Soft-Tissue Sarcoma
http://www.100md.com
《新英格兰医药杂志》
To the Editor: With regard to the article by Clark et al. (Aug. 18 issue),1 we would like to call attention to the usefulness of fine-needle aspiration biopsy for soft-tissue sarcoma. In their article, the authors point out that fine-needle aspiration biopsy is useful for the diagnosis of metastatic or recurrent lesions. Although we concur, we and others2,3,4,5 have found this technique to be remarkably reliable in the diagnosis of primary soft-tissue sarcoma. The accurate typing and grading of a large proportion of sarcomas are feasible. This is especially true if additional cellular material is collected by extra needle passes (an advantage of fine-needle aspiration) for immunocytochemical, cytogenetic, and molecular analyses.
In our center, preliminary biopsy results are available within a few minutes, which substantially expedites our evaluations. A growing body of literature supports this approach.2,3,4,5 We have found fine-needle aspiration biopsy to be quite useful as part of initial diagnostic testing for soft-tissue sarcoma, after history taking, examination, and imaging. We believe that centers with dedicated cytology teams should consider making fine-needle aspiration biopsy a part of the evaluation of soft-tissue sarcoma.
Kim R. Geisinger, M.D.
William G. Ward, M.D.
Edward A. Levine, M.D.
Wake Forest University School of Medicine
Winston-Salem, NC 27157
kgeis@wfubmc.edu
References
Clark MA, Fisher C, Judson I, Thomas JM. Soft-tissue sarcomas in adults. N Engl J Med 2005;353:701-711.
Wakely PE Jr, Kneisl JS. Soft tissue aspiration cytopathology. Cancer 2000;90:292-298.
Gonzales-Compora R. Cytoarchitectural findings in the diagnosis of primary soft tissue tumors. Acta Cytol 2001;45:115-146.
Soft tissue and bone. In: Geisinger KR, Stanley MW, Raab SS, Silverman JF, Abati A. Modern cytopathology. Philadelphia: Churchill Livingstone, 2004:813-71.
Layfield LJ. Cytopathology of bone and soft tissue tumors. New York: Oxford University Press, 2002.
The authors reply: We agree that fine-needle aspiration biopsy can be useful in experienced hands, and the figures for the diagnosis of cancer with this procedure are similar to those with core needle biopsy. However, the technique is less useful than core needle biopsy for subtyping sarcomas, as evidenced by a success rate of 56 percent for fine-needle aspiration biopsy in one study1 and 63 percent in another study2 with the use of cell-block preparations. This method is also less useful than core needle biopsy for providing grading information.3,4 That being said, the Scandinavian group (with the largest cumulative experience in the world) is now advocating a combination of fine-needle aspiration and needle core biopsy.4
Our unit would not consider performing major resections or amputations for soft-tissue sarcoma on the basis of fine-needle aspiration biopsy alone, since even experienced cytopathologists may have difficulty in differentiating soft-tissue sarcomas from benign lesions that look similar on the basis of this method. The best evaluation and treatment of the patient are achieved by the synthesis of clinical, pathological, and imaging data by practitioners who are experienced in diagnosing and treating this entity.
Matthew A. Clark, F.R.A.C.S.
Middlemore Hospital
Auckland, New Zealand
sarcoma@mac.com
Cyril Fisher, F.R.C.Path.
J. Meirion Thomas, F.R.C.S.
Royal Marsden Hospital National Health Service Foundation Trust
London SW3 6JJ, United Kingdom
References
Kilpatrick SE, Ward WG, Cappellari JO, Bos GD. Fine-needle aspiration biopsy of soft tissue sarcomas: a cytomorphologic analysis with emphasis on histologic subtyping, grading, and therapeutic significance. Am J Clin Pathol 1999;112:179-188.
Jones C, Liu K, Hirschowitz S, Klipfel N, Layfield LJ. Concordance of histopathologic and cytologic grading in musculoskeletal sarcomas: can grades obtained from analysis of the fine-needle aspirates serve as the basis for therapeutic decisions? Cancer 2002;96:83-91.
