Open incisional biopsy is a safe and accurate technique for soft tissue tumours

Abstract

Background: Accurate diagnosis of musculoskeletal tumours is important for successful treatment. Studies have reported a high risk of complications following open biopsy and have advocated core biopsy as a safer alternative; however, accuracy may be reduced with the smaller sample. The aims of this study were to determine the accuracy of open incisional biopsy, the complications (overall and those that affected subsequent management) including local recurrence and the need for further surgery.

Methods: This study was a retrospective audit of 135 consecutive open incisional biopsies of soft tissue tumours. The complications, including changes to surgical management as a direct result of complications of the biopsy, were recorded for all 135 cases. The accuracy of the open biopsy was determined by comparing the histology of the biopsy with the final histology of the 88 cases that proceeded to definitive surgical resection.

Results: There were two complications attributable to the biopsy (complication rate 1.5%). No complication affected the definitive management. There were three cases where the biopsy incorrectly reported a benign condition when it was malignant (benign versus malignant accuracy 96%). There were no cases of benign initially being reported as malignant. The tissue diagnosis was correct in 72 of the excised specimens (accuracy 82%). The false positive rate for malignant versus benign was 0%, sensitivity 93%, specificity 100% and positive predictor value 100%.

Discussion: Open incisional biopsy remains a safe and accurate method of obtaining a tissue diagnosis when the principles of biopsy are adhered to.