ASO Author Reflections: Advances in Retroperitoneal Liposarcoma Management May Benefit from Improved Biopsy Accuracy
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Advances in Retroperitoneal Liposarcoma Management May Benefit from Improved Biopsy Accuracy Fabio Tirotta, MD1
, and Marco Fiore, MD2
1
Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK; 2Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
PAST
PRESENT
Preoperative diagnosis is a cornerstone of surgical oncology. Nonetheless, in the past, fine-needle aspiration and core needle biopsy in retroperitoneal sarcoma (RPS) were considered to rarely yield a correct diagnosis. In addition, they were considered at risk of complications, such as bleeding and tumor seeding.1 As a result, most RPS series before 2015 still reported preoperative biopsy in only 40–50% of patients. In recent years, improved diagnostics, molecular testing, and protected coaxial needle have become available, and percutaneous biopsy in RPS has been proven safe in terms of potential complications and seeding.2 Indication for percutaneous biopsy has therefore been strongly advocated by expert consensus as a standard approach in all suspected RPS.3 Moreover, robust data about different risk patterns in single histological subtypes have become available. Retroperitoneal liposarcoma (LPS) represents the main histology, and within this well-differentiated LPS (WDLPS), grade 2 and grade 3 dedifferentiated LPS (DDLPS) have different prognoses.
Diagnostic accuracy of percutaneous biopsy for RPS demonstrated an overall concordance with final pathology in 67.2% of biopsies in a series at two referral centers (2005–2016).4 The majority of misdiagnoses involved DDLPS being inaccurately characterized as WDLPS. In light of this, the same centers repeated the analysis in a more recent series of 121 patients (2016–2019),5 after guidelines for targeting the solid component in suspected retroperitoneal LPS had been issued.3 Diagnostic accuracy for DDLPS improved from 40 to 74% (p \ 0.001), and targeted biopsies on solid nodules yielded a diagnostic sensitivity for DDLPS of 100% compared with 10% in nontargeted biopsies (p \ 0.001). Results from this study suggest that increased diagnostic accuracy for retroperitoneal LPS is achievable, with the targeting of solid nodules confirmed as a key component. The importance of multidisciplinary management of these patients from the early phase of the diagnostic pathway is intrinsic to this approach. FUTURE
Ó Society of Surgical Oncology 2020 First Received: 20 April 2020 M. Fiore, MD e-mail: [email protected]
An immediate advantage of improved biopsy accuracy is expected within the upcoming European Organisation for Research and Treatment of Cancer (EORTC) randomized trial STRASS2, specifically designed to investigate neoadjuvant chemotherapy in high-risk retroperitoneal DDLPS and leiomyosarcoma. In this context, the potential risk of undertreating retroperitoneal LPS by omitting neoadjuvant therapies could be mar
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