Researchers suggest avoiding excisional biopsies of soft tissue sarcoma of the hand
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BOSTON — Excisional biopsies of soft tissue sarcoma of the hand are associated with more positive margins and a longer time to patients’ first intervention vs. incisional/needle biopsies, results of a study showed.
Talia R. Chapman, MD and colleagues collected and analyzed data for 109 patients who underwent definitive surgical excision of primary soft tissue sarcoma of the hand at their institution that involved either excisional biopsy or incisional/needle biopsy.
Chapman presented the findings at the American Society for Surgery of the Hand Annual Meeting, here.
Researchers studied demographic, oncologic and surgical data for the patients and the sarcomas, classifying sarcoma by location, size and depth, and type of biopsy. Biopsies were classified as being performed internal or external to the researchers’ institution prior to referral and by whether biopsies could be effectively incorporated into a definitive surgical amputation or limb salvage incision.
“All six positive margins occurred after an excisional biopsy was performed. There was a higher rate of soft tissue coverage after excisional biopsies,” Chapman said.
Soft tissue coverage was needed in 48% of patients who underwent excisional biopsies, results showed.
The abstract showed a statistically significantly longer time to first intervention among patients who underwent excisional biopsy.
In general, the median size of tumors treated with incisional or needle biopsy was larger than tumors treated with excisional biopsy at 3.15 cm vs. 2 cm, respectively.
According to the abstract, overall, 29 biopsies (26.6%) could not be incorporated into standard limb salvage treatment or amputation flaps.
“Most importantly, 36% of excisional biopsies could not be incorporated into standard limb salvage or amputation flaps,” Chapman said.
The univariate analysis researchers performed to characterize biopsies that could not be incorporated into amputation flaps or standard limb salvage incisions showed “factors associated with biopsies that could not be incorporated included size greater than 2.5 cm and an excisional type of biopsy. Additionally, all of those biopsies were for deep tumors,” she said.
When researchers characterized tumors that were high risk — essentially unable to be incorporated — they found anatomic areas in which these occurred included the first web space; thumb proximal to the interphalangeal joint; the radial palm, which included the thenar eminence; and the carpal tunnel or volar wrist, Chapman said.
“Therefore, based on these results, we recommend referral to a sarcoma center when the tumor is deep, larger than 2.5 cm or in a high-risk anatomic location and, if you are unable to refer, we recommend incisional biopsy or core needle biopsy, as those have less risk of being unable to be incorporated into the ultimate surgical treatment,” she said.
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Chapman T, et al. Paper 71. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 29-Oct. 1, 2022; Boston.
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