Study Group, the Cooperative Weichteilsarkom Studiengruppe and the Oncology Task Force of the European Society of Paediatric Radiology (ESPR), in an ongoing collaboration with the International Soft-Tissue Sarcoma Database Consortium, provided guidance for high-quality imaging. In this educational paper, given as a lecture during the 2022 postgraduate ESPR course, the multi-disciplinary team of our national paediatric oncology centre presents the journey of two patients with rhabdomyosarcoma and discusses the impact on and considerations for the clinical (paediatric) radiologist and nuclear physician. The key learning points of the guidelines and their implementation in clinical practice are highlighted and up-to-date insights provided for all aspects from clinical suspicion of rhabdomyosarcoma and its differential diagnosis, to biopsy, staging, risk stratification, treatment response assessment and follow-up.
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Affiliation(s)
| | - Roelof van Ewijk
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Laura M E Adriaansen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Anneloes E Bohte
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Arthur J A T Braat
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Raquel Dávila Fajardo
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiotherapy, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Laura S Hiemcke-Jiwa
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Pathology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marinka L F Hol
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Otorhinolaryngology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Simone A J Ter Horst
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Bart de Keizer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Rutger R G Knops
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Michael T Meister
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Oncode Institute, Utrecht, the Netherlands
| | - Reineke A Schoot
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Ludi E Smeele
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute (NCI), Amsterdam, the Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Bas Vaarwerk
- Department of Paediatrics, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Suite C1-423.1, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands.
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MAZZOLIN VINICIUSDEABREU, KALLUF JULIAROCHA, OGATA FIAMAKURODA, OLIVEIRA NATHALIASUNDINPALMEIRADE, GARCIA JAIROGRECO, PETRILLI MARCELODETOLEDO, KORUKIAN MARCOS, VIOLA DANCARAIMAIA. EPIDEMIOLOGICAL PROFILE AND EVOLUTION IN MUSCULOSKELETAL TUMORS AT THE LEVEL OF THE ELBOW. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e261309. [PMID: 36844124 PMCID: PMC9949311 DOI: 10.1590/1413-785220233101e261309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/02/2022] [Indexed: 02/22/2023]
Abstract
Objective To present the epidemiological profile of bone and soft tissue tumors that affect the elbow region treated at an oncology referral center in Brazil. Methods Retrospective observational case series study to evaluate the results of elbow cancer undergoing clinical and/or surgical treatment with the first visit from 1990 to 2020. The dependent variables were benign bone tumor, malignant bone tumor, benign soft tissue tumor, malignant soft tissue tumor. Independent variables were sex, age; presence of symptoms (pain/increase in local volume/fracture); diagnosis; treatment and recurrence. Results In total, 37 patients were included, 51.35% of whom were female, with a mean age at diagnosis of 33.5 years. Soft tissue neoplasms correspond to 51% of cases against 49% of bone tumors. Among the symptoms, the general prevalence of pain was 56.75%, the general increase in local volume occurred in 54.04% of the patients and the presence of fractures in 13.43%. Surgical treatment occurred in 75.67% of cases and recurrence in 16.21% of cases. Conclusion The tumors that affect the elbow in our series correspond mostly to benign tumors, involving bone or soft tissues, with a higher occurrence in young adult patients. Level of Evidence IV, Case Series.
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Affiliation(s)
| | - JULIA ROCHA KALLUF
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, São Paulo, SP, Brazil
| | - FIAMA KURODA OGATA
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, São Paulo, SP, Brazil
| | - NATHALIA SUNDIN PALMEIRA DE OLIVEIRA
- Universidade do Estado do Rio de Janeiro, Pedro Ernesto University Hospital, Orthopedics and Traumatology Education and Care Unit, Rio de Janeiro, RJ, Brazil
| | - JAIRO GRECO GARCIA
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, São Paulo, SP, Brazil.,Grupo de Apoio ao Adolescente e à Criança com Câncer, Institute of Pediatrics Oncology, São Paulo, SP, Brazil
| | - MARCELO DE TOLEDO PETRILLI
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, São Paulo, SP, Brazil.,Grupo de Apoio ao Adolescente e à Criança com Câncer, Institute of Pediatrics Oncology, São Paulo, SP, Brazil
| | - MARCOS KORUKIAN
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, São Paulo, SP, Brazil
| | - DAN CARAI MAIA VIOLA
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, São Paulo, SP, Brazil.,Grupo de Apoio ao Adolescente e à Criança com Câncer, Institute of Pediatrics Oncology, São Paulo, SP, Brazil.,Columbia University Medical Center, New York, NY, USA
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Ruthberg JS, Meleca JB, Ko JS, Billings SD, Ku JA. Rhabdomyosarcoma Arising in an Old Rhytidectomy Scar. Ann Otol Rhinol Laryngol 2023; 132:221-225. [PMID: 35311358 DOI: 10.1177/00034894221084482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The clinical evaluation and management of an adult with head and neck rhabdomyosarcoma is explored to delineate the diagnostic challenge posed by soft-tissue sarcomas bordering scar tissue. CASE REPORT A 59 year old female presents with persistent, evolving paresthesia and burning in the right posterior neck, which was found to be in close proximity to a well-healed rhytidectomy scar. Serial biopsies were non-diagnostic. Six months after initial presentation, rhabdomyosarcoma was diagnosed subsequent to histopathological and immunohistochemistry analysis. A wide local excision with posterolateral neck dissection was performed. CONCLUSION A high index of suspicion for soft-tissue sarcoma should be maintained for patients with persistent soft-tissue lesions, especially in areas of scarred tissue, who present with new-onset neurological symptoms in the context of nondiagnostic biopsies.
