A Comparison of Commonly Utilized Diagnostic Biopsy Techniques for Pediatric Patients With Cancer: A Systematic Review by the APSA Cancer Committee

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

doi:10.1016/j.jpedsurg.2024.161893

A Comparison of Commonly Utilized Diagnostic Biopsy Techniques for Pediatric Patients With Cancer: A Systematic Review by the APSA Cancer Committee

J Pediatr Surg. 2024 Sep 2;60(2):161893. doi: 10.1016/j.jpedsurg.2024.161893. Online ahead of print.

Authors

Martha Teke¹, Barrie S Rich², Ashley Walther³, Dana Schwartz⁴, Lucas A McDuffie⁵, Gisela Butera⁶, Jonathan P Roach⁷, David H Rothstein⁸, Dave R Lal⁹, Kimberly Riehle⁸, Andres Espinoza¹⁰, Nicholas Cost⁷, Elisabeth Tracy¹¹, David Rodeberg¹², Timothy Lautz¹³, Jennifer H Aldrink⁴, Erin G Brown¹⁴

Affiliations

¹ Department of Surgery, University of Texas at Southwestern Medical Center, Dallas, TX, USA.
² Division of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA.
³ Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
⁴ Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.
⁵ Division of Pediatric General and Thoracic Surgery, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, USA.
⁶ National Institutes of Health Library, Office of Research Services, U.S. Department of Health and Human Services, Bethesda, MD, USA.
⁷ Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
⁸ Dept of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA.
⁹ Division of Pediatric Surgery, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI, USA.
¹⁰ Divisions of Pediatric Surgery and Surgical Research, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
¹¹ Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
¹² Division of Pediatric Surgery, Kentucky Children's Hospital, Department of Surgery, University of Kentucky College of Medicine, Lexington KY, USA.
¹³ Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA.
¹⁴ Division of Pediatric Surgery, Department of Surgery, University of California Davis Children's Hospital, Sacramento, CA, USA. Electronic address: egbrown@ucdavis.edu.

PMID: 39317569
DOI: 10.1016/j.jpedsurg.2024.161893

Abstract

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.

Level of evidence: Treatment study, Level III.

Keywords: Children with cancer; Core needle biopsy; Diagnostic techniques; Pediatric cancer; Pediatric malignancies; Surgical biopsy.

Publication types

Review