Evolving biopsy techniques for the diagnosis of neuroblastoma in children

doi:10.1016/j.jpedsurg.2018.04.012

Journal of Pediatric Surgery

Volume 53, Issue 11, November 2018, Pages 2235-2239

https://doi.org/10.1016/j.jpedsurg.2018.04.012 Get rights and content

Abstract

Background/Purpose

To compare the adequacy and safety of percutaneous core needle biopsy and surgical wedge biopsy of neuroblastoma in children.

Methods

A retrospective review of patients who underwent biopsy for intermediate- or high-risk neuroblastoma at our institution between 2011 and 2015 was performed (recent cohort). Procedure details and outcomes were collected and analyzed using descriptive statistics and Wilcoxon rank tests; P < 0.05 was considered significant. Published data from 2002 to 2010 were compared (historic cohort).

Results

Since 2011, percutaneous, ultrasound-guided, core needle biopsy has been more commonly utilized (47% (16/34) recent vs. 25% (7/28) historic; P = 0.07), and the number of core needle samples increased from median 7 (historic) to 25 (recent). Complications decreased (21% (7/34) recent vs. 64% (18/28) historic; P < 0.01). Biopsy adequacy in the recent cohort was similar (94% percutaneous vs. 89% surgical; P = 1.00), which is improved from the historic cohort (71% percutaneous vs. 100% surgical; P = 0.06). Larger tumors were more likely to have a percutaneous biopsy (82 ± 37 cm percutaneous vs. 47 ± 29 cm surgical; P = 0.04).

Conclusions

When multiple cores are obtained, percutaneous core needle biopsy is adequate for complete tissue diagnosis of neuroblastoma and can be safely performed. This can be considered as an alternative to open surgical biopsy.

Type of study

Treatment Study.

Level of evidence

III.

Section snippets

Patient selection and study design

In this IRB-approved retrospective study, the charts of all children who underwent core needle biopsy and surgical wedge biopsy of intermediate- and high-risk neuroblastoma at Texas Children's Hospital (TCH) from 2011 to 2015 were reviewed. The study included 16 patients who underwent core needle biopsy and 18 patients who underwent surgical biopsy. Data recorded for each patient included patient demographics, the anatomical location of the tumor biopsy specimen, the largest dimension of the

Patient and tumor characteristics

Differences in patient demographics and tumor characteristics among the different biopsy methods in the recent cohort can be seen in Table 1. There were no statistically significant differences between the two biopsy groups regarding mean age at biopsy (P = 0.40), race (P = 0.90), or gender (P = 0.18). Tumor location was not significantly different between the two groups (P = 0.13).

The difference in mean tumor size, represented by the largest measured dimension, was statistically significant

Discussion

There is a growing body of literature in support of percutaneous core needle biopsy as a safe and efficacious method of obtaining adequate tissue for diagnosis of neuroblastoma in children [2], [6], [13], [14]. Despite the lack of an agreed-upon standard method of obtaining tissue for intermediate- and high-risk neuroblastoma in the pediatric population, surgeons at our academic institution demonstrated a trend in favor of percutaneous core needle biopsy over surgical biopsy over the last two

Conclusions

Surgeon-performed percutaneous core needle biopsy is adequate for complete tissue diagnosis of neuroblastoma and can be safely performed. This can be considered as an alternative to surgical biopsy when both biopsy methods are clinically indicated. The results at our institution over the last two decades support the emerging use of percutaneous core needle biopsy and minimally invasive surgical techniques, as these methods of biopsy are increasingly able to guide management by providing an