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Affiliation(s)
- Jeremy S Ruthberg
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Joseph B Meleca
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer S Ko
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jamie A Ku
- Section of Head and Neck Surgical Oncology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Otolaryngology - Head & Neck Surgery, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Yee EJ, Stewart CL, Clay MR, McCarter MM. Lipoma and Its Doppelganger: The Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma. Surg Clin North Am 2022; 102:637-656. [PMID: 35952693 DOI: 10.1016/j.suc.2022.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Lipomatous tumors are among the most common soft tissue lesions encountered by the general surgeon. Shared history and clinical presentation make differentiation between benign lipomas and low-grade liposarcomas a diagnostic dilemma. This article reviews the epidemiology, clinical history, diagnostic workup, management, natural history, and surveillance of benign lipomas and atypical lipomatous tumors/well-differentiated liposarcomas. Although it is important that aggressive, potentially malignant atypical lipomatous tumors and liposarcomas be managed in a multidisciplinary, preferably high-volume setting, it is equally as important for the nonspecialist general surgeon to be familiar with lipoma and its doppelganger-the well-differentiated liposarcoma.
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Affiliation(s)
- Elliott J Yee
- Department of Surgery, University of Colorado, 12605 East 16th Avenue, Aurora, CO 80045, USA.
| | - Camille L Stewart
- Department of Surgery, University of Colorado, 12605 East 16th Avenue, Aurora, CO 80045, USA
| | - Michael R Clay
- Department of Pathology, Univeristy of Colorado, 12605 East 16th Avenue, Aurora, CO 80045, USA
| | - Martin M McCarter
- Department of Surgery, University of Colorado, 12605 East 16th Avenue, Aurora, CO 80045, USA
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Klein A, Birkenmaier C, Fromm J, Knösel T, Di Gioia D, Dürr HR. Sarcomas of the extremities and the pelvis: comparing local recurrence after incisional and after core-needle biopsy. World J Surg Oncol 2022; 20:14. [PMID: 35016693 PMCID: PMC8750807 DOI: 10.1186/s12957-021-02481-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/21/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The degree of contamination of healthy tissue with tumor cells during a biopsy in bone or soft tissue sarcomas is clearly dependant on the type of biopsy. Some studies have confirmed a clinically relevant contamination of the biopsy tract after incisional biopsies, as opposed to core-needle biopsies. The aim of our prospective study was to evaluate the risk of local recurrence depending on the biopsy type in extremity and pelvis sarcomas. METHODS We included 162 patients with a minimum follow-up of 6 months after wide resection of extremity sarcomas. All diagnostic and therapeutic procedures were performed at a single, dedicated sarcoma center. The excision of the biopsy tract after an incisional biopsy was performed as a standard with all tumor resections. All patients received their follow-up after the conclusion of therapy at our center by means of regional MRI studies and, at a minimum, CT of the thorax to rule out pulmonary metastatic disease. The aim of the study was the evaluation of the influence of the biopsy type and of several other clinical factors on the rate of local recurrence and on the time of local recurrence-free survival. RESULTS One hundred sixty-two patients with bone or soft tissue tumors of the extremities and the pelvis underwent either an incisional or a core-needle biopsy of their tumor, with 70 sarcomas (43.2%) being located in the bone. 84.6% of all biopsies were performed as core-needle biopsies. The median follow-up time was 55.6 months, and 22 patients (13.6%) developed a local recurrence after a median time of 22.4 months. There were no significant differences between incisional and core-needle biopsy regarding the risk of local recurrence in our subgroup analysis with differentiation by kind of tissue, grading of the sarcoma, and perioperative multimodal therapy. CONCLUSIONS In a large and homogenous cohort of extremity and pelvic sarcomas, we did not find significant differences between the groups of incisional and core-needle biopsy regarding the risk of local recurrence. The excision of the biopsy tract after incisional biopsy in the context of the definitive tumor resection seems to be the decisive factor for this result.
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Affiliation(s)
- Alexander Klein
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377, Munich, Germany.
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Christof Birkenmaier
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Julian Fromm
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Thomas Knösel
- Institute of Pathology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Dorit Di Gioia
- Department of Medicine III, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Hans Roland Dürr
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377, Munich, Germany
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10
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Zöllner SK, Amatruda JF, Bauer S, Collaud S, de Álava E, DuBois SG, Hardes J, Hartmann W, Kovar H, Metzler M, Shulman DS, Streitbürger A, Timmermann B, Toretsky JA, Uhlenbruch Y, Vieth V, Grünewald TGP, Dirksen U. Ewing Sarcoma-Diagnosis, Treatment, Clinical Challenges and Future Perspectives. J Clin Med 2021; 10:1685. [PMID: 33919988 PMCID: PMC8071040 DOI: 10.3390/jcm10081685] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 02/08/2023] Open
Abstract
Ewing sarcoma, a highly aggressive bone and soft-tissue cancer, is considered a prime example of the paradigms of a translocation-positive sarcoma: a genetically rather simple disease with a specific and neomorphic-potential therapeutic target, whose oncogenic role was irrefutably defined decades ago. This is a disease that by definition has micrometastatic disease at diagnosis and a dismal prognosis for patients with macrometastatic or recurrent disease. International collaborations have defined the current standard of care in prospective studies, delivering multiple cycles of systemic therapy combined with local treatment; both are associated with significant morbidity that may result in strong psychological and physical burden for survivors. Nevertheless, the combination of non-directed chemotherapeutics and ever-evolving local modalities nowadays achieve a realistic chance of cure for the majority of patients with Ewing sarcoma. In this review, we focus on the current standard of diagnosis and treatment while attempting to answer some of the most pressing questions in clinical practice. In addition, this review provides scientific answers to clinical phenomena and occasionally defines the resulting translational studies needed to overcome the hurdle of treatment-associated morbidities and, most importantly, non-survival.
