OPEN VS PERCUTANEOUS CORE NEEDLE BIOPSY (CNB) FOR MUSCULOSKELETAL MALIGNANCIES

Main Article Content

Qaisar Alam
Naeem Ullah
Muhammad Salman
Zulfiqar Ullah
Sajjad Haider

Keywords

musculoskeletal lesions, open biopsy, percutaneous core needle biopsy (CNB), diagnostic accuracy, healthcare costs, comparative analysis, musculoskeletal malignancies

Abstract

Background: Musculoskeletal lesions pose diagnostic challenges, requiring histopathologic verification for precise characterization. This study compares open biopsy and percutaneous core needle biopsy (CNB) for musculoskeletal malignancies.


Methods: The study was conducted at National Institute of Rehabilitation Medicine Islamabad during the period from January 2021 to July 2023. A retrospective analysis of medical records and diagnostic reports included patients undergoing either open biopsy or percutaneous CNB. Diagnostic accuracy, complication rates, hospitalization duration, and healthcare costs were assessed.


Results: Percutaneous CNB demonstrated superior diagnostic accuracy (46%) compared to open biopsy (42%), aligning with existing literature. Complication rates favored CNB (16%) over open biopsy (24%). CNB led to a significantly shorter hospitalization duration (1.5 days) compared to open biopsy (4 days). Cost analysis revealed a compelling advantage for CNB, with an average cost per case of PKR 825,000, contrasting with PKR 1,200,000 for open biopsy.


Conclusion: Percutaneous CNB emerges as a preferred option for musculoskeletal malignancy diagnosis, offering enhanced diagnostic accuracy, lower complication rates, shorter hospitalization, and cost-effectiveness. Economic considerations play a pivotal role in healthcare decision-making, emphasizing the need for a balanced approach considering both clinical and financial dimensions.

