title: Evaluation of core needle biopsy as a substitute to open biopsy in the diagnosis of soft-tissue masses.
abstract: Open biopsy is recommended for a soft-tissue sarcoma (s-t-S) diagnosis. Core needle biopsy (CNB) was recently associated with minimal morbidity, cost and time-consumption, but also potential inaccuracy. Its diagnostic utility was investigated retrospectively in 110 patients with soft-tissue masses (s-t-M) undergoing CNB between September 1994 and September 2000. Sensitivity (Se), specificity (Sp), positive (PPV) and negative (NPV) predictive values were determined for malignancy (benign/malign), soft-tissue tumour (yes/no), and sarcoma diagnosis (yes/no), comparing CNB and the best standard test available; concordance was evaluated. 103/110 CNB were suitable for analysis. Final diagnosis was 23 benign tumours (19%), 65 s-t-S (59%), 9 lymphomas (8%), 6 fibromatoses (desmoid) (5%) and 7 carcinomas (6%). CNB Sp and PPV were 100%, Se was 95, 99 and 92%, and NPV 85, 95 and 88% for diagnosing malignancy, soft-tissue tumour and sarcoma. CNB Se and NPV were 100% for malignancy, connective tumour and sarcoma in lymphomas, high-grade sarcomas and desmoid tumours. In low grade sarcomas, Se was 94 and 85%, and NPV 84 and 77% for malignancy and sarcoma. Histological grade on CNB seems uneasy, except for grade-III tumours. CNB is accurate, not misleading for s-t-M diagnosis, avoids open biopsy complications, and allows one-surgery or neo-adjuvant chemotherapy planning when combined with appropriate imaging.
authors.affiliation: Centre Léon Bérard, 28 rue Laënnec, Lyon 69008, France. ray@lyon.fnclcc.fr
authors.forename: I
authors.initials: I
authors.lastname: Ray-Coquard
authors.forename: D
authors.initials: D
authors.lastname: Ranchère-Vince
authors.forename: P
authors.initials: P
authors.lastname: Thiesse
authors.forename: H
authors.initials: H
authors.lastname: Ghesquières
authors.forename: P
authors.initials: P
authors.lastname: Biron
authors.forename: M-P
authors.initials: MP
authors.lastname: Sunyach
authors.forename: M
authors.initials: M
authors.lastname: Rivoire
authors.forename: L
authors.initials: L
authors.lastname: Lancry
authors.forename: P
authors.initials: P
authors.lastname: Méeus
authors.forename: C
authors.initials: C
authors.lastname: Sebban
authors.forename: J-Y
authors.initials: JY
authors.lastname: Blay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D001707:Biopsy, Needle / Q000379:methods; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012983:Soft Tissue Neoplasms / Q000473:pathology*