What is the role of biopsy in the workup of postradiation sarcoma (PRS)?

Updated: Jul 01, 2020
  • Author: Nagarjun Rao, MD, FRCPath; Chief Editor: Omohodion (Odion) Binitie, MD  more...
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Answer

Fine-needle aspiration (FNA) biopsies or Tru-Cut core biopsies can be obtained from the lesion for histopathologic/cytopathologic confirmation of diagnosis and for typing and grading of the lesion. In the case of a deep-seated lesion, CT-guided biopsies can be obtained. The biopsy should be the final diagnostic procedure because it can distort the findings from imaging studies, especially MRI.

Careful preoperative planning is required before biopsy is attempted. Imaging studies aid the surgeon in selecting the best site for tissue diagnosis. Usually, the best diagnostic site is at the interface between the tumor and adjacent normal tissue; this also prevents the occurrence of fracture at the biopsy site, in that biopsy in this location usually does not violate cortical bone.

A frozen section can be obtained to determine whether adequate representative tissue has been obtained. A definitive diagnosis usually is delayed until permanent sections are analyzed.

Olson et al conducted a retrospective review of 13 patients (median age, 61 years) who underwent FNA in the treatment of PRS. [24]  Patients generally presented with large tumors (median, 8 cm; range, 3-12 cm), and median survival was 14 months (range, 6-46 months). Nine of the 13 patients died of their disease, and one was lost to follow-up. The tumors were morphologically heterogeneous. The researchers concluded that PRS can be diagnosed by means of FNA and that immunohistochemistry is often required to rule out locally recurrent malignancy.


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