title: The value of preoperative biopsy in the management of solid presacral tumors.
abstract: BACKGROUND
  Surgical decision making and the use of neoadjuvant therapy in the management of solid presacral tumors rely greatly on an accurate preoperative diagnosis. The utility of preoperative biopsy has been questioned because of potential complications and the increasing accuracy of modern imaging.
  
  
  OBJECTIVE
  The aim of this study was to analyze biopsy-related morbidity and to compare the accuracy of imaging versus biopsy in making a preoperative diagnosis.
  
  
  METHODS
  This study is a retrospective review of all patients who underwent biopsy of presacral tumors at Mayo Clinic Rochester between 1990 and 2010. The demographics, pathology, complications of biopsy, and imaging were reviewed. Biopsy results and radiologic findings were matched with the final pathology and analyzed.
  
  
  METHODS
  This study was conducted at a tertiary care center.
  
  
  METHODS
  Adult patients with solid presacral tumors who underwent preoperative biopsy were evaluated.
  
  
  METHODS
  The primary outcomes measured were the biopsy-related complications and the accuracy of preoperative imaging and biopsy in comparison with final pathology.
  
  
  RESULTS
  Seventy-six biopsies were performed in 73 patients. Fifty-six patients underwent percutaneous biopsies, 14 underwent open biopsies, and 3 underwent both. Biopsy-specific complications included 2 hematomas (1 open, 1 percutaneous). Preoperative biopsy correlated with the postoperative pathologic diagnosis in 63 patients (91%). Of the 6 solid presacral tumors diagnosed incorrectly on biopsy, 1 was falsely reported as benign. Sensitivity, specificity, and positive and negative predictive values of biopsy to detect malignant disease was 96%, 100%, 100%, and 98%. Ten of 35 patients (29%) with a definitive imaging diagnosis were given incorrect diagnoses. Sensitivity, specificity, and positive and negative predictive values of imaging to diagnose malignant disease was 83%, 81%, 83%, and 81%.
  
  
  CONCLUSIONS
  This investigation was designed as a retrospective study.
  
  
  CONCLUSIONS
  Preoperative biopsy of presacral tumors is safe and highly concordant with postoperative pathology in comparison with imaging. Given the significant differences in therapeutic approach for benign versus malignant solid presacral tumors, as well as the current limitations of imaging, a percutaneous preoperative biopsy should be obtained to guide management decisions.
authors: Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors: Amit
authors: A
authors: Merchea
authors: David W
authors: DW
authors: Larson
authors: Martin
authors: M
authors: Hubner
authors: Doris E
authors: DE
authors: Wenger
authors: Peter S
authors: PS
authors: Rose
authors: Eric J
authors: EJ
authors: Dozois
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009369:Neoplasms / Q000473:pathology*; D011300:Preoperative Care / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012445:Sacrococcygeal Region / Q000473:pathology*; D055815:Young Adult