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Affiliation(s)
- Stefan K. Zöllner
- Pediatrics III, University Hospital Essen, 45147 Essen, Germany;
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
| | - James F. Amatruda
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA;
| | - Sebastian Bauer
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Medical Oncology, Sarcoma Center, University Hospital Essen, 45147 Essen, Germany
| | - Stéphane Collaud
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Thoracic Surgery, Ruhrlandklinik, University of Essen-Duisburg, 45239 Essen, Germany
| | - Enrique de Álava
- Institute of Biomedicine of Sevilla (IbiS), Virgen del Rocio University Hospital, CSIC, University of Sevilla, CIBERONC, 41013 Seville, Spain;
- Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, 41009 Seville, Spain
| | - Steven G. DuBois
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA 02215, USA; (S.G.D.); (D.S.S.)
| | - Jendrik Hardes
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Musculoskeletal Oncology, Sarcoma Center, 45147 Essen, Germany
| | - Wolfgang Hartmann
- Division of Translational Pathology, Gerhard-Domagk Institute of Pathology, University Hospital Münster, 48149 Münster, Germany;
- West German Cancer Center (WTZ), Network Partner Site, University Hospital Münster, 48149 Münster, Germany
| | - Heinrich Kovar
- St. Anna Children’s Cancer Research Institute and Medical University Vienna, 1090 Vienna, Austria;
| | - Markus Metzler
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, 91054 Erlangen, Germany;
| | - David S. Shulman
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA 02215, USA; (S.G.D.); (D.S.S.)
| | - Arne Streitbürger
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Musculoskeletal Oncology, Sarcoma Center, 45147 Essen, Germany
| | - Beate Timmermann
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre, 45147 Essen, Germany
| | - Jeffrey A. Toretsky
- Departments of Oncology and Pediatrics, Georgetown University, Washington, DC 20057, USA;
| | - Yasmin Uhlenbruch
- St. Josefs Hospital Bochum, University Hospital, 44791 Bochum, Germany;
| | - Volker Vieth
- Department of Radiology, Klinikum Ibbenbüren, 49477 Ibbenbühren, Germany;
| | - Thomas G. P. Grünewald
- Division of Translational Pediatric Sarcoma Research, Hopp-Children’s Cancer Center Heidelberg (KiTZ), 69120 Heidelberg, Germany;
- Division of Translational Pediatric Sarcoma Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Core Center, 69120 Heidelberg, Germany
| | - Uta Dirksen
- Pediatrics III, University Hospital Essen, 45147 Essen, Germany;
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
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11
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Szaro P, Wong A, Blain E, Gataa KG, Geijer M. The diagnostic value of ultrasound-guided percutaneous core needle biopsy of musculoskeletal soft tissue lesions. J Ultrason 2021; 21:22-33. [PMID: 33791113 PMCID: PMC8008202 DOI: 10.15557/jou.2021.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/17/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction Percutaneous ultrasound-guided core needle biopsy is a well-established method in the diagnosis of musculoskeletal tumors. It is unclear which factors contribute the most to a successful biopsy. The aim of the study was to determine the value of ultrasound-guided core needle biopsy of solid lesions in the musculoskeletal system using a 16-gauge needle. Material and methods A retrospective analysis performed at a regional sarcoma center over one year included patients referred for ultrasound-guided biopsy of musculoskeletal soft tissue lesions. At least 6 months’ clinical and radiological follow-up, results from repeat or excisional biopsy, or interventional treatment, served as outcome reference. The biopsy procedure and yield were analyzed. The biopsy was classified as ‘diagnostic’ when a definitive diagnosis could be made on the first biopsy, and ‘accurate’ when only the malignant or benign nature of the tumor could be determined. Results From 102 referrals for biopsy of soft tissue lesions in 2019, a total of 73 biopsies of solid lesions with a 16-gauge cutting needle were included (73 patients). There were 34 males and 39 females, with a mean age of 57.7 years. The overall proportion of diagnostic biopsies was 84%, for malignant lesions 88% and benign lesions 81%. The tumor could be classified as malignant or benign in 12 patients (16%) (accurate biopsy). It was possible to discriminate between malignant and benign lesions in each case. The majority of biopsied lesions were benign 64% (n = 47). Conclusion The diagnostic value of ultrasound-guided percutaneous core needle biopsy of musculoskeletal soft tissue lesions performed with 16-gauge needle is good, with a high rate of diagnostic biopsies, both for benign and malignant lesions.
