title: Initial diagnostic management of pediatric bone tumors.
abstract: BACKGROUND
  Osteosarcoma (OS) and the Ewing sarcoma family of tumors (ESFT) are the most common primary pediatric bone malignancies. We sought to assess the diagnostic accuracy of initial tumor biopsies in patients with OS or ESFT at a pediatric cancer center.
  
  
  METHODS
  All biopsies performed at initial presentation of patients with OS or ESFT at our institution from 2003 to 2012 were retrospectively reviewed. Diagnostic accuracy and incidence of complications were correlated with study variables using logistic regression analysis.
  
  
  RESULTS
  One hundred forty-two biopsies were performed in 105 patients (median age 13.4years, range: 1.8-23.0), 104 (73.2%) OS and 38 (27.8%) ESFT. Thirty-one (21.8%) were performed on metastatic sites. Eighty-five (76.6%) of 111 primary site biopsies were open procedures, and 26 were percutaneous (23.4%). Primary site biopsies were successful in 94.1% of open and 73.1% of percutaneous procedures. Odds of obtaining a successful diagnostic specimen were 7.8 times higher with open approach (CI: 1.6-36.8). Metastatic site biopsies were successful in 66.7% of percutaneous and 100% of open and thoracoscopic procedures.
  
  
  CONCLUSIONS
  Biopsy of metastatic sites was equal to primary site in obtaining diagnostic material with the added benefit of accurate staging, with few adverse events and high diagnostic yield.
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Rodrigo B
authors.initials: RB
authors.lastname: Interiano
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Alpin D
authors.initials: AD
authors.lastname: Malkan
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore.
authors.forename: Amos H P
authors.initials: AH
authors.lastname: Loh
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Hinkle
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Fazal N
authors.initials: FN
authors.lastname: Wahid
authors.affiliation: Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Armita
authors.initials: A
authors.lastname: Bahrami
authors.affiliation: Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Shenghua
authors.initials: S
authors.lastname: Mao
authors.affiliation: Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Jianrong
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Bishop
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Neel
authors.affiliation: Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Gold
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Bhaskar N
authors.initials: BN
authors.lastname: Rao
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Davidoff
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA. Electronic address: israel.fernandez-pineda@stjude.org.
authors.forename: Israel
authors.initials: I
authors.lastname: Fernandez-Pineda
mesh_terms: D000293:Adolescent; D001706:Biopsy; D001859:Bone Neoplasms / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012516:Osteosarcoma / Q000473:pathology*; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000473:pathology*; D055815:Young Adult
keywords: Biopsy; Diagnosis; Ewing sarcoma; Osteosarcoma; Pediatrics; Tumor