A Comparison of Commonly Utilized Diagnostic Biopsy Techniques for Pediatric Patients w/ Cancer | Systematic Review | 27 studies, 2477 patients | APSA Cancer Committee | Patients ≤21 years | 2010 - 2023 | Biopsy for diagnosis of • liver tumors • neuroblastoma (NB) • soft tissue sarcoma (STS) • lymphoma | 820 patients had neuroblastoma, 307 liver tumors, 96 STS, 151 lymphoma, 1103 had multiple diagnoses | Surgical biopsy (SB) | Core needle biopsy (CNB) | Complication rate (p < 0.001) | 21.4% | 2.9% | Bleeding (p < 0.001) | 22.1% | 2.3% | Diagnostic Rate (p < 0.001) | 98.8% | 90.8% | Conclusion: Both SB and CNB achieved >90% diagnostic success, but SB's complication rate was nearly 10x higher. CNB is safer, and improving its accuracy warrants further research. | https://pubmed.ncbi.nlm.nih.gov/39317569/ | Source: Teke M et. al. | Department of Surgery, University of Texas at Southwestern Medical Center, Dallas, TX, USA | @EmGooteMD | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
A Comparison of Commonly Utilized Diagnostic Biopsy Techniques for Pediatric Patients With Cancer: A Systematic Review by the APSA Cancer Committee
Infographic · Nov 2024 · 1 min read
In brief
In brief
This APSA systematic review of 2,477 pediatric cancer patients found core needle biopsy achieved 90.8% diagnostic accuracy with significantly lower complication rates (2.9%) compared to surgical biopsy (21.4%), though surgical biopsy remained more diagnostic (98.8%). The findings support CNB as a safe first-line approach for pediatric solid tumor diagnosis.
- Core needle biopsy achieved 90.8% diagnostic success vs 98.8% for surgical biopsy in 2477 pediatric cancer patients across multiple tumor types.
- Complication rates were 10-fold lower with CNB (2.9%) compared to surgical biopsy (21.4%), primarily due to reduced bleeding risk (2.3% vs 22.1%).
- CNB offers acceptable diagnostic accuracy with significantly lower morbidity for pediatric solid tumors including neuroblastoma, liver tumors, and sarcomas.
- The 8% diagnostic gap between CNB and surgical biopsy may be acceptable given the substantial reduction in procedure-related complications.
- Future research should focus on optimizing CNB technique to improve diagnostic yield while preserving its safety advantage over open surgical approaches.
Written by the GCMD Library team from the infographic.
A teal and yellow infographic with three main sections: header with study details, middle section showing patient distribution and biopsy comparison data in a table format, and yellow conclusion banner at bottom. Illustrations include a researcher at desk (left), family group (right), and clinician with microscope (center-right). Color coding uses green for core needle biopsy data and black for surgical biopsy data.
Martha Teke, Barrie S. Rich, Ashley Walther, Dana Schwartz, Lucas A. McDuffie, Gisela Butera, Jonathan P. Roach, David H. Rothstein, Dave R. Lal, Kimberly Riehle, Andres Espinoza, Nicholas Cost, Elisabeth Tracy, David Rodeberg, Timothy Lautz, Jennifer H. Aldrink, Erin G. Brown
Background: Historically, surgical biopsy (SB) for diagnosis of pediatric solid tumors was considered necessary to provide adequate tissue for histologic and molecular analysis. Less invasive biopsy techniques such as image-guided core needle biopsy (CNB), have shown comparable accuracy with decreased morbidity in some adult studies. However, data regarding the safety and efficacy of CNB in pediatric tumors is limited. This study's aim was to assess the overall rate of successful diagnosis and safety of CNB compared to SB in children with malignancies.
Methods: A PRISMA compliant systematic review was performed in MEDLINE via PubMed, Embase and CINAHL Plus database searches from 2010 to 2023. Studies were included with relevance to the following clinical question: For children with concern for malignancy requiring biopsy for diagnosis, how does CNB compare to open or laparoscopic/thoracoscopic SB in terms of safety and diagnostic efficacy? Data for patients ≤21 years requiring biopsy for diagnosis of liver tumors, neuroblastoma (NB), soft tissue sarcoma (STS), and lymphoma were included.
Results: Twenty-seven studies including 2477 patients met inclusion criteria, with 2065 undergoing CNB and 412 SB. Of the 2477 patients, 820 patients had NB, 307 liver tumors, 96 STS, 151 lymphoma, and 1103 patients were from studies that included multiple diagnoses. The average complication rate for CNB was 2.9% compared to 21.4% for SB (p < 0.001). Bleeding was the most common complication in both groups, but significantly higher after SB (22.1% vs 2.3%) (p < 0.001). CNB was diagnostic in 90.8% of patients compared to 98.8% who underwent SB (p < 0.001).
Conclusions: Rates of successful diagnosis were greater than 90% for both CNB and SB, though significantly higher for SB. Conversely, complication rates were close to ten times higher after SB compared to CNB. Given its relatively lower risk profile, CNB can be a safe and useful diagnostic tool for children with solid malignancies. Research focused on enhancing CNB's diagnostic accuracy while maintaining low morbidity should be further explored.