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Affiliation(s)
- Paweł Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Poland
| | - Andrew Wong
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Sweden
| | - Elena Blain
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Sweden
| | - Khaldun Ghali Gataa
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Sweden
| | - Mats Geijer
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Clinical Sciences, Lund University, Sweden
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12
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The Risk of Tumor Contamination Associated With Thoracic Instrumentation in Patients With Osteosarcoma: 2 Case Reports and a Literature Review. J Pediatr Hematol Oncol 2021; 43:e207-e211. [PMID: 32205783 DOI: 10.1097/mph.0000000000001778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/30/2020] [Indexed: 11/26/2022]
Abstract
Orthopedic surgeons are well aware of tumor contamination at the site of initial biopsy in osteosarcoma. However, tumor contamination in patients with osteosarcoma associated with thoracic instrumentation is not well described. The authors summarize 2 reported cases in addition to the 2 cases at their institution of this phenomenon. Knowledge of tumor contamination and preventative measures against tumor contamination is sparse in the literature, especially pertaining to patients with osteosarcoma undergoing thoracic instrumentation. In this report, the authors hope to increase awareness of these cases and suggest preventative measures to mitigate against tumor contamination in patients with osteosarcoma. The authors report that the median time between thoracic instrumentation and the visible detection of tumor migration to local sites was 5 months. They conclude that tumor contamination associated with thoracic instrumentation is characterized by patients with multiple sites of relapse and aggressive, fatal disease.
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13
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Biopsy. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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14
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Vasilevska Nikodinovska V, Ivanoski S, Samardziski M, Janevska V. Percutaneous Imaging-Guided versus Open Musculoskeletal Biopsy: Concepts and Controversies. Semin Musculoskelet Radiol 2020; 24:667-675. [PMID: 33307583 DOI: 10.1055/s-0040-1717113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Bone and soft tissue tumors are a largely heterogeneous group of tumors. Biopsy of musculoskeletal (MSK) tumors is sometimes a challenging procedure. Although the open biopsy is still considered the gold standard for the biopsy of MSK lesions, core needle biopsy can replace it in most cases, with similar accuracy and a low complication rate. The biopsy should be performed in a tertiary sarcoma center where the multidisciplinary team consists of at minimum a tumor surgeon, an MSK pathologist, and an MSK radiologist who can assess all steps of the procedure. Several factors can influence the success of the biopsy including the lesion characteristics, the equipment, and the method used for the procedure. This review highlights some of the important aspects regarding the biopsy of the MSK tumors, with special attention to imaging a guided core needle biopsy and highlighting some of the recent advancements and controversies in the field.
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Affiliation(s)
- Violeta Vasilevska Nikodinovska
- Department of Radiology, Faculty of Medicine, University Surgical Clinic, St. Naum Ohridski Skopje, Ss. Cyril and Methodius University of Skopje, Skopje, North Macedonia
| | - Slavcho Ivanoski
- Department of Radiology, Special Hospital for Orthopedic Surgery and Traumatology, St. Erazmo - Ohrid, Macedonia, Ss. Cyril and Methodius University of Skopje, Skopje, North Macedonia
| | - Milan Samardziski
- University Clinic for Orthopedic Surgery, Ss. Cyril and Methodius University of Skopje, Skopje, North Macedonia
| | - Vesna Janevska
- Institute of Pathology, Faculty of Medicine, Ss. Cyril and Methodius University of Skopje, Skopje, North Macedonia
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15
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Biopsy Path Contamination in Primary Bone Sarcomas. Rev Bras Ortop 2019; 54:33-36. [PMID: 31363240 PMCID: PMC6424802 DOI: 10.1016/j.rbo.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/05/2017] [Indexed: 12/02/2022] Open
Abstract
Objective To determine the incidence of contamination of the biopsy pathway in patients with primary bone sarcomas, as well as the clinical characteristics that influenced this outcome. Materials and Methods The anatomopathological reports of the patients who were treated by the Orthopedic Oncology Sector of the Orthopedic and Traumatology Department of this institution were retrospectively evaluated. Results Of the 148 patients included for evaluation in the present study, only 1 presented contamination by neoplastic cells in his biopsy pathway. Conclusion The bone biopsy procedure in patients with primary bone sarcomas presents great safety regarding pathway contamination when performed in specialized centers that treat this type of pathology.
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16
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Berger-Richardson D, Burtenshaw SM, Ibrahim AM, Gladdy RA, Auer R, Beecroft R, Dickson BC, Purgina B, Ambacher K, Nessim C, Swallow CJ. Early and Late Complications of Percutaneous Core Needle Biopsy of Retroperitoneal Tumors at Two Tertiary Sarcoma Centers. Ann Surg Oncol 2019; 26:4692-4698. [PMID: 31372868 DOI: 10.1245/s10434-019-07656-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Concern persists regarding percutaneous core needle biopsy (CNB) of a potentially malignant lesion of the retroperitoneum due to the perceived risk of immediate complications and adverse oncologic outcomes, including needle tract seeding (NTS). OBJECTIVE The aim of this study was to evaluate the incidence of (1) early complications and (2) NTS following CNB of suspected retroperitoneal sarcoma (RPS). METHODS Patients who underwent CNB of an RP mass with pre-biopsy suspicion of sarcoma were identified from a prospective database at two centers: (1) Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto (2009-2015); and (2) The Ottawa Hospital (1999-2015). Early complications, including bleeding, pain, infection, and organ injury, were recorded. Instances of NTS were identified from long-term follow-up of patients who underwent resection of primary RPS at these two centers after initial CNB (1996-2013). RESULTS Of 358 percutaneous CNBs of suspected RPS performed over the study period, 7 (2.0%) resulted in minor bleeding with no transfusion, 3 (0.8%) resulted in significant pain, 1 (0.3%) resulted in unplanned admission to hospital for observation, and 1 (0.3%) resulted in a pneumothorax. There were no infections. In 203 patients who underwent resection of RPS following CNB, crude cumulative local recurrence was 24% at 5 years. At a median follow-up of 44 months, there was one case of NTS (approximately 0.5%). CONCLUSION This large bi-institutional experience with CNB of an RP mass demonstrates that both the early complication rate and the incidence of NTS are very low. Physicians and patients can be reassured that the benefits of CNB in diagnosing sarcoma and determining its histologic subtype and grade far outweigh the risks.
