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Updated: May 5, 2026
A Mouse Model of Incompletely Resected Soft Tissue Sarcoma for Testing Neoadjuvant Therapies
Published on: July 28, 2020
Sampling modality influences the predictive value of grading in adult soft tissue extremity sarcomas
Hatim Khoja1, Anthony Griffin, Brendan Dickson
1From the Departments of Pathology and Laboratory Medicine (Drs Khoja, Dickson, Howarth, and Kandel) and Orthopaedic Surgery (Mr Griffin and Drs Wunder and Ferguson), Mount Sinai Hospital, Toronto, Ontario, Canada; and the Departments of Laboratory Medicine and Pathobiology (Drs Dickson, Howarth, and Kandel) and Surgery (Drs Wunder and Ferguson), University of Toronto, Toronto, Ontario, Canada.
Context:
Histologic grade is one of the best predictors of outcome in adult soft tissue sarcomas. Current grading systems were validated on resection specimens; however, there has been a trend toward the use of biopsies to diagnosis these tumors.
Objectives:
To determine whether the grade of an extremity soft tissue sarcoma determined on tissue obtained by either core needle biopsy or incisional biopsy is predictive of metastasis- or disease-free survival, and whether either sampling modality is superior.
Design:
One hundred three core needle biopsies and 107 incisional biopsies of nonmetastatic spindle cell sarcomas of the extremities were retrieved from the archives. All cases had a minimum 2-year follow-up. Patient data and outcome and tumor characteristics were recorded. Tumors were reviewed and evaluated using the French Federation of Cancer Centers Sarcoma Group grading system. Kaplan-Meier survival curves were generated to correlate tumor grade with metastasis- and disease-free survival for both groups.
Results:
Patient and tumor characteristics were similar between groups except that more tumors were grade 3 and superficial in the incisional biopsy group. Grade determined on core needle biopsy was not predictive of either metastasis-free survival (P = .59) or disease-free survival (P = .50). In contrast, grade determined on incisional biopsy was predictive of both metastasis-free survival (P < .001) and disease-free survival (P = .001).
Conclusions:
Biopsy, particularly core needle biopsy, represents a convenient diagnostic tool, particularly in the context of neoadjuvant therapy. However, based on these results incisional biopsy is recommended if grading is to be used to predict prognosis in spindle cell soft tissue sarcomas of the extremities.
