Fine needle aspiration biopsy compared to surgical open biosy in management of bone neoplasms

Abstract

This was a prospective study to evaluate FNAB/C on bone neoplasms. It was designed to determine the reliability, area of diagnostic difficulty and limitations of FNAB/C on bone neoplasms encountered at KNH. A total of 59 patients were recruited between 1 st OctobeF2003 and 30th August 2004. Patients who had previous histopathological diagnosis by open biopsy were excluded. Aspirate material from 53 of the 59 patients were considered adequate for cytological diagnosis. There were 6 insufficient aspirates. Of these 53, 44 aspirates were conclusive for specific diagnosis of which 9 were sufficient but undiagnostic. The aspirates were categorized into 5 groups; primary benign bone tumuors 13, primary malignant bone tumuours 11, metastases 5, soft tissue tumours 3 and osteomyelitis 12. Cytohistopathologic correlation was possible in 51 aspirates. There were 36 true positives and this gave an overall accuracy for FNAB/C of 70.6% and 92.3% excluding the inconclusive aspirates. The specificity and sensitivity of FNAB/C was 27.2% and 75% respectively. The positive predictive value and negative predictive value was 81.8% and 20% respectively. The mean time lapse between first clinic visit and procedure for FNAB/C and open biopsy was 5 and 26 days and for first clinic visit and diagnostic confirmation 19 and 50 days respectively. Complications occurred more in open biopsy with overall of 61 % compared to 18.6% of FNAB/C. Average costs for procedures were 100 shillings for FNAB/C and 5,056 shillings for open biopsy. This study demonstrates that FNAB/C is reliable, quick and acceptably accurate procedure. Not only is it convenient but its well tolerated with low morbidity and is cost effective. However, it cannot entirely replace open biopsy. Future efforts should focus on teamwork, more training for clinicians, pathologists and radiologists on this procedure to improve skill and improved instrumentation to obtain higher rate of conclusive aspirate material.