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Affiliation(s)
- David Berger-Richardson
- Department of Surgery, University of Toronto, Toronto, ON, Canada. .,Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.
| | - Sally M Burtenshaw
- Division of General Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and Sinai Health System, Toronto, ON, Canada
| | | | - Rebecca A Gladdy
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Division of General Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and Sinai Health System, Toronto, ON, Canada
| | - Rebecca Auer
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Surgery, University of Ottawa, Ottawa, ON, Canada.,Division of General Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Rob Beecroft
- Joint Department of Medical Imaging, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Brendan C Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada
| | - Bibianna Purgina
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Carolyn Nessim
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Surgery, University of Ottawa, Ottawa, ON, Canada.,Division of General Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Carol J Swallow
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Division of General Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and Sinai Health System, Toronto, ON, Canada
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17
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Stitzlein RN, Wojcik J, Sebro RA, Balamuth NJ, Weber KL. Team Approach: Osteosarcoma of the Distal Part of the Femur in Adolescents. JBJS Rev 2019; 5:e5. [PMID: 29278618 DOI: 10.2106/jbjs.rvw.17.00030] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Russell N Stitzlein
- Departments of Orthopaedic Surgery (R.N.S. and K.L.W.), Pathology and Laboratory Medicine (J.W.), Radiology (R.A.S.), and Pediatrics (N.J.B.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - John Wojcik
- Departments of Orthopaedic Surgery (R.N.S. and K.L.W.), Pathology and Laboratory Medicine (J.W.), Radiology (R.A.S.), and Pediatrics (N.J.B.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Ronnie A Sebro
- Departments of Orthopaedic Surgery (R.N.S. and K.L.W.), Pathology and Laboratory Medicine (J.W.), Radiology (R.A.S.), and Pediatrics (N.J.B.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Naomi J Balamuth
- Departments of Orthopaedic Surgery (R.N.S. and K.L.W.), Pathology and Laboratory Medicine (J.W.), Radiology (R.A.S.), and Pediatrics (N.J.B.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.,Divisions of Oncology (N.J.B.) and Orthopaedics (K.L.W.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kristy L Weber
- Departments of Orthopaedic Surgery (R.N.S. and K.L.W.), Pathology and Laboratory Medicine (J.W.), Radiology (R.A.S.), and Pediatrics (N.J.B.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.,Divisions of Oncology (N.J.B.) and Orthopaedics (K.L.W.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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18
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Turkoz KH, Erol B, Seven IE. Tumor cell seeding in the biopsy tract and its clinical significance in osteosarcomas. J Surg Oncol 2018; 118:1335-1340. [PMID: 30399199 DOI: 10.1002/jso.25282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/09/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The reasons behind the removal of the biopsy tract in osteosarcomas are not well known, and studies about tumor seeding in the biopsy tract have generated conflicting results. This study is designed to evaluate the presence and possible clinical significance of tumor cell seeding in the biopsy tract of osteosarcomas. METHODS We prospectively evaluated 55 cases of osteosarcomas for tumor cell seeding and other clinical and pathologic prognostic parameters. RESULTS Eleven cases (20%) involved microscopic tumor foci in the biopsy tract. The higher local recurrence rates (P = 0.005) and worse recurrence-free survivals ( P = 0.009) were observed in patients with tumor cell foci in the biopsy tract. Mitotic rate, tumor cell pleomorphism, and matrix production in main tumor foci were higher in cases with tumor seeding ( P = 0.047, P = 0.012, and P = 0.005, respectively) CONCLUSIONS: Tumor seeding in the biopsy tract is a fact in osteosarcomas. The higher local recurrence rates are more likely to occur in cases with tumor seeding.
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Affiliation(s)
- Kemal H Turkoz
- Department of Pathology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Bulent Erol
- Department of Orthopedics and Traumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Ipek E Seven
- Department of Pathology, Marmara University, School of Medicine, Istanbul, Turkey
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19
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Baad-Hansen T, Freund SS, Bech BH, Keller J. Is there consensus regarding surgical treatment of bone sarcomas? World J Orthop 2018; 9:173-179. [PMID: 30254974 PMCID: PMC6153138 DOI: 10.5312/wjo.v9.i9.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/20/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To perform an Internet based survey on the surgical management of bone sarcomas in the lower extremity amongst sarcoma surgeons.
METHODS All orthopedic surgical members of the Scandinavian Sarcoma Group were invited to participate in an online questionnaire. The questionnaire consisted of a clinical case involving resection of a malignant bone tumor. Several questions were asked, subdivided into categories. Among these, surgical/technical considerations, e.g., choice of implant; choice of antibiotics, dosage, and duration of treatment, choice of antithrombotic drug, initial start-up, dosage, and duration were included.
RESULTS In terms of choice of implant fixation, the majority of surgeons preferred an uncemented prosthesis in younger patients until the age of 50. All participants administer intravenous prophylactic antibiotics for endoprosthetic reconstructive surgery. First choice of antibiotics was cephalosporin. Less common used was glycopeptide, penicillin, or a combination. Duration of prophylactic antibiotics ranged from less than one day to more than four days. All participants used low molecular weight heparins as antithrombotic prophylaxis and 55% of the participants answered that initial treatment was started preoperatively, 3% perioperatively and 42% postoperatively. Duration of the antithrombotic treatment ranged from five days to more than twenty-eight days.