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Comparing safety and adequacy between surgical biopsy versus core needle biopsy in diagnosing neuroblastoma
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Citation Excerpt :
To mitigate this potential issue, the College of American Pathologists protocol suggests multiple core biopsies of NB (at least 2–4 biopsied from the same tumor). A recent retrospective review comparing older (2002–2010) and recent cohorts (2011–2015) reported that the older needle core biopsy cohort had an average of 7 cores with an adequacy of 71% for complete characterization while the recent cohort had an average of 25 cores with an adequacy of 94% [9]. The College of American Pathologists protocol also asserts that grading can be performed on samples from metastatic sites, provided that the specimen is large enough to be representative [14].
Adequate tissue biopsy is essential for diagnosis and risk stratification of neuroblastoma (NB). Historically, NB diagnosis has relied on tissue obtained via surgical biopsy. However, core needle biopsy may provide a safe and adequate method of obtaining tissue in pediatric patients.
The aim of this study is to compare the adequacy and safety between core needle biopsy and surgical biopsy for the diagnosis of NB in children at our institution.
Institutional approval was obtained. Medical records of patients diagnosed with NB from 2004 – 2019 were retrospectively reviewed. Patients had either core needle biopsy (CNB) or surgical biopsy (SB) including open/minimally invasive biopsy. Data included patient demographics, tumor location and size, sample adequacy for diagnosis and risk stratification, post-biopsy complications, length of hospital stay, and need for repeat biopsy. Statistical analysis was conducted using the Mann-Whitney U test or Student's t-test.
Thirty-eight patients were included; 53 biopsies were performed including 41 SB and 12 CNB. Patient and tumor characteristics were similar in both groups, as well as the biopsy adequacy for diagnosis and risk stratification. In all cases, there was no need for repeat biopsy. The CNB group demonstrated reduced length of stay (2 ± 0.4 days vs 5 ± 0.5 days; P < 0.0001) and fewer complications (8%) than the SB group (44%) (P = 0.038).
Core needle biopsy is an acceptable modality for diagnosis and risk stratification in the pediatric population. Advantages include decreased length of stay and fewer post-procedure complications.
Update on pediatric rhabdomyosarcoma: A report from the APSA Cancer Committee
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If image-guided percutaneous core needle biopsy is chosen, a generous number of large caliber cores verified by real-time involvement of the pathologist to ensure adequate viable tissue for complete assessment of biologic markers is highly encouraged. Reports on image-guided core needle biopsies have shown excellent diagnostic yields with low complication rates in pediatric solid masses including hepatoblastoma and neuroblastoma [33–35]. However, success in obtaining adequate tissue for ancillary testing is variable, ranging from 64% to 98% [36–39].
Rhabdomyosarcoma is the most common soft tissue sarcoma in children and young adults and requires multimodality treatment. The purpose of this review is to present an update on risk stratification as well as surgical and medical management strategies in pediatric rhabdomyosarcoma.
A comprehensive review of the current literature on pediatric rhabdomyosarcoma, including the most recent Children's Oncology Group studies and several international collaboratives, was performed by the authors and key findings were summarized in the manuscript.
FOXO1 fusion status is a stronger prognostic factor than histology and is now used for risk stratification in treatment protocols. For assessment of regional nodal involvement, FDG-PET-CT shows poor sensitivity and specificity to detect histologically confirmed nodal metastasis. Thus, surgical assessment of regional lymph nodes is required for rhabdomyosarcoma of the extremities or trunk as well as paratesticular rhabdomyosarcoma in patients ≥ 10 years of age, although adherence to surgical guidelines remains poor. Hemiscrotectomy performed for scrotal violation in paratesticular rhabdomyosarcoma has not shown an improvement in event free survival and is not recommended.
Surgical and medical treatment strategies for rhabdomyosarcoma in children continue to evolve. This review provides current evidence-based treatment standards with an emphasis on surgical care.
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Tetrandrine induces apoptosis in human neuroblastoma through regulating the Hippo/YAP signaling pathway
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Neuroblastoma (NB) is the most common extracranial neoplasm occurring in infants and very young children [1]. Despite the fact that it is a rare type of cancer, NB accounts for nearly 8%–10% of all pediatric cancers and 15% of cancer-related deaths in children [2]. Currently, the approaches for treating NB include surgical resection, chemotherapy, radiotherapy, as well as myeloablative therapy with autologous stem cell rescue (ASCR) to relieve symptoms and improve quality of life.
Tetrandrine (TET), a bis-benzylisoquinoline alkaloid, shows cytotoxicity against several different types of tumors. However, the mechanism by which TET exerts its anti-cancer capabilities remains unclear. In this study, we confirmed that TET inhibits proliferation and induces apoptosis in neuroblastoma (NB) in vitro and in vivo. Moreover, we revealed that the anti-cancer ability of TET is associated with a decreased expression of anti-apoptotic Bcl-2. Importantly, we demonstrated that the Hippo/YAP pathway is involved in down-regulating of Bcl-2. Notably, YAP overexpression promoted proliferation and suppressed apoptosis, even partially reversed TET-induced effects in NB cells. Our findings support the prospect that TET could be a potential therapeutic agent for NB, and suggest that targeting the Hippo/YAP pathway may represent a valuable approach to NB treatment.
Update on neuroblastoma
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The standard biopsy procedure has traditionally been open or minimally-invasive surgical wedge biopsy for the establishment of neuroblastoma diagnosis in children. Percutaneous image-guided core needle biopsy is now increasingly used to characterize neuroblastoma and other pediatric solid tumors given its safety, diagnostic adequacy, and efficiency [39]. The choice of open or percutaneous biopsy is based on the availability of an accessible anatomic window to access the tumor and surgeon preference.
Neuroblastoma is an embryonic cancer arising from neural crest stem cells. This cancer is the most common malignancy in infants and the most common extracranial solid tumor in children. The clinical course may be highly variable with the possibility of spontaneous regression in the youngest patients and increased risk of aggressive disease in older children. Clinical heterogeneity is a consequence of the diverse biologic characteristics that determine patient risk and survival. This review will focus on current progress in neuroblastoma staging, risk stratification, and treatment strategies based on advancing knowledge in tumor biology and genetic characterization.
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Percutaneous core needle biopsy of neuroblastoma in the pediatric population: what have we learned in the last decade
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Percutaneous biopsy for the diagnosis, risk stratification, and molecular profiling of neuroblastoma: A single-center retrospective study
2024, Pediatric Blood and Cancer

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^☆☆: Declarations of interest: None.

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OncologyEvolving biopsy techniques for the diagnosis of neuroblastoma in children☆,☆☆

Abstract

Background/Purpose

Methods

Results

Conclusions

Type of study

Level of evidence

Section snippets

Patient selection and study design

Patient and tumor characteristics

Discussion

Conclusions

Semin Pediatr Surg

J Pediatr Surg

Hematol Oncol Clin North Am

J Pediatr Surg

J Pediatr Surg

Eur J Cancer

Long-term results for children with high-risk neuroblastoma treated on a randomized trial of myeloablative therapy followed by 13-cis-retinoic acid: a children's oncology group study

J Clin Oncol

Image-guided percutaneous core needle biopsy of soft-tissue masses in the pediatric population

Pediatr Radiol

Imaging-guided core biopsy for the diagnosis of malignant tumors in pediatric patients

AJR Am J Roentgenol

Ultrasound-guided core needle biopsy in diagnosis of abdominal and pelvic neoplasm and pediatric patients

Pediatr Surg Int

Oncology
Evolving biopsy techniques for the diagnosis of neuroblastoma in children☆,☆☆