TY - JOUR
T1 - Fine-needle aspiration biopsy for the diagnosis of bone and soft tissue lesions
T2 - a systematic review and meta-analysis
AU - Chambers, Meagan
AU - O'Hern, Keegan
AU - Kerr, Darcy A.
N1 - Funding Information:
We additionally found FNA to be 87.0% accurate (range: 60.8%-99.3%) for histologic subtype, again mirroring the 88% (95% CI: 86-90%) accuracy of CNB to define the histotype of soft tissue neoplasms in the Birgin et al meta-analysis, albeit with a wider range.1 Therefore, FNA demonstrates comparable sensitivity/specificity for the nature of MSK lesions and ability to provide the tumor's line of differentiation compared with CNB. We additionally found a high rate of adequacy (92.3%) and a low rate of complications (0.7%), although data in the latter were limited. These results support the expanded use of FNA in the diagnostic workup of bone and soft tissue lesions.In some MSK lesions, confidence in the nature of the lesion is sufficient; a benign FNA paired with indolent radiographic features may support the approach of observation only. Similarly, malignancy on FNA may lead to appropriate surgical planning or chemotherapy without the need for additional biopsy.15 This meta-analysis showed high levels of sensitivity and specificity with regard to the nature of the lesion, and lower?but still significant?accuracy with regard to a definitive diagnosis. This is perhaps not surprising as mesenchymal neoplasms are distinctly rare and represent an incredibly diverse range of types and subtypes histologically (>150, including >70 sarcomas), many with overlapping clinicopathologic features.50
Publisher Copyright:
© 2020 American Society of Cytopathology
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Introduction: The workup of musculoskeletal (MSK) lesions utilizes a range of diagnostic tests including incisional biopsy, core needle biopsy, and fine-needle aspiration (FNA). FNA is the most cost-effective and least invasive biopsy method, but variation in its reported diagnostic performance has constrained its use for MSK lesions. Herein, we undertake a meta-analysis to clarify the diagnostic performance of FNA for bone and soft tissue lesions. Materials and methods: A systematic search was run in MEDLINE, EMBASE, and CINAHL. Included studies were aggregated for pooled estimates of adequacy, accuracy, and sensitivity/specificity for all MSK lesions as well as bone and soft tissue independently. Analysis of heterogeneity and risk of bias were assessed across studies. Covariate subgroup analyses were attempted to investigate potential influences on diagnostic accuracy. Results: Twenty-five articles met inclusion criteria, representing 4604 FNAs. Adequacy was 92.3% (range: 59.2%-98.0%, S = 9.4%), and sensitivity/specificity for the nature (malignant or benign) of the lesion was 95.6% (95% CI: 94.5%-96.5%) and 96.9% (95% CI: 95.9%-97.7%). FNA was 75.8% accurate (range: 42.5%-99.3%, S = 17.3%) for definitive diagnosis. FNA provides higher accuracy for benign versus malignant nature in bone lesions but achieves a definitive diagnosis more frequently in soft tissue lesions. Conclusions: The results of this meta-analysis support the expanded use of FNA in the diagnostic workup of bone and soft tissue lesions, particularly in light of a sensitivity and specificity comparable to incisional and core needle biopsy.
AB - Introduction: The workup of musculoskeletal (MSK) lesions utilizes a range of diagnostic tests including incisional biopsy, core needle biopsy, and fine-needle aspiration (FNA). FNA is the most cost-effective and least invasive biopsy method, but variation in its reported diagnostic performance has constrained its use for MSK lesions. Herein, we undertake a meta-analysis to clarify the diagnostic performance of FNA for bone and soft tissue lesions. Materials and methods: A systematic search was run in MEDLINE, EMBASE, and CINAHL. Included studies were aggregated for pooled estimates of adequacy, accuracy, and sensitivity/specificity for all MSK lesions as well as bone and soft tissue independently. Analysis of heterogeneity and risk of bias were assessed across studies. Covariate subgroup analyses were attempted to investigate potential influences on diagnostic accuracy. Results: Twenty-five articles met inclusion criteria, representing 4604 FNAs. Adequacy was 92.3% (range: 59.2%-98.0%, S = 9.4%), and sensitivity/specificity for the nature (malignant or benign) of the lesion was 95.6% (95% CI: 94.5%-96.5%) and 96.9% (95% CI: 95.9%-97.7%). FNA was 75.8% accurate (range: 42.5%-99.3%, S = 17.3%) for definitive diagnosis. FNA provides higher accuracy for benign versus malignant nature in bone lesions but achieves a definitive diagnosis more frequently in soft tissue lesions. Conclusions: The results of this meta-analysis support the expanded use of FNA in the diagnostic workup of bone and soft tissue lesions, particularly in light of a sensitivity and specificity comparable to incisional and core needle biopsy.
KW - Bone neoplasms
KW - Connective and soft tissue neoplasms
KW - Fine needle aspiration
KW - Meta-analysis
KW - Musculoskeletal diseases
KW - Sensitivity and specificity
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U2 - 10.1016/j.jasc.2020.05.012
DO - 10.1016/j.jasc.2020.05.012
M3 - Article
C2 - 32622858
AN - SCOPUS:85087216354
VL - 9
SP - 429
EP - 441
JO - Journal of the American Society of Cytopathology
JF - Journal of the American Society of Cytopathology
SN - 2213-2945
IS - 5
ER -