CONCLUSION The use of resection prosthesis in the treatment of bone sarcomas is a well-established procedure. However, therse is a significant discrepancy in the surgical treatment algorithm between the sarcoma centers. Still the treatment is mainly based on best clinical practice, due to the lack of evidence-based medicine in the surgical management of bone sarcomas.
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Affiliation(s)
- Thomas Baad-Hansen
- Department of Orthopaedic Oncology, Aarhus University Hospital, Aarhus C8000, Denmark
| | - Sarah Stammose Freund
- Department of Orthopaedic Oncology, Aarhus University Hospital, Aarhus C8000, Denmark
| | - Bodil Hammer Bech
- Department of Public Health, Aarhus University, Aarhus C8000, Denmark
| | - Johnny Keller
- Department of Orthopaedic Oncology, Aarhus University Hospital, Aarhus C8000, Denmark
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20
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Berger-Richardson D, Xu RS, Gladdy RA, McCart JA, Govindarajan A, Swallow CJ. Glove and instrument changing to prevent tumour seeding in cancer surgery: a survey of surgeons' beliefs and practices. ACTA ACUST UNITED AC 2018; 25:e200-e208. [PMID: 29962846 DOI: 10.3747/co.25.3924] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Some surgeons change gloves and instruments after the extirpative phase of cancer surgery with the intent of reducing the risk of local and wound recurrence. Although this practice is conceptually appealing, the evidence that gloves or instruments act as vectors of cancer-cell seeding in the clinical setting is weak. To determine the potential effect of further investigation of this question, we surveyed the practices and beliefs of a broad spectrum of surgeons who operate on cancer patients. Methods Using a modified Dillman approach, a survey was mailed to all 945 general surgeons listed in the College of Physicians and Surgeons of Ontario public registry. The survey consisted of multiple-choice and free-text response questions. Responses were tabulated and grouped into themes, including specific intraoperative events and surgeon training. Predictive variables were analyzed by chi-square test. Results Of 459 surveys returned (adjusted response rate: 46%), 351 met the inclusion criteria for retention. Of those respondents, 52% reported that they change gloves during cancer resections with the intent of decreasing the risk of tumour seeding, and 40%, that they change instruments for that purpose. The proportion of respondents indicating that they take measures to protect the wound was 73% for laparoscopic cancer resections and 31% for open resections. Training and years in practice predicted some of the foregoing behaviours. The most commonly cited basis for adopting specific strategies to prevent tumour seeding was "gut feeling," followed by clinical training. Most respondents believe that it is possible or probable that surgical gloves or instruments harbour malignant cells, but that a cancer recurrence proceeding from that situation is unlikely. Conclusions There is no consensus on how gloves and instruments should be handled in cancer operations. Further investigation is warranted.
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Affiliation(s)
- D Berger-Richardson
- Division of General Surgery, Department of Surgery, University of Toronto.,Institute of Medical Science, University of Toronto.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System; and
| | - R S Xu
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System; and
| | - R A Gladdy
- Division of General Surgery, Department of Surgery, University of Toronto.,Institute of Medical Science, University of Toronto.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System; and
| | - J A McCart
- Division of General Surgery, Department of Surgery, University of Toronto.,Institute of Medical Science, University of Toronto.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System; and
| | - A Govindarajan
- Division of General Surgery, Department of Surgery, University of Toronto.,Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON
| | - C J Swallow
- Division of General Surgery, Department of Surgery, University of Toronto.,Institute of Medical Science, University of Toronto.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System; and
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21
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Claro G, Meyer N, Meresse T, Gangloff D, Grolleau JL, Chaput B. Does needle biopsy cause an increased risk of extracapsular extension in the diagnosis of metastatic lymph node in melanoma? Int J Dermatol 2018; 57:410-416. [PMID: 29430630 DOI: 10.1111/ijd.13936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 11/16/2017] [Accepted: 01/09/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Needle biopsy is a rapid, reliable, and reproducible procedure for histological confirmation of metastatic melanoma localization. Nonetheless, this procedure presents a theoretical risk of a mechanical weakening of the lymph node capsule with perinodal tumor seeding. The objective of the study was to evaluate the incidence of extracapsular extension after needle biopsy in comparison with surgical adenectomy in patients suspected of metastatic lymph node of melanoma. METHODS We conducted a retrospective study of 1056 patients who underwent lymphadenectomy for melanoma between 2000 and 2016 in our unit. Sixty-nine patients were clinically and/or radiologically suspected of metastatic lymph node of melanoma. Patients were divided according to external lymph node biopsy or surgical adenectomy before lymphadenectomy. The primary endpoint was the histopathological identification of extracapsular extension in analyzed lymph nodes. RESULTS The two populations were comparable except for the mitotic index, which was more frequently > 1/mm2 in the group with surgical adenectomy (P = 0.005). The proportion of extracapsular extension was significantly greater in the needle biopsy group (28/37) than in patients who underwent surgical adenectomy (14/32) (P = 0.0067; OR = 4 [95% CI: 1.4-11]). CONCLUSION Our results suggest an increased risk of extracapsular extension after external lymph node biopsy in cases of suspicion of metastatic lymph node of melanoma. Thus, this encourages us to prefer surgical adenectomy in patients with suspected adenopathy accessible surgically. In other cases, needle biopsy should be carried out under radiological guidance using devices limiting tumor seeding.
