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(P 138) ACCURACY AND COMPLICATIONS OF CORE NEEDLE BIOPSY OF PERIPHERAL NERVE TUMORS

    Author(s)

  • Toshihiko Nishisho, MD PhD

    Designated Associate Professor
    Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School
    Tokushima, Tokushima, Japan

    • Co-Author(s)

  • ST

    Shunichi Toki, MD.PhD

    Department of Orthopedics Institute of Biomedical Sciences
    Tokushima, Tokushima, Japan

  • RM

    Ryo Miyagi, MD

    Department of Orthopaedic Surgery, Tokushima Prefectural Central Hospital
    Tokushima, Tokushima, Japan

  • KS

    Koichi Sairyo, MD.PhD

    Tokushima University
    Tokushima, Tokushima, Japan

Objective: Peripheral nerve tumors (PNTs) have unique clinical and image finishings and are often diagnosed without histological confirmation, while some PNTs lacks typical findings. These lesions need biopsy, which may cause neurological deficit. The aim of this study was to evaluate accuracy and complications of biopsies in patients with PNTs.

Methods: A retrospective study was conducted on 77 patients with 80 lesions histologically diagnosed as PNTs. Accuracy of the biopsy was determined through comparison to the results of pathological diagnosis of the surgical excised specimen. Neurological complications after biopsy were analyzed. Statistical analysis was performed by R3.6.3.

Results: Among the patients, 38 were men and 39 were women, with a median age of 53.2 years. Average follow-up time was 16.1 months. There were 67 benign tumors (63 schwannomas, 3 neurofibromas, 1 undiagnosed benign lesion) and 13 malignant tumors (11 malignant peripheral nerve sheath tumor, 1 malignant lymphoma and 1 malignant perinurioma). Forty lesions were surgically excised without preoperative biopsy. Other Forty lesions underwent biopsy, including 33 core needle biopsies (CNB), and 7 open biopsies (OB). Of them, 21 lesions underwent surgical definitive excision after biopsy. The correct histopathological diagnosis compared to the subsequent resection specimen was obtained in 100% (6/6) after OB and in 87.5% (13/15) after CNB. Two cases presented neurofibroma in CNB turned out low grade malignant peripheral nerve sheath tumor in resection specimen. Following the biopsy, 24.2% of CNB and 42.9% of OB experienced new or worsening neurological symptom which resolved in all cases within 17 days. Preoperative neurological symptom was a risk factor for postoperative complications in CNB (p=0.047).

Conclusion: Biopsy of PNTs is associated with neurological deterioration, which immediately resolved. It could be an accurate and safe method although careful selection is mandatory.