Courtney Pendleton1, B Matthew Howe1, Robert J Spinner2. 1. Departments of Neurosurgery and Radiology, Mayo Clinic, 200 First Street SW, Gonda 8-214, Rochester, MN, 55905, USA. 2. Departments of Neurosurgery and Radiology, Mayo Clinic, 200 First Street SW, Gonda 8-214, Rochester, MN, 55905, USA. spinner.robert@mayo.edu.
Abstract
BACKGROUND: The decision to biopsy a peripheral nerve tumor is largely based on its presumed behavior and prognosis, determined by patient history, clinical exam, and radiologic characteristics. Percutaneous image-guided biopsy is not without risk in patients with malignant peripheral nerve sheath tumors (MPNSTs); in particular, there may be concern regarding worsening neurologic function, increasing neuropathic pain, and incorrect or absent diagnosis. METHODS: Following approval by our institutional review board, we reviewed records from 1990 to 2019 at our institution's three main sites ("our institution"). Patients with pathology-proven MPNST were selected. Further inclusion criteria included image-guided percutaneous biopsy performed at our institution, pathology report available for review, and follow-up documentation to determine post-biopsy complications. RESULTS: Three hundred thirty-one patients with MPNST were reviewed. In total, 73 patients undergoing image-guided percutaneous biopsies were included. Twenty-two (30.1%) had biopsy-related complications. This included ten patients with misdiagnosis (13.7%) and six patients with non-diagnostic biopsies (8.2%). Six patients had new or worsened pain that resolved with time and neuropathic pain medication (8.2%), and one patient had subjectively worsened proximal weakness (1.3%) which resolved. CONCLUSION: We found nearly a third of patients undergoing biopsy had a biopsy-related complication. The single largest complication was the inability to obtain an accurate diagnosis (21.9%) with the first biopsy. This may lead to the need for repeat percutaneous or open biopsies, or a non-oncologic initial surgery with implications for disease-free and overall survival. Neurologic complications including exacerbation of pain or a deficit were rare and transient. It remains important that clinicians balance the potential risks and benefits based on individual patient characteristics when determining the necessity of an image-guided percutaneous biopsy.
BACKGROUND: The decision to biopsy a peripheral nerve tumor is largely based on its presumed behavior and prognosis, determined by patient history, clinical exam, and radiologic characteristics. Percutaneous image-guided biopsy is not without risk in patients with malignant peripheral nerve sheath tumors (MPNSTs); in particular, there may be concern regarding worsening neurologic function, increasing neuropathic pain, and incorrect or absent diagnosis. METHODS: Following approval by our institutional review board, we reviewed records from 1990 to 2019 at our institution's three main sites ("our institution"). Patients with pathology-proven MPNST were selected. Further inclusion criteria included image-guided percutaneous biopsy performed at our institution, pathology report available for review, and follow-up documentation to determine post-biopsy complications. RESULTS: Three hundred thirty-one patients with MPNST were reviewed. In total, 73 patients undergoing image-guided percutaneous biopsies were included. Twenty-two (30.1%) had biopsy-related complications. This included ten patients with misdiagnosis (13.7%) and six patients with non-diagnostic biopsies (8.2%). Six patients had new or worsened pain that resolved with time and neuropathic pain medication (8.2%), and one patient had subjectively worsened proximal weakness (1.3%) which resolved. CONCLUSION: We found nearly a third of patients undergoing biopsy had a biopsy-related complication. The single largest complication was the inability to obtain an accurate diagnosis (21.9%) with the first biopsy. This may lead to the need for repeat percutaneous or open biopsies, or a non-oncologic initial surgery with implications for disease-free and overall survival. Neurologic complications including exacerbation of pain or a deficit were rare and transient. It remains important that clinicians balance the potential risks and benefits based on individual patient characteristics when determining the necessity of an image-guided percutaneous biopsy.
Authors: Mikkel Tøttrup; Jacob D Eriksen; Michel B Hellfritzsch; Flemming B Sørensen; Thomas Baad-Hansen Journal: J Clin Ultrasound Date: 2019-08-22 Impact factor: 0.910
Authors: Danielle S Graham; Tara A Russell; Mark A Eckardt; Kambiz Motamedi; Leanne L Seeger; Arun S Singh; Nicholas M Bernthal; Anusha Kalbasi; Sarah M Dry; Scott D Nelson; David Elashoff; Benjamin D Levine; Fritz C Eilber Journal: Am J Clin Oncol Date: 2019-10 Impact factor: 2.339
Authors: David E Reuss; Antje Habel; Christian Hagenlocher; Jana Mucha; Ulrike Ackermann; Claudia Tessmer; Jochen Meyer; David Capper; Gerhard Moldenhauer; Victor Mautner; Pierre-Olivier Frappart; Jens Schittenhelm; Christian Hartmann; Christian Hagel; Kathrin Katenkamp; Iver Petersen; Gunhild Mechtersheimer; Andreas von Deimling Journal: Acta Neuropathol Date: 2014-01-25 Impact factor: 17.088