title: Percutaneous guided biopsy for diagnosing suspected primary malignant bone tumors in pediatric patients: a safe, accurate, and cost-saving procedure.
abstract: BACKGROUND
  Percutaneous biopsy is the reference diagnostic procedure for adult musculoskeletal tumors. Its place in pediatrics is controversial and open biopsy remains recommended.
  
  
  OBJECTIVE
  To assess diagnostic performance and feasibility of percutaneous biopsy performed on children and young adults for suspected malignant bone tumors.
  
  
  METHODS
  We conducted a 5-year retrospective study including patients ≤21 years who underwent a bone biopsy for a suspected malignant bone tumor. We assessed diagnostic yield (percentage of analyzable biopsies), accuracy (percentage of accurate diagnoses among all analyzable biopsies) and efficacy (percentage of accurate diagnoses among all biopsies), costs, anesthetic requirements and sample availability for biomedical research. Patients diagnosed with an open biopsy were used to compare diagnostic performances, anesthetic requirements and costs.
  
  
  RESULTS
  We included 90 percutaneous and 27 open biopsies in 117 patients. For percutaneous biopsy, diagnostic yield was 95.5% (95% confidence interval [CI] 88.8-98.7%), accuracy was 96.2% (95% CI 86.8-99.5%) and efficacy was 89.3% (95% CI 78.1-96.0%). There was no statistical difference with open biopsy (Fisher exact test, P > 0.05). Mean costs were reduced with percutaneous biopsy: €1,937 (standard deviation [SD] €2,408) versus €6,362 (SD €5,033; Mann-Whitney, P < 0.0001). Thirty-two of the 48 (67%) patients included in clinical trials and diagnosed with percutaneous biopsy had suitable samples for ancillary analyses.
  
  
  CONCLUSIONS
  Percutaneous biopsy is a valid alternative to open biopsy for diagnosing pediatric and young adult primary malignant bone tumors.
authors.affiliation: Institut d'Hématologie et d'Oncologie Pédiatriques (IHOPe), 1, place du Pr. Joseph Renault, 69008, Lyon, France. antony.ceraulo@chu-lyon.fr.
authors.forename: Antony
authors.identifier: http://orcid.org/0000-0002-4995-1494
authors.initials: A
authors.lastname: Ceraulo
authors.affiliation: Institut d'Hématologie et d'Oncologie Pédiatriques (IHOPe), 1, place du Pr. Joseph Renault, 69008, Lyon, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Ouziel
authors.affiliation: Clinical Research and Innovation Direction (DRCI), Cancer Center Léon Bérard, Lyon, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Lavergne
authors.affiliation: Clinical Research and Innovation Direction (DRCI), Cancer Center Léon Bérard, Lyon, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Perrier
authors.affiliation: Department of Pathology, Cancer Center Léon Bérard, Lyon, France.
authors.forename: Anne-Valérie
authors.initials: AV
authors.lastname: Decouvelaere
authors.affiliation: Department of Pediatric Orthopedic Surgery, Hospices Civils de Lyon - Hôpital Femme-Mère Enfant, Bron, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Chotel
authors.affiliation: Department of Radiology, Cancer Center Léon Bérard, Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Thiesse
authors.affiliation: Institut d'Hématologie et d'Oncologie Pédiatriques (IHOPe), 1, place du Pr. Joseph Renault, 69008, Lyon, France.
authors.forename: Perrine
authors.initials: P
authors.lastname: Marec-Berard
mesh_terms: D000293:Adolescent; D001707:Biopsy, Needle; D001859:Bone Neoplasms / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D007223:Infant; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D015641:Radiography, Interventional; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Accuracy; Bone neoplasm; Children; Cost analysis; Fine-needle aspiration; Percutaneous core-needle biopsy