恶性骨肿瘤活检安全性评估

The safety evaluation of biopsy in malignant bone tumors

目的研究恶性骨肿瘤穿刺及切开活检道后被肿瘤污染的发生率及活检的安全性。方法选取2005年7月至2007年10月恶性骨肿瘤行穿刺活检后的病理标本48例，男37例，女11例；年龄10-64岁，平均23.3岁；骨肉瘤37例，恶性纤维组织细胞瘤5例，皮质旁骨肉瘤1例，髓内高分化骨肉瘤1例，骨膜骨肉瘤1例，骨原发恶性黑色素瘤1例，软骨肉瘤2例。活检至再次手术间隔0-2个月，平均1-3个月；均行保肢治疗。选取同期行切开活检病理标本26例，男21例，女5例；年龄8-59岁，平均21．9岁；骨肉瘤20例，Ewing肉瘤1例，软骨肉瘤2例，间叶性软骨肉瘤1例，恶性纤维组织细胞瘤1例，淋巴瘤1例。活检至再次手术间隔1-4个月，平均2．3个月。活检道的手术切除范围均为其内外各2cm，连同瘤段整块切除。对活检道途经的组织取材，以病理为标准判断活检道途经的组织有无恶性肿瘤污染，并确定被肿瘤污染的发生率及范围。结果48例穿刺活检患者中44例获得随访，随访时间4-39个月，平均17．6个月。4例（4／48，8．3％）活检道存在恶性肿瘤种植污染。末次随访时，4例发生非活检道肿瘤复发。26例切开活检患者均获得随访，随访时间2-29个月，平均12．9个月。2例活检道病理可见肿瘤，阳性率为7．7％（2／26）。末次随访时，3例发生非活检道肿瘤复发。结论恶性骨肿瘤进行穿刺活检和切开活检虽存在活检道被肿瘤污染的危险，但在最终手术时活检道连同肿瘤一同切除后不会发生因活检而造成的肿瘤复发。

Objective To investigate the incidence and extent of biopsy tract contamination in malignant bone tumors by either core needle biopsy or open biopsy and detect the safe extent in resection of biopsy tract. Methods Forty-eight cases were performed core needle biopsy, including 37 osteosarcomas, 5 malignant fibrous histiocytomas, 1 juxtacortical osteosarcoma, 1 low grade central osteosarcoma, 1 periosteal osteosarcoma, 1 primary malignant melanoma of bone and 2 chondrosarcomas. There were 37 males and 11 females with a mean age of 23.3 years （range, 10-64 years）. The mean time between core needle biopsy and definitive surgery was 1.3 months （range, 0-2 months）. All the patients were performed limb salvage surgery. Twenty-six cases were performed open biopsy, including 20 osteosarcomas, 1 Ewing＇s sarcoma, 2 chondrosarcomas, 1 mesenchymal chondrosarcoma, 1 malignant fibrous histiocytoma, 1 lymphoma. There were 21 males and 5 females with a mean age of 21.9 years （range, 8-59 years）. The mean time between open biopsy and definitive surgery was 2.3 months （range, 1-4 months）. The tumor and tissue around the biopsy tract at least 2 cm were resected. The pathological examination was performed in specimens via the biopsy tract, including the normal soft tissue outside the tumor, deep fascia, subcutaneous tissue and skin. The incidence and extent of biopsy tract contamination were evaluated with pathological examination. Results Forty-four cases were followed up. The mean follow-up time was 17.6 months （range, 4-39 months）. In core needle biopsy group, four of forty-eight cases were found malignant tumor cells seeding in biopsy tract, the positive rate was 8.3%. In open biopsy group, all the cases were followed up with the mean time of 12.9 months （range, 2-29 months）, and two of twenty-six cases were found malignant tumor cells seeding in biopsy tract, the positive rate was 7.7%. Conclusion Biopsy of malignant bone tumors has the risk of biopsy tract contamination. The tumor cell seeding exists in both core needle biopsy and open biopsy. The biopsy tract should be performed en bloc resection with the tumor.