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References

1. Veltri A, Bargellini I, Giorgi L, Almeida PAMS, Akhan O. CIRSE Guidelines on Percutaneous Needle Biopsy (PNB). Cardiovasc Intervent Radiol 2017;40:1501–13.
https://doi.org/10.1007/s00270-017-1658-5.
2. Gogna A, Peh WCG, Munk PL. Image-Guided Musculoskeletal Biopsy. Radiol Clin North Am 2008; 46:455–73. https://doi.org/10.1016/j.rcl.2008.04.014.
3. Liu B, Limback J, Kendall M, Valente M, Armaly J, Grekoski V, et al. Safety of CT-Guided Bone Marrow Biopsy in Thrombocytopenic Patients: A Retrospective Review. Journal of Vascular and Interventional Radiology 2017;28:1727–31. https://doi.org/10.1016/j.jvir.2017.08.009.
4. Holmes MG, Foss E, Joseph G, Foye A, Beckett B, Motamedi D, et al. CT–Guided Bone Biopsies in Metastatic Castration-Resistant Prostate Cancer: Factors Predictive of Maximum Tumor Yield. Journal of Vascular and Interventional Radiology 2017;28:1073-1081.e1.
https://doi.org/10.1016/j.jvir.2017.04.019.
5. Tam AL, Lim HJ, Wistuba II, Tamrazi A, Kuo MD, Ziv E, et al. Image-Guided Biopsy in the Era of Personalized Cancer Care: Proceedings from the Society of Interventional Radiology Research Consensus Panel. Journal of Vascular and Interventional Radiology 2016;27:8–19. https://doi.org/10.1016/j.jvir.2015.10.019.
6. Heare TC, Enneking WF, Heare MM. Staging techniques and biopsy of bone tumors. Orthop Clin North Am 1989;20:273–85.
7. Gerrand CH, Rankin K. The Hazards of Biopsy in Patients with Malignant Primary Bone and Soft-Tissue Tumors. Classic Papers in Orthopaedics, London: Springer London; 2014, p. 491–3. https://doi.org/10.1007/978-1-4471-5451-8_129.
8. Boriani S, Ruggieri P, Sudanese A. Biopsy: considerations on surgical technique derived from a study of 749 cases of bone tumour. Ital J Orthop Traumatol 1984;10:489–99.
9. SKRZYNSKI MC, BIERMANN JS, MONTAG A, SIMON MA. Diagnostic Accuracy and Charge-Savings of Outpatient Core Needle Biopsy Compared with Open Biopsy of Musculoskeletal Tumors*. J Bone Joint Surg 1996;78:644–9. https://doi.org/10.2106/00004623-199605000-00002.
10. Ball ABS, Fisher C, Pittam M, Watkins RM, Westbury G. Diagnosis of soft tissue tumours by Tru-Cut® biopsy. British Journal of Surgery 2005;77:756–8.
https://doi.org/10.1002/bjs.1800770713.
11. Ray-Coquard I, Ranchère-Vince D, Thiesse P, Ghesquières H, Biron P, Sunyach M-P, et al. Evaluation of core needle biopsy as a substitute to open biopsy in the diagnosis of soft-tissue masses. Eur J Cancer 2003;39:2021–5. https://doi.org/10.1016/S0959-8049(03)00430-1.
12. Welker JA, Henshaw RM, Jelinek J, Shmookler BM, Malawer MM. The percutaneous needle biopsy is safe and recommended in the diagnosis of musculoskeletal masses. Cancer 2000;89:2677–86.
https://doi.org/10.1002/1097-0142(20001215)89:12<2677::AID-CNCR22>3.0.CO;2-L.
13. Thomas JM. Surgical Biopsy Techniques and Differential Diagnosis of Soft Tissue Tumours, 1995, p. 25–9. https://doi.org/10.1007/978-3-642-78768-3_4.
14. Ayala AG, Ro JY, Fanning C V., Flores JP, Yasko AW. Core Needle Biopsy and Fine-Needle Aspiration in the Diagnosis of Bone and Soft-Tissue Lesions. Hematol Oncol Clin North Am 1995;9:633–52. https://doi.org/10.1016/S0889-8588(18)30088-1.
15. Carrino JA, Khurana B, Ready JE, Silverman SG, Winalski CS. Magnetic Resonance Imaging-Guided Percutaneous Biopsy of Musculoskeletal Lesions. J Bone Joint Surg 2007;89:2179–87. https://doi.org/10.2106/JBJS.F.01230.
16. Puri A, Shingade VU, Agarwal MG, Anchan C, Juvekar S, Desai S, et al. CT–guided percutaneous core needle biopsy in deep seated musculoskeletal lesions: a prospective study of 128 cases. Skeletal Radiol 2006;35:138–43. https://doi.org/10.1007/s00256-005-0038-4.
17. Shin H-J, Amaral JG, Armstrong D, Chait PG, Temple MJ, John P, et al. Image-guided percutaneous biopsy of musculoskeletal lesions in children. Pediatr Radiol 2007;37:362–9. https://doi.org/10.1007/s00247-007-0421-5.