Akerman M. The cytology of soft tissue tumours. Acta Orthop Scand Suppl 1997;273:54-59.
Domanski HA, Akerman M, Carlen B, et al. Core-needle biopsy performed by the cytopathologist: a technique to complement fine-needle aspiration of soft tissue and bone lesions. Cancer 2005;105:229-239.
In our center, preliminary biopsy results are available within a few minutes, which substantially expedites our evaluations. A growing body of literature supports this approach.2,3,4,5 We have found fine-needle aspiration biopsy to be quite useful as part of initial diagnostic testing for soft-tissue sarcoma, after history taking, examination, and imaging. We believe that centers with dedicated cytology teams should consider making fine-needle aspiration biopsy a part of the evaluation of soft-tissue sarcoma.
Kim R. Geisinger, M.D.
William G. Ward, M.D.
Edward A. Levine, M.D.
Wake Forest University School of Medicine
Winston-Salem, NC 27157
kgeis@wfubmc.edu
References
Clark MA, Fisher C, Judson I, Thomas JM. Soft-tissue sarcomas in adults. N Engl J Med 2005;353:701-711.
Wakely PE Jr, Kneisl JS. Soft tissue aspiration cytopathology. Cancer 2000;90:292-298.
Gonzales-Compora R. Cytoarchitectural findings in the diagnosis of primary soft tissue tumors. Acta Cytol 2001;45:115-146.
Soft tissue and bone. In: Geisinger KR, Stanley MW, Raab SS, Silverman JF, Abati A. Modern cytopathology. Philadelphia: Churchill Livingstone, 2004:813-71.
Layfield LJ. Cytopathology of bone and soft tissue tumors. New York: Oxford University Press, 2002.
The authors reply: We agree that fine-needle aspiration biopsy can be useful in experienced hands, and the figures for the diagnosis of cancer with this procedure are similar to those with core needle biopsy. However, the technique is less useful than core needle biopsy for subtyping sarcomas, as evidenced by a success rate of 56 percent for fine-needle aspiration biopsy in one study1 and 63 percent in another study2 with the use of cell-block preparations. This method is also less useful than core needle biopsy for providing grading information.3,4 That being said, the Scandinavian group (with the largest cumulative experience in the world) is now advocating a combination of fine-needle aspiration and needle core biopsy.4
Our unit would not consider performing major resections or amputations for soft-tissue sarcoma on the basis of fine-needle aspiration biopsy alone, since even experienced cytopathologists may have difficulty in differentiating soft-tissue sarcomas from benign lesions that look similar on the basis of this method. The best evaluation and treatment of the patient are achieved by the synthesis of clinical, pathological, and imaging data by practitioners who are experienced in diagnosing and treating this entity.
Matthew A. Clark, F.R.A.C.S.
Middlemore Hospital
Auckland, New Zealand
sarcoma@mac.com
Cyril Fisher, F.R.C.Path.
J. Meirion Thomas, F.R.C.S.
Royal Marsden Hospital National Health Service Foundation Trust
London SW3 6JJ, United Kingdom
References
Kilpatrick SE, Ward WG, Cappellari JO, Bos GD. Fine-needle aspiration biopsy of soft tissue sarcomas: a cytomorphologic analysis with emphasis on histologic subtyping, grading, and therapeutic significance. Am J Clin Pathol 1999;112:179-188.
Jones C, Liu K, Hirschowitz S, Klipfel N, Layfield LJ. Concordance of histopathologic and cytologic grading in musculoskeletal sarcomas: can grades obtained from analysis of the fine-needle aspirates serve as the basis for therapeutic decisions? Cancer 2002;96:83-91.
Akerman M. The cytology of soft tissue tumours. Acta Orthop Scand Suppl 1997;273:54-59.
Domanski HA, Akerman M, Carlen B, et al. Core-needle biopsy performed by the cytopathologist: a technique to complement fine-needle aspiration of soft tissue and bone lesions. Cancer 2005;105:229-239.