Percutaneous image-guided biopsy in malignant peripheral nerve sheath tumors
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ORIGINAL ARTICLE - PERIPHERAL NERVES
Percutaneous image-guided biopsy in malignant peripheral nerve sheath tumors Courtney Pendleton 1 & B. Matthew Howe 1 & Robert J. Spinner 1 Received: 19 June 2020 / Accepted: 26 August 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background The decision to biopsy a peripheral nerve tumor is largely based on its presumed behavior and prognosis, determined by patient history, clinical exam, and radiologic characteristics. Percutaneous image-guided biopsy is not without risk in patients with malignant peripheral nerve sheath tumors (MPNSTs); in particular, there may be concern regarding worsening neurologic function, increasing neuropathic pain, and incorrect or absent diagnosis. Methods Following approval by our institutional review board, we reviewed records from 1990 to 2019 at our institution’s three main sites (“our institution”). Patients with pathology-proven MPNST were selected. Further inclusion criteria included imageguided percutaneous biopsy performed at our institution, pathology report available for review, and follow-up documentation to determine post-biopsy complications. Results Three hundred thirty-one patients with MPNST were reviewed. In total, 73 patients undergoing image-guided percutaneous biopsies were included. Twenty-two (30.1%) had biopsy-related complications. This included ten patients with misdiagnosis (13.7%) and six patients with non-diagnostic biopsies (8.2%). Six patients had new or worsened pain that resolved with time and neuropathic pain medication (8.2%), and one patient had subjectively worsened proximal weakness (1.3%) which resolved. Conclusion We found nearly a third of patients undergoing biopsy had a biopsy-related complication. The single largest complication was the inability to obtain an accurate diagnosis (21.9%) with the first biopsy. This may lead to the need for repeat percutaneous or open biopsies, or a non-oncologic initial surgery with implications for disease-free and overall survival. Neurologic complications including exacerbation of pain or a deficit were rare and transient. It remains important that clinicians balance the potential risks and benefits based on individual patient characteristics when determining the necessity of an imageguided percutaneous biopsy. Keywords Malignant peripheral nerve sheath tumor . Percutaneous image-guided biopsy . Tissue diagnosis . Neurologic deficit
Introduction The decision to biopsy a peripheral nerve tumor is largely based on its presumed behavior and prognosis, determined by patient history, clinical exam, and radiologic characteristics. Standard practice is to avoid biopsy in tumors that are likely benign (i.e., the risk of the biopsy outweighs the benefit of tissue diagnosis) and routinely biopsy tumors that are likely This article is part of the Topical Collection on Peripheral Nerves * Robert J. Spinner [email protected] 1
Departments of Neurosurgery and Radiology, Mayo Clinic, 200 First Street SW, Gonda 8-214, Rochester, MN 55905, USA
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