[Open Incisional Biopsy and Ultrasound-Guided Core Needle Biopsy of Extremity-Localized Musculoskeletal Tumors]

PURPOSE OF THE STUDY To evaluate the results of incisional open biopsies and ultrasound-guided core needle biopsies for musculoskeletal lesions in extremity and limb girdle locations. MATERIAL AND METHODS In 2019, 176 open incisional biopsies were performed at our department, 113 from bone lesions and 63 from soft tissue lesions. In the period of September 2019 to February 2020, we started performing also ultrasound-guided core needle biopsies from soft tissue lesions in limited indications, namely in 23 cases. The diagnostic accuracy, complications and pain associated with the procedure were evaluated. RESULTS Of 113 open incisional biopsies of bone, 91.1% was fully representative and 6.2% non-representative with an indication for re-biopsy. In 53 cases another surgical procedure followed, which fully confirmed the diagnosis made based on the biopsy in 79.2%. In 7.5% the diagnosis slightly changed, with no therapeutic impact, in 5.7% the histological grade was changed, and in 7.5% the diagnosis was substantially modified. Complications appeared in 9.8% of cases. The procedure was associated with pain expressed by an increase in VAS score by 2.7 points. Of 63 soft tissue open incisional biopsies, 100% was fully representative. In 30 cases another surgical procedure followed, which fully confirmed the diagnosis made based on the biopsy in 96.7%, in one case the diagnosis was changed from aggressive benign lesion to a low-grade sarcoma. Complications appeared in 6.4% of cases. The procedure was associated with pain expressed by an increase in VAS score by 1.4 points. Of 23 ultrasound-guided core needle biopsies from soft tissues in limited indications, 100% was representative. In 11 cases another surgical procedure followed, which fully confirmed the diagnosis made based on the biopsy in 81.8%, in 2 cases the diagnosis was slightly changed, with no therapeutic impact or a change of histological grade. No complications were reported. The procedure was associated with minimal pain expressed by an increase in VAS score by 0.1 points. When comparing the group of soft tissue open incisional biopsies and ultrasound-guided core needle biopsies, a statistically significant less pain associated with the procedure was found in the group of core needle biopsies. CONCLUSIONS The biopsy of musculoskeletal tumors should be performed at specialty centers for treatment of these rare conditions. In that case it produces good results and is associated with a low rate of complications. Indications for open biopsy or core needle biopsy must be assessed individually. Key words: musculoskeletal tumors, bone and soft tissue sarcomas, open incisional biopsy, core needle biopsy, fine needle aspiration biopsy, ultrasound-guided core needle biopsy.