David Berger-Richardson1,2, Sally M Burtenshaw3,4, Andrea M Ibrahim5, Rebecca A Gladdy6,7,3,4, Rebecca Auer5,8,9, Rob Beecroft10, Brendan C Dickson11, Bibianna Purgina12, Kristin Ambacher5, Carolyn Nessim5,8,9, Carol J Swallow6,7,3,4. 1. Department of Surgery, University of Toronto, Toronto, ON, Canada. david.berger.richardson@mail.utoronto.ca. 2. Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada. david.berger.richardson@mail.utoronto.ca. 3. Division of General Surgery, Mount Sinai Hospital, Toronto, ON, Canada. 4. Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and Sinai Health System, Toronto, ON, Canada. 5. The Ottawa Hospital Research Institute, Ottawa, ON, Canada. 6. Department of Surgery, University of Toronto, Toronto, ON, Canada. 7. Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada. 8. Department of Surgery, University of Ottawa, Ottawa, ON, Canada. 9. Division of General Surgery, The Ottawa Hospital, Ottawa, ON, Canada. 10. Joint Department of Medical Imaging, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada. 11. Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada. 12. Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
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.
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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Authors: Carol J Swallow; Dirk C Strauss; Sylvie Bonvalot; Piotr Rutkowski; Anant Desai; Rebecca A Gladdy; Ricardo Gonzalez; David E Gyorki; Mark Fairweather; Winan J van Houdt; Eberhard Stoeckle; Jae Berm Park; Markus Albertsmeier; Carolyn Nessim; Kenneth Cardona; Marco Fiore; Andrew Hayes; Dimitri Tzanis; Jacek Skoczylas; Samuel J Ford; Deanna Ng; John E Mullinax; Hayden Snow; Rick L Haas; Dario Callegaro; Myles J Smith; Toufik Bouhadiba; Silvia Stacchiotti; Robin L Jones; Thomas DeLaney; Christina L Roland; Chandrajit P Raut; Alessandro Gronchi Journal: Ann Surg Oncol Date: 2021-04-14 Impact factor: 4.339