Received: 29 March 2016 Revised: 6 September 2016 Accepted: 8 September 2016 DOI: 10.1002/pbc.26284 Pediatric Blood & Cancer The American Society of Pediatric Hematology/Oncology RESEARCH ARTICLE Comparative retrospective study on the modalities of biopsying peripheral neuroblastic tumors: a report from the Italian Pediatric Surgical Oncology Group (GICOP) Stefano Avanzini 1 Maria Grazia Faticato 1,2 Alessandro Crocoli 3 Calogero Virgone 4 Camilla Viglio 5 Elisa Severi 6 Anna Maria Fagnani 7 Giovanni Cecchetto 4 Giovanna Riccipetitoni 5 Bruno Noccioli 6 Ernesto Leva 7 Angela Rita Sementa 8 Girolamo Mattioli 1,2 Alessandro Inserra 3 1 Department of Pediatric Surgery, IRCCS G. Gaslini, Genoa, Italy 2 Department of Neuroscience, Rehabilitation, Ophtalmology, Gynecology, and Maternal- Infantile sciences (DINOGMI), University of Genoa, Genoa, Italy 3 Department of General and Thoracic Surgery, Bambino Gesù Children Hospital-Research Institute, Rome, Italy 4 Department of Pediatric Surgery, Padova University Hospital, Padova, Italy 5 Department of Pediatric Surgery, Buzzi Hospital, Milan, Italy 6 Department of Pediatric Surgery, Meyer Chil- dren Hospital, Florence, Italy 7 Department of Pediatric Surgery, Founda- tion IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy 8 Department of Pathology, IRCCS G. Gaslini, Genoa, Italy Correspondence Stefano Avanzini, Pediatric Surgery Department, IRCCS G. Gaslini, Genoa-Largo G. Gaslini, 5, 16147 Genoa, Italy. Email: stefanoavanzini@gaslini.org Abstract Background: Peripheral neuroblastic tumors are the most common extracranial solid neoplasms in children. Early and adequate tissue sampling may speed up the diagnostic process and ensure a prompt start of optimal treatment whenever needed. Different biopsy techniques have been described. The purpose of this multi-center study is to evaluate the accuracy and safety of the various examined techniques and to determine whether a preferential procedure exists. Methods: All children who underwent a biopsy, from January 2010 to December 2014, as a result of being diagnosed with a peripheral neuroblastic tumor, were retrospectively reviewed. Data collected included patients’ demographics, clinical presentation, intraoperative technical details, postoperative parameters, complications, and histology reports. The Mann–Whitney U and Fisher’s exact tests were used for statistical analysis. Results: The cohort included 100 patients, 32 of whom underwent an incisional biopsy (performed through open or minimally invasive access) (Group A), and the remaining 68 underwent multi- ple needle-core biopsies (either imaging-guided or laparoscopy/thoracoscopy-assisted) (Group B). Comparing the two groups revealed that Group A patients had a higher rate of complications, a greater need for postoperative analgesia, and required red blood cell transfusion more often. Overall adequacy rate was 94%, without significant differences between the two groups (100% vs. 91.2% for Group A and Group B, respectively, P = 0.0933). Conclusions: Both incision and needle-core biopsying methods provided sub-optimal to optimal sampling adequacy rates in children affected by peripheral neuroblastic tumors. However, the for- mer method was associated with a higher risk of both intraoperative and postoperative complica- tions compared with the latter. KEYWORDS biopsy, imaging-guided needle-core biopsy, minimally invasive surgery, neuroblastoma, pathology, pediatric Abbreviations: GICOP, Italian Group of Oncological Pediatric Surgery; IDRFs, image-defined risk factors; INPC, International Neuroblastoma Pathology Classification; INRG, International Neuroblastoma Risk Group; INRGSS, International Neuroblastoma Risk Group Staging System; MKI, mitosis-karyorrhexis index; NB, peripheral neuroblastic tumors 1 INTRODUCTION Peripheral neuroblastic tumors (NB) are the most common extracra- nial solid tumors in children and account for nearly 8% of all pediatric malignancies. They are responsible for at least 15% of all oncological deaths in children. NB derive from primitive neuroectodermal cells of Pediatr Blood Cancer 2017; 64: e26284 c  2016 Wiley Periodicals, Inc. 1 of 6 wileyonlinelibrary.com/journal/pbc