E2502. Hand/Finger Ultrasound-Guided Percutaneous Core Needle Biopsies Distal to the Radiocarpal Joint: A Safe Procedure with High Diagnostic Yield
  1. Stephanie Magoon; University of Miami Miller School of Medicine
  2. Vanessa Peters; University of Miami Miller School of Medicine
  3. Felipe Ferreira de Souza; Sylvester Comprehensive Cancer Center; University of Miami
  4. David Chen; University of Miami
  5. Patrick Owens; University of Miami
  6. Juan Pretell-Mazzini; University of Miami
  7. Ty Subhawong; Sylvester Comprehensive Cancer Center; University of Miami
To determine the diagnostic yield and complication rates of ultrasound-guided percutaneous needle biopsies of soft tissue masses in the hand and fingers.

Materials and Methods:
In this single institution IRB-approved retrospective study, radiology reports from all ultrasound-guided procedures between 5/21/2014 and 3/17/2022 were queried for keywords including “hand,” OR “finger,” AND “biopsy.” Only soft tissue tumors were included. We excluded bone biopsies, cases where only fine-needle aspiration (FNA) or cyst aspiration was performed, and those that were proximal to the radiocarpal joint. Patient demographics, lesion size and location, biopsy needle gauge and the number of cores obtained were recorded. Size of needle, cores sampled, and biopsy technique were determined by the radiologist performing the procedure. The final pathology of the mass excision was then compared to the core needle biopsy (CNB) for each patient who underwent subsequent surgical excision. The time interval between the CNB and surgery was also noted as well as any complications that occurred within 30 days of CNB.

Sixty-six patient records were reviewed, and thirty-seven patients met inclusion criteria. The mean age was 55, with a range between 19 - 78, 65% of which were women. Maximum lesion diameter averaged 1.45 cm with a range between 0.4 to 4.3 cm. The frequency of needle gauges used was 14G (14%), 16G (24%), 18G (38%), 20G (11%), and “not reported” (14%). The mean number of tissue cores obtained was 2.9 (std dev 1.2; range 1 - 6), excluding 9 cases that reported “multiple.” A histologic diagnosis was rendered in 100% of CNB procedures, with the most frequent diagnoses being tenosynovial giant cell tumor (TGCT) at 30%, ganglion cyst at 11%, and peripheral neural sheath tumor (neurofibroma), hemangioma, and fibrofatty tissue each at 8%. CNB was 100% sensitive in detecting the three (8%) malignancies: myxoinflammatory fibroblastic sarcoma (recurrent), carcinosarcoma, and metastatic squamous cell carcinoma. Of the 37 tumors that were biopsied, 16 were surgically excised. One excised angiomyoma was initially diagnosed as hemangioma on multiple CNB, but it did not alter management. Additionally, an epidermal inclusion cyst was diagnosed with multiple CNBs, while the final surgical excision result was a pilar cyst. All other histologic results were concordant for a diagnostic yield of 92%. There was a mean interval of 108 days between CNB and surgical excision and a mean of 29 days between CNB and surgical excision for the three malignancies. Only two minor CNB complications occurred, one of which was post-procedural paresthesia from a TGCT encasing the digital nerve, which has diminished over time but is still ongoing. The other complication was post-biopsy bruising from palmar fibromatosis, which has since resolved.

Given that three malignancies were found, which consisted of 8% of the total biopsies obtained, performing ultrasound-guided CNBs of soft tissue masses in the hand and fingers prior to surgery appears justifiable.