Surgery (St Vincent's) - Research Publications
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ItemDiagnostic accuracy of computed tomography-guided biopsy in pathological fractures(WILEY, 2017-07)BACKGROUND: Obtaining a histological diagnosis is essential for appropriate management of pathological fractures. Computed tomography (CT) is an accurate method of obtaining diagnosis for musculoskeletal tumours. We analysed whether diagnostic accuracy was maintained in the evaluation of pathological fractures. METHODS: A retrospective review of 101 consecutive patients presenting to our tertiary musculoskeletal tumour centre with pathological fracture was performed. Patients underwent core needle biopsy under CT guidance of pathological fractures diagnosed by plain radiography and either CT or magnetic resonance imaging. The histopathology of the CT-guided biopsy was compared with the sample obtained from open biopsy or definitive surgery to determine diagnostic accuracy. RESULTS: The mean age at diagnosis was 52 ± 20 years (range: 18-85) in a cohort of 46 men and 55 women. Diagnostic accuracy of CT-guided biopsy was 82.18%. There were 65 malignant and 36 benign tumours with diagnostic accuracy of 86.15% and 80.56%, respectively. The positive predictive value for a malignant tumour was 98.21% whilst it was 93.1% for benign tumours. The femur (53 cases) and humerus (25 cases) were the commonest bones fractured. The most frequent diagnoses were metastasis (20.79%), giant cell tumour (17.82%), osteosarcoma (9.90%) and myeloma (9.90%). There were no complications of CT-guided biopsy. CONCLUSION: Pathological fracture does not confound the diagnosis of musculoskeletal tumours. CT-guided biopsy is an accurate diagnostic tool in the evaluation of pathological fractures. Final diagnosis and management should be made in the context of appropriate anatomical and functional imaging using a multidisciplinary approach.
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ItemCorrelation between percutaneous biopsy and final histopathology for retroperitoneal sarcoma: a single-centre study(WILEY, 2020-04)BACKGROUND: Retroperitoneal sarcomas are rare soft tissue tumours accounting for 10-15% of soft tissue sarcomas. Patient prognosis and treatment recommendations (including extent of surgery and neoadjuvant strategies) are determined by the pre-operative histopathological subtype and grade obtained from biopsy and thus it is important to understand the accuracy of biopsy in retroperitoneal masses. METHODS: This study presents a case series of primary retroperitoneal sarcomas managed at Peter MacCallum Cancer Centre (PMCC) between 2008 and 2019. Statistical analyses were performed to determine correlation between histopathology from percutaneous biopsy and surgical excision. RESULTS: A total of 117 patients who underwent percutaneous core biopsy and surgical excision of retroperitoneal sarcoma were included. Diagnostic accuracy varied with histopathological diagnosis, but overall precise concordance between biopsy and final histopathology was seen in 61% (κ = 0.57). Biopsy was most sensitive for identifying well-differentiated liposarcoma (WDLPS) (sensitivity 85%, 95% CI 0.06-0.96) and leiomyosarcoma (sensitivity 81%, 95% CI 0.54-0.96) and was least sensitive for identifying de-differentiated liposarcoma (DDLPS) (sensitivity 40%, 95% CI 0.25-0.56). Overall agreement between biopsy and final histopathology increased with use of PET/CT scan pre-biopsy and with use of fluorescence in situ hybridisation testing on biopsy, however, neither test improved recognition of de-differentiated components within WD/DDLPS on core biopsy. CONCLUSIONS: Pre-operative biopsy is important for clinical decision making in the treatment of retroperitoneal sarcoma. A significant portion of patients with a WDLPS will have a de-differentiated component identified at the time of resection that was not identified on initial biopsy.
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ItemDiagnostic accuracy of functional imaging modalities for chondrosarcoma: A systematic review and meta-analysis(ELSEVIER, 2019-12)INTRODUCTION: The distinction between low-grade (grade 1) chondrosarcoma and its benign counterparts can be challenging. This systematic review aims to quantify the diagnostic accuracies of all functional imaging modalities used in the diagnosis of chondrosarcoma. METHODS: Medline and Embase were searched in February 2019. We included studies of either retrospective or prospective design if the results of functional scans were compared with pre-determined reference standards. Studies had to be primary diagnostic reports on patients with chondral tumours at first diagnosis. Two review authors independently performed study selection, extracted data and assessed the methodological quality. We calculated diagnostic accuracy measures for each included study. RESULTS: Four functional imaging modalities were identified across thirteen studies that met the inclusion criteria. 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (FDG-PET) was a sensitive and specific test. Technetium-99 m with methylene diphosphonate (Tc-99 m MDP) had an overall low specificity of 4%. Thallium-201 scintigraphy demonstrated high positive predictive values across the studies. The negative predictive values of Technetium-99 m pentavalent dimercaptosuccinic acid (Tc-99 m DMSA (V)) were consistently 100%. CONCLUSIONS: Low-grade chondrosarcomas continue to pose a diagnostic dilemma. FDG-PET demonstrated superior diagnostic accuracy compared to Tc-99 m MDP, Thallium-201 and Tc-99 m DMSA (V). Characteristic uptake patterns of Thallium-201 and Tc-99 m DMSA (V) may provide additional metabolic information to guide the diagnosis in this challenging group of tumours.