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Affiliation(s)
- Gilles Claro
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rangueil Hospital, Toulouse, France.,Department of Surgical Oncology, Cancer University Institute of Toulouse Oncopole, Toulouse Cedex 09, France
| | - Nicolas Meyer
- Department of Dermatology, Cancer University Institute of Toulouse Oncopole, Toulouse Cedex 09, France
| | - Thomas Meresse
- Department of Surgical Oncology, Cancer University Institute of Toulouse Oncopole, Toulouse Cedex 09, France
| | - Dimitri Gangloff
- Department of Surgical Oncology, Cancer University Institute of Toulouse Oncopole, Toulouse Cedex 09, France
| | - Jean-Louis Grolleau
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rangueil Hospital, Toulouse, France
| | - Benoit Chaput
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rangueil Hospital, Toulouse, France.,Department of Surgical Oncology, Cancer University Institute of Toulouse Oncopole, Toulouse Cedex 09, France
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22
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Van Houdt W, Schrijver A, Cohen-Hallaleh R, Memos N, Fotiadis N, Smith M, Hayes A, Van Coevorden F, Strauss D. Needle tract seeding following core biopsies in retroperitoneal sarcoma. Eur J Surg Oncol 2017; 43:1740-1745. [DOI: 10.1016/j.ejso.2017.06.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/24/2017] [Accepted: 06/08/2017] [Indexed: 01/21/2023] Open
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23
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Barrientos-Ruiz I, Ortiz-Cruz EJ, Serrano-Montilla J, Bernabeu-Taboada D, Pozo-Kreilinger JJ. Are Biopsy Tracts a Concern for Seeding and Local Recurrence in Sarcomas? Clin Orthop Relat Res 2017; 475:511-518. [PMID: 27655183 PMCID: PMC5213942 DOI: 10.1007/s11999-016-5090-y] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 09/12/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND A biopsy is the final step in the diagnosis of sarcomas. Complete resection of the biopsy tract traditionally has been recommended in musculoskeletal oncology guidelines, as that tract is considered potentially seeded with tumor cells. However, to our knowledge, the frequency and implications of contamination of the biopsy tract-specifically with respect to the likelihood of local recurrence-and the factors that affect cell seeding are not well described. QUESTIONS/PURPOSES We asked: (1) How often are biopsy tracts contaminated with pathologically detectable tumor cells at the time of tumor resection? (2) What factors, in particular biopsy type (open versus percutaneous), are associated with tumoral seeding? (3) Is biopsy tract contamination associated with local recurrence? METHODS This is a retrospective study of a database with patient data collected from a single center between 2000 and 2013. We treated 221 patients with sarcomas. A total of 27 patients (12%) were excluded and 14 (6%) were lost to followup. One hundred eighty patients finally were included in the analysis who either had biopsies at our center (112) or biopsies at outside institutions (68). Of those performed at our center, 15 (13%) were open and 97 (87%) were percutaneous; of those at outside centers, those numbers were 47 (69%) and 21 (31%) respectively. Median followup was 40 months (range, 24-152 months). During the study period, we generally performed percutaneous biopsies as a standard practice for the diagnosis of bone and soft tissue sarcomas and open biopsies were done when the percutaneous procedure failed to provide a histologic characterization. The mean age of the population was 48 years (range, 7-87 years); 60% were male; 42% had bone sarcomas. Nineteen patients had preoperative radiotherapy and 56 had postoperative radiotherapy. Fifty-seven patients received neoadjuvant chemotherapy and 73 had adjuvant chemotherapy. We determined what proportion of biopsy tracts were contaminated by pathologic analysis of the biopsy tract specimen; during the period in question, our routine practice was to excise the biopsy tract whenever possible at the time of the definitive resection. Using the logistic regression test and Mantel-Haenszel test, we compared open with percutaneous biopsies in terms of the proportion of those that were contaminated at our site and for outside referral biopsies separately, because we do not assume the level of expertise was the same (our site is a referral tumor center). We compared the local recurrence-free survival between patients with and without contamination and between open and percutaneous biopsies using the Kaplan Meier test, again separating those performed at our site from those referred for purposes of this analysis. RESULTS Twenty-one of 180 biopsy tracts were contaminated (12%). Twenty of 62 (32%) of the open biopsies and one of 118 (0.8%) of the percutaneous core needle biopsies had cell seeding (odds ratio [OR], 56; 95% CI, 7-428; p < 0.001. One of 97 (1%) percutaneous biopsies performed in our center, and none of the 21 (0%) percutaneous biopsies performed in other centers had contaminated biopsy tracts (p = 0.047). Two of 15 (13%) open biopsies performed at our center and 18 of 41(38%) open biopsies performed at other centers had contaminated biopsy tracts (OR, 4; 95% CI, 1-7; p = 0.001). Four of 74 (5%) bone sarcomas and 18 of 106 (17%) soft tissue sarcomas had biopsy tract contamination (OR, 3; 95% CI, 1-10; p = 0.023). The local recurrence-free survival was longer for patients without contaminated tracts (mean, 107 months; 95% CI, 74-141 months) than for those with biopsy tract seeding (mean, 11 months; 95% CI, 1-20 months; p < 0.001). CONCLUSIONS Open biopsies were associated with an increased risk of tumoral seeding of the biopsy site, and tumoral seeding was associated with an increased risk of local recurrence. However, it is possible that other factors, such as increased complexity of the tumor or a difficult location, influenced the decision to obtain an open biopsy. Even so, based on these results, we believe that higher risk of local recurrence may be caused by an incomplete biopsy tract resection. In our opinion, the percutaneous biopsy with neoadjuvant or adjuvant therapy is the preferred method of biopsy at our center. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Irene Barrientos-Ruiz
- grid.81821.320000000089709163Orthopaedic Oncologist Unit, La Paz University Hospital, Paseo de la Castellana 261, Madrid, Spain ,MD Anderson International Hospital, Calle Arturo Soria 270, Madrid, Spain
