Is it necessary to biopsy the obvious?

Area of Science:

• Oncology
• Radiology
• Diagnostic Imaging

Background:

• Histologic confirmation via biopsy is standard before altering cancer therapy.
• Radiologists and oncologists frequently suspect recurrent disease based on imaging.

Purpose of the Study:

• To evaluate the accuracy of imaging in distinguishing recurrent cancer from new primary tumors or benign conditions.
• To determine if biopsy is always necessary when imaging suggests recurrence.

Main Methods:

• Retrospective review of medical and imaging records for 253 patients undergoing CT-guided biopsy.
• Analysis of imaging patterns in 69 patients with a history of primary tumors to assess for recurrence or metastasis.

Main Results:

• In 55 of 69 patients, imaging suggested recurrence, which was confirmed by biopsy.
• In 14 patients, imaging was atypical for recurrence; biopsy revealed new primary tumors (n=4), benign processes (n=2), or recurrence (n=8).
• No new primary tumors were missed in patients whose imaging suggested recurrence.

Conclusions:

• Imaging findings suggestive of recurrence did not lead to missed diagnoses of new primary tumors in this cohort.
• Prospective data are needed to assess the feasibility of treatment decisions based solely on imaging findings without biopsy.