A comparison of fine-needle aspiration, core biopsy, and surgical biopsy in the diagnosis of extremity soft tissue masses.

BACKGROUND: Biopsy tissue can be obtained through a fine needle, a wider coring needle, or through an open surgical incision. Though much literature exists regarding the diagnostic yield of these techniques individually, none compare accuracy of diagnosis in the same mass. QUESTIONS/PURPOSES: We asked how the diagnostic accuracy of fine-needle aspiration, core biopsy, and open surgical biopsy compare in regard to identifying malignancy, establishing the exact diagnosis, and guiding the appropriate treatment of soft tissue masses. PATIENTS AND METHODS: We prospectively studied 57 patients with palpable extremity soft tissue masses, performing fine-needle aspiration, followed by core biopsy, followed by surgical biopsy of the same mass. RESULTS: Open surgical biopsy was 100% accurate on all accounts. With regard to determining malignancy, fine-needle aspiration and core biopsy had 79.17% and 79.2% sensitivity, 72.7% and 81.8% specificity, 67.9% and 76% positive predictive value, 82.8% and 84.4% negative predictive value, and an overall accuracy of 75.4% and 80.7%, respectively. In regard to determining exact diagnosis, fine-needle aspiration had a 33.3% accuracy and core biopsy had a 45.6% accuracy. With regard to eventual treatment, fine-needle aspiration was 38.6% accurate and core biopsy was 49.1% accurate. CONCLUSIONS: In soft tissue mass diagnosis, core biopsy is more accurate than fine-needle aspiration on all accounts, and open biopsy is more accurate than both in determining malignancy, establishing the exact diagnosis, and the guiding appropriate treatment.

Cooperative role of E-cadherin and sialyl-Lewis X/A-deficient MUC1 in the passive dissemination of tumor emboli in inflammatory breast carcinoma.

Inflammatory breast carcinoma (IBC) is characterized by florid tumor emboli within lymphovascular spaces termed lymphovascular invasion (LVI). Using a human-scid model of IBC (MARY-X), we have demonstrated using retrovirally-mediated dominant-negative E-cadherin mutant approaches (H-2K(d)-E-cad), that the tumor cell embolus (IBC spheroid) forms on the basis of an intact and overexpressed E-cadherin/alpha, beta-catenin axis which mediates tumor cell-tumor cell adhesion analogous to the embryonic blastocyst and accounts for the compactness of the embolus. The tumor cell embolus (IBC spheroid), in contrast, fails to bind the surrounding vascular endothelial cells both in vitro and in vivo because of markedly decreased sialyl-Lewis X/A carbohydrate ligand-binding epitopes on its overexpressed MUC1 which are necessary for binding endothelial cell E-selectin. This tumor cell-endothelial cell aversion further contributes to the compactness of the IBC spheroid and its passivity in metastasis dissemination. This passivity is manifested by a dramatic increase in metastatic pulmonary emboli following palpation of the primary tumor. In assessing this passivity of metastatic dissemination, we compared the effects of palpation on MARY-X with the effects of palpation on a derived dominant-negative E-cadherin mutant (H-2K(d)-E-cad), as well as other well known human tumoral xenografts exhibiting no (MCF-7, T47D), low (MDA-MB-231, MDA-MB-468) or high (C8161, M24(met)) levels of spontaneous metastasis but no LVI. Palpation of each xenograft similarly increased intratumoral pressure by 200% (10-->30 mmHg) but dramatically increased the numbers and sizes of pulmonary metastases 10-100-fold (P<0.001) only in MARY-X. The mechanism of this effect was through an immediate post-palpation release of circulating tumor emboli detected 2-3 min after palpation (P<0.01) by human cytokeratin 19 RT-PCR of extracted RNA from 300 microl of murine blood. Although circulating human tumor cell-derived growth factors (IGF-I, IGF-II, TGF-alpha and TGF-beta) and angiogenic factors (VEGF and bFGF) were detected by ELISA in murine serum of MARY-X, palpation did not further increase the circulating levels of these factors (P>0.1). Our findings support the cooperative role of E-cadherin and sialyl-Lewis X/A-deficient MUC1 in the passive dissemination of tumor emboli in IBC.

Autologous chondrocyte implantation of the ankle: 2- to 10-year results.

BACKGROUND: The treatment of osteochondral lesions of the talus after failed surgery is challenging, with no clear solution. Short-term results using autologous chondrocyte implantation have been promising. PURPOSE: To report the long-term outcomes of patients who underwent autologous chondrocyte implantation (ACI) of the talus after failed marrow stimulation techniques for osteochondral lesions of the talus (OLTs). STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty-two consecutive patients underwent ACI of the talus, and 29 patients (15 male, 14 female; mean age, 34 years [range, 16-54 years]) were available for follow-up. There were 23 medial and 6 lateral lesions, with a mean size of 18 × 11 mm (198 mm(2); range, 80-500 mm(2)). Twenty patients underwent ACI of the talus alone; 9 underwent ACI with bone grafting of underlying cysts. Follow-up was performed at a mean of 70 months (range, 24-129 months). Patient outcomes were evaluated using the simplified symptomatology score, Tegner activity score, Finsen score, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Twenty-five patients (86%) underwent second-look arthroscopic surgery at the time of hardware removal and were assessed with the International Cartilage Repair Society (ICRS) score. Postoperative magnetic resonance imaging (MRI) was performed on 24 patients (83%) and compared with preoperative MRI scans. RESULTS: Preoperatively, 26 patients rated their ankles as poor and 3 as fair using the simplified symptomatology score. At last follow-up, 9 were classified as excellent, 14 as good, 5 as fair, and 1 as poor using the same score. The mean AOFAS score improved from 50.1 to 85.9 (range, 65-100). The mean Tegner activity score improved from 1.6 to 4.3 (P < .0001). The mean Finsen score (modified Weber score) showed significant improvement from 13.7 to 5.1 (P < .0001). CONCLUSION: Autologous chondrocyte implantation of the talus yields improvement in all parameters tested with enduring long-term results in patients who have failed previous surgery for OLTs.

Six-month magnetic resonance imaging follow-up of large and massive rotator cuff repairs reinforced with porcine small intestinal submucosa.

Small intestinal submucosa (SIS) has been used for reinforcement of other tissues in the body with success and has been shown to act as a bioabsorbable tissue scaffold that promotes and assists healing. The effectiveness of using porcine SIS as a tissue scaffold for reinforcement of rotator cuff repair is unclear. This study evaluates both clinical and magnetic resonance imaging (MRI) follow-up at 6 months in patients with large and massive rotator cuff tears treated with open repair and SIS reinforcement or interpositional grafting. Eleven consecutive patients who underwent open rotator cuff repair with SIS augmentation for large or massive tears were selected retrospectively, and their charts were reviewed. Magnetic resonance images were then obtained at least 6 months after the index procedure. Patients were evaluated clinically and with a questionnaire, and an American Shoulder and Elbow Surgeons shoulder score was calculated. Results showed retear on MRI in 10 of 11 patients with recurrence of large, retracted tears. One repair remained intact by MRI evaluation at 10 months. Clinically, there was no statistically significant difference between preoperative and postoperative shoulder scores by use of a paired t test analysis (P =.70). Five patients had worse scores postoperatively. We concluded that, though SIS xenografting may be effective in other areas of the body for tendon healing, its use in reinforcement of large and massive rotator cuff repairs seems to be ineffective and does not improve clinical outcome.