title: Optimal Diagnostic Yield Achieved With On-site Pathology Evaluation of Fine-Needle Aspiration-Assisted Core Biopsies for Pediatric Osseous Lesions: A Single-Center Experience.
abstract: BACKGROUND
  - Image-guided, fine-needle aspiration-assisted core needle biopsy with an on-site evaluation by a pathologist (FNACBP) of osseous lesions is not a common practice in pediatric institutions.
  
  
  OBJECTIVE
  - To evaluate the diagnostic adequacy and accuracy of FNACBP for pediatric osseous lesions and to compare the adequacy with procedures that do not use fine-needle aspiration.
  
  
  METHODS
  - Six-year, retrospective review of 144 consecutive children biopsied for osseous lesions with and without fine-needle aspiration assistance.
  
  
  RESULTS
  - Pathologic diagnosis was achieved in 79% (57 of 72) of the core biopsies without an on-site evaluation, 78% (32 of 41) of the open biopsies (9 with intraoperative consultation), and 97% (30 of 31) of the FNACBPs as the initial diagnostic procedure. Three FNACBP cases were preceded by nondiagnostic open biopsies. Among 34 lesions sampled by FNACBP, 33 (97%) succeeded with diagnostic tissue, with most (30 of 33; 91%) being neoplasms, including 16 malignant (48%), 13 benign (39%), and 1 indeterminate (3%) lesions. The most-common diagnoses were osteosarcoma (9 of 33; 27%) and Langerhans cell histiocytosis (7 of 33; 21%). In cases with follow-up information available, 93% (28 of 30) of the FNACBP-rendered diagnoses were clinically useful, allowing initiation of appropriate therapy. The FNACBP procedure had 100% specificity, sensitivity, and positive predictive value for all 14 malignant lesions, with the sensitivity being 88% in benign lesions. Most FNACBP procedures (32 of 34; 94%) yielded adequate material for ancillary testing. A gradual upward trend was observed for the choice of FNACBP as an initial diagnostic procedure for osseous lesions.
  
  
  CONCLUSIONS
  - The FNACBP procedure yields sufficient material for diagnosis and ancillary studies in pediatric, osseous lesions and may be considered an initial-diagnostic procedure of choice.
authors.forename: Kalyani
authors.initials: K
authors.lastname: Patel
authors.forename: Darryl
authors.initials: D
authors.lastname: Kinnear
authors.forename: Norma M
authors.initials: NM
authors.lastname: Quintanilla
authors.forename: John
authors.initials: J
authors.lastname: Hicks
authors.forename: Eumenia
authors.initials: E
authors.lastname: Castro
authors.forename: Choladda
authors.initials: C
authors.lastname: Curry
authors.forename: John
authors.initials: J
authors.lastname: Dormans
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ashton
authors.forename: J Alberto
authors.initials: JA
authors.lastname: Hernandez
authors.affiliation: From the Departments of Pathology (Drs Patel, Quintanilla, Hicks, Castro, Curry, and Wu and Mr Kinnear), Surgery (Dr Dormans); and Radiology (Drs Ashton and Hernandez), Texas Children's Hospital and Baylor College of Medicine, Houston.
authors.forename: Hao
authors.initials: H
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D044963:Biopsy, Fine-Needle / Q000379:methods*; D062005:Biopsy, Large-Core Needle / Q000379:methods*; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D002813:Chondrosarcoma; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D012516:Osteosarcoma / Q000000981:diagnostic imaging / Q000473:pathology; D010372:Pediatrics; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018335:Rhabdoid Tumor; D012512:Sarcoma, Ewing; D055815:Young Adult