18. van der Bijl AE, Taminiau AH, Hermans J, Beerman H, Hogendoorn PC. Accuracy of the Jamshidi trocar biopsy in the diagnosis of bone tumors. Clin Orthop Relat Res 1997:233–43.
19. Wu JS, Goldsmith JD, Horwich PJ, Shetty SK, Hochman MG. Bone and Soft-Tissue Lesions: What Factors Affect Diagnostic Yield of Image-guided Core-Needle Biopsy? Radiology 2008; 248:962–70. https://doi.org/10.1148/radiol.2483071742.
20. Zornoza J, Bernardino ME, Ordonez NG, Thomas JL, Cohen MA. Percutaneous needle biopsy of soft tissue tumors guided by ultrasound and computed tomography. Skeletal Radiol 1982;9:33–6. https://doi.org/10.1007/BF00367378.
21. Woon DTS, Serpell JW. PREOPERATIVE CORE BIOPSY OF SOFT TISSUE TUMOURS FACILITATES THEIR SURGICAL MANAGEMENT: A 10‐YEAR UPDATE. ANZ J Surg 2008;78:977–81. https://doi.org/10.1111/j.1445-2197.2008.04715.x.
22. Ward WG, Kilpatrick S. Fine Needle Aspiration Biopsy of Primary Bone Tumors. Clin Orthop Relat Res 2000;373:80–7. https://doi.org/10.1097/00003086-200004000-00011.
23. Serpell JW, Pitcher ME. PRE‐OPERATIVE CORE BIOPSY OF SOFT‐TISSUE TUMOURS FACILITATES THEIR SURGICAL MANAGEMENT. Australian and New Zealand Journal of Surgery 1998;68:345–9. https://doi.org/10.1111/j.1445-2197.1998.tb04769.x.
24. Stoker D, Cobb J, Pringle J. Needle biopsy of musculoskeletal lesions. A review of 208 procedures. J Bone Joint Surg Br 1991;73-B:498–500. https://doi.org/10.1302/0301-620X.73B3.1670457.
25. Heslin MJ, Lewis JJ, Woodruff JM, Brennan MF. Core needle biopsy for diagnosis of extremity soft tissue sarcoma. Ann Surg Oncol 1997;4:425–31. https://doi.org/10.1007/BF02305557.
26. Sung K-S, Seo S-W, Shon M-S. The diagnostic value of needle biopsy for musculoskeletal lesions. Int Orthop 2009;33:1701–6. https://doi.org/10.1007/s00264-009-0835-9.
27. Le H, Lee S, Munk P. Image-Guided Musculoskeletal Biopsies. Semin Intervent Radiol 2010;27:191–8. https://doi.org/10.1055/s-0030-1253517.
28. Filippiadis D, Charalampopoulos G, Mazioti A, Keramida K, Kelekis A. Bone and Soft-Tissue Biopsies: What You Need to Know. Semin Intervent Radiol 2018;35:215–20.
https://doi.org/10.1055/s-0038-1669467.
29. Ceraulo A, Ouziel A, Lavergne E, Perrier L, Decouvelaere A-V, Chotel F, et al. Percutaneous guided biopsy for diagnosing suspected primary malignant bone tumors in pediatric patients: a safe, accurate, and cost-saving procedure. Pediatr Radiol 2017;47:235–44.
https://doi.org/10.1007/s00247-016-3735-3.
30. Pouedras M, Briand S, Crenn V, Cassagnau E, Gouin F. Non image-guided core needle biopsies can be used safely to improve diagnostic efficiency for soft tissue tumors. Surg Oncol 2021;37:101518. https://doi.org/10.1016/j.suronc.2020.12.012.
31. Kasraeian S, Allison DC, Ahlmann ER, Fedenko AN, Menendez LR. A Comparison of Fine-needle Aspiration, Core Biopsy, and Surgical Biopsy in the Diagnosis of Extremity Soft Tissue Masses. Clin Orthop Relat Res 2010; 468:2992–3002. https://doi.org/10.1007/s11999-010-1401-x.
32. Seng C, Png W, Tan MH. Accuracy of Core Needle Biopsy for Musculoskeletal Tumours. Journal of Orthopaedic Surgery 2013; 21:92–5. https://doi.org/10.1177/230949901302100123.
33. Crenn V, Vezole L, Bouhamama A, Meurgey A, Karanian M, Marec-Bérard P, et al. Percutaneous Core Needle Biopsy Can Efficiently and Safely Diagnose Most Primary Bone Tumors. Diagnostics 2021; 11:1552. https://doi.org/10.3390/diagnostics11091552.
34. Adams SC, Potter BK, Pitcher DJ, Temple TH. Office-based Core Needle Biopsy of Bone and Soft Tissue Malignancies: An Accurate Alternative to Open Biopsy with Infrequent Complications. Clin Orthop Relat Res 2010; 468:2774–80. https://doi.org/10.1007/s11999-010-1422-5.

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