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Image-guided percutaneous biopsy of peripheral nerve tumors of indeterminate nature: risks and benefits.
Acta Neurochirurgica ( IF 2.4 ) Pub Date : 2020-02-10 , DOI: 10.1007/s00701-020-04257-1
Courtney Pendleton 1 , Robert J Spinner 1
Affiliation  

BACKGROUND Usual management of peripheral nerve tumors is to avoid biopsy in those that are likely benign; the risk of biopsy outweighs the benefit of definitive tissue diagnosis. Biopsy of presumed malignant lesions is performed widely. There is a subset of peripheral nerve tumors that are not easily categorized as benign or malignant based on the clinical and/or radiological features alone. The role of biopsy in peripheral nerve tumors of uncertain character remains controversial and the risk of biopsy (and the potential risk/benefit ratio) for these lesions is not known. METHODS Following approval by our institutional review board, we reviewed all notes of a single peripheral nerve surgeon from 2000 to 2018 with respect to image-guided percutaneous biopsy of nerve tumors. We divided these patients into 3 groups based on clinicoradiologic features. We determined the risk of complications and the "hit rate" for patients with peripheral nerve tumors of uncertain behavior, defined as the percentage of patients sent for percutaneous biopsy who had a malignancy on their final pathology. RESULTS Of 82 patients with tumors of uncertain behavior, 9 had complications, and 23 had malignant final pathology (a "hit rate" of 27.7%). Neurosurgical referral for biopsy of tumors of uncertain behavior was made in 60 patients. Twenty-two had malignant final pathology ("hit rate"= 36.7%). Non-neurosurgical referral for biopsy was made in 22 patients with tumors of uncertain behavior. Two had malignant final pathology ("hit rate"= 4.55%). There was a statistically significant difference between the "hit rate" for the two groups (p = 0.021). CONCLUSIONS The decision to biopsy a peripheral nerve tumor is largely based on the presumed behavior and prognosis, determined via clinicoradiologic characteristics. Patient care might be improved by delaying percutaneous biopsy of peripheral nerve lesions until after a neurosurgical evaluation.

中文翻译:

不确定性的周围神经肿瘤的图像引导经皮穿刺活检:风险和收益。

背景技术对周围神经肿瘤的常规处理是为了避免对可能良性的肿瘤进行活检。活检的风险大于确定的组织诊断的益处。假定的恶性病变的活检广泛进行。仅根据临床和/或放射学特征,有一部分周围神经肿瘤不容易归类为良性或恶性。活检在特征不确定的周围神经肿瘤中的作用仍存在争议,并且尚不清楚这些病变的活检风险(以及潜在的风险/获益比)。方法在获得机构审查委员会的批准后,我们​​对2000年至2018年一位外周神经外科医生在图像引导下对神经肿瘤进行经皮活检的所有记录进行了回顾。我们根据临床放射学特征将这些患者分为3组。我们确定了行为不确定的周围神经肿瘤患者发生并发症的风险和“命中率”,其定义为经皮穿刺活检后其最终病理结果为恶性的患者所占的百分比。结果在82例行为不确定的肿瘤患者中,9例发生并发症,23例恶性最终病理(“命中率”为27.7%)。对60例行为不明的肿瘤进行神经外科转诊。22名患者的最终病理结果为恶性(“命中率” = 36.7%)。22例行为不确定的肿瘤患者接受了非神经外科活检。两人的最终病理为恶性(“命中率” = 4.55%)。两组的“命中率”之间存在统计学上的显着差异(p = 0.021)。结论对周围神经肿瘤进行活检的决定主要取决于通过临床放射学特征确定的预期行为和预后。通过将周围神经病变的经皮穿刺活检推迟到进行神经外科手术评估之后,可能会改善患者的护理。
更新日期:2020-02-10
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