Conclusiveness of biopsy techniques for diagnosis of bone and soft tissue tumours: a retrospective, single-centre observational study.

Abstract

Background: Given the differences between biopsy techniques, especially regarding the representativeness and amount of tissue obtained upon diagnostic workup of suspicious bone and soft tissue lesions, this study aimed at evaluating the diagnostic conclusiveness of different biopsy techniques at a tertiary sarcoma centre.

Materials and methods: Overall, 222 consecutive patients (50.9% males, median age 63.3 [IQR 47.4-71.8] years) undergoing biopsy for a suspected bone or soft tissue lesion at a single centre between December 2021 and December 2023 were included. Biopsy techniques included core needle biopsy in the outpatient setting (without image guidance), sonography-guided and CT-guided and open biopsy. The conclusiveness rate of the first biopsy was defined as a histologically plausible result that enabled subsequent treatment planning.

Results: Soft tissue and bone lesions were present in 114 (51.4%) and 108 (48.6%) patients, respectively. Core needle (n = 85; 38.3%) and CT-guided biopsies (n = 61; 27.5%) were most commonly employed. Median interval from first presentation to biopsy was 14 (IQR 3-29) days for bone and 0 (IQR 0-17) days for soft tissue lesions, attributable to the long delay of CT-guided biopsies (bone: median 28 [IQR 15-47] days; soft tissue: median 18 [14-45] days; p < 0.001). Complications were highest following CT-guided biopsies for soft tissue lesions (n = 2/18; 11.1% [95% CI 1.4%-34.7%]) and sonography-guided biopsies for bone lesions (n = 1/5; 20.0% [95% CI 5.1%-71.6%]). Overall, the first biopsy was conclusive in 88.0% (95% CI 80.3%-93.4%; n = 95/108) and 88.6% (95% CI 81.3%-93.8%; n = 101/114) of bone and soft tissue lesions, respectively, with no difference between biopsy types. A repeated biopsy became necessary in 9.5% of patients (n = 21/222). None of the parameters investigated (BMI, age, lesion size, biopsy type, location) were associated with the conclusiveness rate of bone or soft tissue biopsies.

Conclusions: The time delay from initial presentation to biopsy varies with the biopsy technique employed, as do complication rates. Yet, all biopsy techniques-when applied according to clinical indication-achieve high diagnostic conclusiveness rates.

Level of evidence: IV.