| | - Eduardo José Ortiz-Cruz
- grid.81821.320000000089709163Orthopaedic Oncologist Unit, La Paz University Hospital, Paseo de la Castellana 261, Madrid, Spain ,MD Anderson International Hospital, Calle Arturo Soria 270, Madrid, Spain
| | - José Serrano-Montilla
- grid.28479.300000000122065938Orthopaedic Oncologist Unit, Rey Juan Carlos University Hospital, Madrid, Spain
| | - Daniel Bernabeu-Taboada
- grid.81821.320000000089709163Musculoskeletal Radiology Unit, La Paz University Hospital, Madrid, Spain
| | - Jose Juan Pozo-Kreilinger
- grid.81821.320000000089709163Musculoskeletal Pathology Unit, La Paz University Hospital, Madrid, Spain
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24
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Berger‐Richardson D, Swallow CJ. Needle tract seeding after percutaneous biopsy of sarcoma: Risk/benefit considerations. Cancer 2016; 123:560-567. [DOI: 10.1002/cncr.30370] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 08/08/2016] [Indexed: 12/17/2022]
Affiliation(s)
- David Berger‐Richardson
- Division of General Surgery, Department of SurgeryUniversity of TorontoToronto Ontario Canada
- Institute of Medical ScienceUniversity of TorontoToronto Ontario Canada
- Lunenfeld‐Tanenbaum Research Institute, Mount Sinai HospitalToronto Ontario Canada
| | - Carol J. Swallow
- Division of General Surgery, Department of SurgeryUniversity of TorontoToronto Ontario Canada
- Institute of Medical ScienceUniversity of TorontoToronto Ontario Canada
- Lunenfeld‐Tanenbaum Research Institute, Mount Sinai HospitalToronto Ontario Canada
- Department of Surgical OncologyPrincess Margaret Cancer CentreToronto Ontario Canada
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25
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Abstract
OBJECTIVES To determine the utility and necessity of submitting tissue sections from the biopsy tracts of osteosarcoma resection specimens. METHODS The prevalence of residual tumor in representative sections of osteosarcoma biopsy tracts was assessed in a series of 97 osteosarcoma resection specimens. RESULTS No residual tumor cells were identified in 97 sampled biopsy tracts (0%; 95% confidence interval, 0%-2.5%). CONCLUSIONS Pathologists do not need to submit sections of resected biopsy tracts unless there is clinical or gross evidence that would warrant further examination.
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Affiliation(s)
- Justin M M Cates
- From the Department of Pathology, Vanderbilt University Medical Center, Nashville, TN.
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26
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Buy X, Kind M, Stoeckle E, Catena V, Gangi A, Palussiere J. Radiologie interventionnelle et tumeurs des tissus mous : du diagnostic au traitement. ONCOLOGIE 2016. [DOI: 10.1007/s10269-016-2614-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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27
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Guarnieri C. Case Study of a Young Adult With Ewing Sarcoma. J Adv Pract Oncol 2016; 7:634-638. [PMID: 29588868 PMCID: PMC5866129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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28
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Luk PP, Vilain R, Crainic O, McCarthy SW, Thompson JF, Scolyer RA. Punch biopsy of melanoma causing tumour cell implantation: another peril of utilising partial biopsies for melanocytic tumours. Australas J Dermatol 2015; 56:227-31. [PMID: 25827527 DOI: 10.1111/ajd.12333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/20/2015] [Indexed: 02/01/2023]
Abstract
The recommended initial management for suspected melanoma is excisional biopsy. The use of partial biopsies of melanocytic tumours poses potential problems including misdiagnosis due to either unrepresentative sampling or the difficulty in evaluating important diagnostic features; an inaccurate assessment of Breslow thickness and other important prognostic features; and the induction of changes capable of mimicking melanoma (i.e., pseudomelanoma). Misdiagnosis, in turn, may lead to inappropriate management of the patient and an adverse outcome. In this report we document a previously unrecognised pitfall of partial biopsies of melanocytic tumours: implantation of tumour cells at the biopsy site potentially leading to the overestimation of tumour thickness or a misdiagnosis of the presence of microsatellites in the subsequent wide excision specimen.
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Affiliation(s)
- Peter P Luk
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Melanoma Institute Australia, Poche Centre, Sydney, New South Wales, Australia
| | - Ricardo Vilain
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Melanoma Institute Australia, Poche Centre, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Oana Crainic
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Stanley W McCarthy
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Melanoma Institute Australia, Poche Centre, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - John F Thompson
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Melanoma Institute Australia, Poche Centre, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Richard A Scolyer
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Melanoma Institute Australia, Poche Centre, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Raleigh DR, Hsu IC, Braunstein S, Chang AJ, Simko JP, Roach M. Bladder wall recurrence of prostate cancer after high-dose-rate brachytherapy. Brachytherapy 2015; 14:185-8. [DOI: 10.1016/j.brachy.2014.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 11/17/2014] [Accepted: 11/17/2014] [Indexed: 11/28/2022]
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30
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The role of 18F-FDG PET/CT in diagnosis and staging of musculoskeletal soft tissue sarcomas. Clin Transl Imaging 2015. [DOI: 10.1007/s40336-015-0108-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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31
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Biopsy techniques for soft tissue and bowel sarcomas. J Surg Oncol 2015; 111:504-12. [DOI: 10.1002/jso.23870] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 11/08/2014] [Indexed: 11/07/2022]
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