Evaluation of the diagnostic accuracy of percutaneous core needle biopsy in bone and soft tissue tumours

Aim: Open (incisional) biopsies have long been accepted as the gold standard in the diagnosis of bone and soft tissue tumours. However, the main disadvantage of this method is that it can lead to increased contamination, hematoma, infection and pathological fracture. Other disadvantages include the need for hospitalisation, application under operating room conditions, a possible need for blood transfusion, high costs, and if radiotherapy is planned after the biopsy the need to wait for the wound site to heal. Compared to open biopsies, percutaneous core needle biopsies are less invasive, do not require hospitalisation, have low costs and low complication rates, and in cases that require radiotherapy there is no need to wait for wound healing. The aim of this study was to evaluate the diagnostic accuracy and reliability of percutaneous core biopsy. Material and Method: The study included the results of 250 percutaneous core needle biopsies of 244 patients who presented at the Orthopaedics and Traumatology Department of Ondokuz Mayis University Medical Faculty in the 10-year period of September 2012 – September 2022, were diagnosed with a bone or soft tissue tumour using the percutaneous core needle biopsy method and then underwent surgical excision in the Orthopaedics and Traumatology Clinic. The lesions were examined in 2 groups as "bone" or "soft tissue" according to the tissue origin of the lesion. A retrospective comparison was made of the preoperative core needle biopsy results and the final diagnoses made after surgical excision. The percutaneous core needle biopsy results were examined in 4 groups of "compatible, incompatible, suspicious, and non- diagnostic material" according to agreement with the biopsy results obtained after surgical incision, guidance in diagnosis, and adequacy for diagnosis. The sensitivity, specificity, positive predictive value (PPV), negative predictve value (NPV), and diagnostic accuracy rates were calculated for the percutaneous core needle biopsy method according to the compatibility of the results. Results: The mean age of the patients was 49.93±22.18 years. The lesions were of bone origin in 102 (41.8%) cases and of soft tissue origin in 142 (58.2%) cases. Of the 250 percutaneous core needle biopsies applied to 244 patients, 163 (65.2%) were performed by an orthopedist, and 87 (34.8%) by a radiologist under imaging guidance. The percutaneous core needle biopsy results of the lesions were compared with the results of surgical (excisional) biopsies taken as reference in the diagnosis. As a result of the comparisons, 219 (89.8%) patients were evaluated in the "compatible" group, 4 (1.6%) in the "incompatible" group, 5 (2%) in the "suspicious" group, and 16 (6.6%) in the "non-diagnostic material" group. The need for a second biopsy for diagnosis was determined in 10 (4.1%) cases, of which 6 (2.5%) were diagnosed with percutaneous core needle biopsy under imaging guidance performed by a radiologist, and 4 (1.6%) were diagnosed with an incisional biopsy performed by an orthopedist. According to the final diagnoses, osteosarcoma was the most frequently encountered lesion of bone tissue origin (25 cases, 24.5%), and benign lipomatous tumours were the most common of the soft tissue lesions (18 cases, 12.7%). According to the statistical analyses of the data, the percutaneous Jamshidi needle biopsies applied to lesions of bone origin had 94.5% sensitivity, 93.1% specificity, 97.2% PPV, 87.1% NPV, and diagnostic accuracy of 94.1%. The Tru-cut needle biopsies applied to lesions of soft tissue origin were determined to have 92.2% sensitivity, 95.8% specificity, 95.9% PPV, 91.9% NPV, and diagnostic accuracy of 93.9%. Conclusion: Percutaneous core needle biopsy is an extremely effective and relaible method in the diagnosis of bone and soft tissue tumours. The management of patients by a team using a multidisciplinary approach will increase diagnostic success. Key words: core needle biopsy, percutaneous, diagnostic accuracy, radiology guided biopsy, bone and soft tissue tumors, pathology