Vasudha Bhagat et al. Biopsy in Histopathological Diagnosis of Soft Tissue Sarcoma 960 International Journal of Medical Science and Public Health | 2013 | Vol 2 | Issue 4 SELECTION OF MODE OF BIOPSY IN HISTOPATHOLOGICAL DIAGNOSIS OF SOFT TISSUE SARCOMA DEPENDING ON DIAGNOSTIC ACCURACY AND FEASIBILITY: DEBATABLE ISSUE IN MODERN ERA Vasudha Bhagat, Kumarbhargav Kaptan, Reena Dudhat, Sonal Italiya, Mitesh Shah, Zarna Dhandha Department of Pathology, Government Medical College, Surat, Gujarat, India Correspondence to: Kumarbhargav Kaptan (dr.bhargavkaptan@gmail.com) DOI: 10.5455/ijmsph.2013.090720131 Received Date: 26.06.2013 Accepted Date: 09.07.2013 ABSTRACT Background: Biopsy method of choice is a controversy issue for diagnosis of soft tissue sarcoma which are traditionally been managed by wide excision surgery and radiotherapy. Chemotherapy is reserved for advanced cases. Aims & Objective: The objective of study was to evaluate diagnostic accuracy of various modes of biopsy focusing on image guided core needle biopsy (CNB). Material and Methods: Current study includes 50 cases of soft tissue sarcoma from January 2010 to October 2012. The Mode of biopsies included image guided CNB, open and excision biopsy. Effective accuracy of each was determined by accuracy of biopsy to provide adequate tissue for histopathological and other special examinations like immunohistochemistry to reach final diagnosis. Results: Out of total 50 cases CNB was done in 13 cases, open biopsy in 2 cases and in 35 cases excision biopsy was done. CNB was adequate in 92.31 % cases and 7.69 % cases it was inadequate. Open and excision biopsy were 100 % adequate. Conclusion: Image guided CNB is very helpful in early diagnosis and shows high accuracy especially for high-grade sarcoma. It is less invasive compared to others and differentiate benign from malignant. It is handful when preoperative diagnosis is essential for planning pre-operative chemotherapy especially in patients with primarily inoperable, advanced tumour with compromised performance status or recurrent tumour. But it should be properly directed and representative of whole tumour and require full radiological correlation by experienced hands. Tumours with myxoid pattern, lipomatous tumours and low grade sarcomas encounters lower diagnostic accuracy on CNB. Key-Words: Soft Tissue Sarcoma; Core Needle Biopsy; Excision Biopsy; Preoperative Diagnosis Introduction Due to growing tendency to perform least radical surgery and least invasive treatment number of major radical surgery specimen received to surgical pathology laboratory has decreased since last two decades. Given the prognostic and therapeutic importance of accurate diagnosis, a biopsy is essential and appropriate method to establish malignancy, to assess histological grade, and to determine the specific histological type of sarcoma, if possible. A treatment plan can then be designed that is tailored to a lesion’s predicted pattern of local growth, risk of metastasis, and likely sites of distant spread. [1] Representative and enough sample from a viable area of sarcoma is usually required for definitive diagnosis and accurate grading. [1] Tissue sampling can be accomplished by open incisional biopsy, fine- needle aspiration (FNA), image guided core needle biopsy (CNB) and excision biopsy. The choice of technique balances the invasiveness, risk, and cost of the procedure against the total amount of tissue obtained. Although open surgical biopsy is considered the reference standard, it is more expensive, may require hospitalization, and has a higher complication rate than image guided core needle biopsy. [2-4] Most limb masses are generally best sampled through a longitudinal incision, so that the entire biopsy tract can be completely excised at the time of definitive resection. Excisional biopsy should be avoided, particularly for lesions greater than 2 cm in size, since such an approach will make definitive re-excision more extensive due to the contamination of surrounding tissue planes. [1] For deep-seated lesions, image guided core needle biopsy approach may be used to establish a diagnosis. [1] When performing FNA, one runs the risk of insufficient tissue sampling. FNA is likely RESEARCH ARTICLE