Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.5
,
No
.2
,
Jun
e
2
016
, pp
. 13
4
~ 1
36
I
S
SN
: 225
2-8
8
0
6
1
34
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Accurati
on of Fin
e
Needle Aspirati
on Biops
y
in Mus
c
ulosk
e
let
a
l
Tumour
Ra
ha
dy
an
M
a
gets
ari
1,2
, He
ngkie
Mar
s
eno
1,2
, Z
i
krina A.
Lanodiyu
1,2
,
P
unto
Dewo
1,2
1
Department of Orthopaedics
an
d
Trau
mato
log
y
, Faculty
of
Medicine, Un
iv
ersitas
Gadjah
Mada, I
ndonesia
2
Dr. Sardji
to Ge
neral
Hospital
,
Yog
y
ak
arta
, Ind
onesia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received Sep 16, 2015
Rev
i
sed
Jan 28, 201
6
Accepted
Mar 30, 2016
Fine need
le
aspiration b
i
ops
y
(FNAB) has
been
reported
to b
e
th
e pref
erabl
e
choice of biops
y for musculoskeletal
tumour. While FNAB appears to have
advantages to
co
re biops
y
in th
e
aspect
of simplicity
and cost, th
e diagnostic
accur
a
c
y
s
hou
ld
be
the m
o
s
t
cr
it
ica
l
par
a
m
e
ter
i
n
det
e
rm
ining th
e cho
i
ce
of
biops
y
.
This res
earch w
a
s desig
n
ed to
ev
alu
a
te
the diagnostic
accuracy
of
fine ne
edle
aspi
ration
in m
u
sculoskelet
a
l tum
o
u
r
in Sardji
to Hospital from
2010 until 2014. This was a descriptive stud
y
fro
m
m
e
dical recor
d
in Sardjito
Hospital from
2010 until 2014
. The in
clusion
crit
eria
are m
u
sculoskel
e
tal
tum
ours in all age lev
e
l th
at h
a
s been perfor
m
ed FNAB with subsequent
operative tr
eatment and
confirmation of histopatholog
y
ex
amination in
Sardjito Hospit
al
. Ther
e were
41
ellig
ible
subjec
ts in this stud
y. C
oncordanc
e
diagnosis of FNAB and hi
stopathological examination
in all musculoskeletal
tum
o
r cases was found to be 86
%. In add
ition
,
t
h
e con
c
ordance
in soft tissue
tum
o
r cases was 94% with th
e d
e
ta
il as fo
llows:
giant
ce
ll
tum
o
r was 86%,
s
y
novial sar
c
oma was 50%
and
liposarco
ma was
50%. In
bone
tu
mours, the
accur
a
c
y
was found to be 60% with the de
tail
as follows: distribut
e
osteosarcoma was 60%, osteoch
ondrom
a was 50
% and chondrosarcoma was
50%. Our dat
a
showed that
accur
a
c
y
of
FNAB for
diagnosis of
musculoskeletal tumours was 86
% with
soft tissu
e tumour 94%, bone tumour
60% and other
s
93%. Ther
efo
r
e, Fine
n
eed
le aspiration bio
p
s
y
is still
important d
i
agn
o
sis tool
in
musculoskeletal tumours.
Keyword:
Diagnostic accuracy
Fi
ne needl
e
as
pi
rat
i
o
n bi
o
p
sy
Histopathological exam
ination
Medical rec
o
rd
Mu
scu
l
o
s
k
e
letal tu
m
o
r
Copyright ©
201
6 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Zi
kri
n
a
A
.
La
n
odi
y
u
,
Depa
rt
m
e
nt
of
Ort
h
o
p
ae
di
cs a
n
d
Tra
u
m
a
t
o
l
ogy
,
Dr Sardj
ito
Gen
e
ral Ho
sp
ital,
Jal
a
n
Kesehat
a
n
no
1
Se
ki
p,
T
e
l
:
+62
8
1
22
7
7
20
2
5
,
Fa
x:
+
6
2
2
7
4
55
3
1
4
3
,
Y
ogy
a
k
art
a
,
I
n
d
o
n
esi
a
Em
a
il: zik
r
in
a.lan
o
d
i
yu
158
@g
m
a
i
l
.co
m
1.
INTRODUCTION
Onc
o
l
o
gy
cas
es i
n
ort
h
o
p
a
e
di
c de
part
m
e
nt
nee
d
s highly
specialized
res
o
urces where
the gold
st
anda
rd
fo
r d
i
agn
o
si
n
g
m
u
scul
os
kel
e
t
a
l
t
u
m
o
r i
s
bi
opsy
.
Aft
e
r
radi
og
r
a
phi
c st
agi
n
g st
udy
i
s
carri
e
d
o
u
t
,
bi
o
p
sy
sh
o
u
l
d
be care
f
ul
l
y
pl
an
ned a
n
d
per
f
o
r
m
e
d by
t
h
e wel
l
-
t
r
ai
ned m
e
di
cal
doct
o
r
.
Thi
s
f
l
ow ca
n
det
e
rm
i
n
e t
h
e
cor
r
el
at
i
on
o
f
r
a
di
o
g
ra
p
h
i
c
an
d
hi
st
ol
o
g
i
c
fi
n
d
i
n
gs
[1]
.
In
o
r
der t
o
ac
hi
eve
pr
o
p
er m
a
nage
m
e
nt
of t
h
ose
pat
i
e
n
t
s and
pre
v
e
n
t
im
pro
p
er m
a
nagem
e
nt
t
h
at
can l
ead i
n
u
nne
cessary
am
put
at
i
ons a
nd m
o
r
t
al
i
t
y
,
l
o
n
g
-st
a
ndi
ng
recom
m
endat
i
ons
su
g
g
est
re
fer
r
i
n
g al
l
pat
i
e
nt
s t
h
at
are
s
u
sp
ect
ed t
o
ha
ve m
u
scul
os
ke
l
e
t
a
l
lesio
n
s
t
o
a
h
i
gh
-vo
l
u
m
e tertia
ry care cen
t
ers
th
at are
cap
a
b
l
e to
d
o
b
i
o
p
sy
an
d d
e
fin
itiv
e t
r
eatm
e
n
t
[2
].
In t
h
e
recent y
ears, t
h
ere
is a
para
digm
shift
whe
r
e
less
invasive
procedures are m
o
re
prefera
b
le due
t
o
t
h
ei
r a
d
vant
ages.
Des
p
i
t
e
of s
u
rgi
cal
ope
n
bi
o
p
sy
i
n
t
h
e
di
ag
n
o
si
s an
d
st
agi
n
g p
h
ase
,
perc
ut
ane
o
us
b
i
ops
y
u
s
ing
larg
e
g
a
u
g
e
n
e
ed
les
hav
e
g
a
in
attentio
n
in or
tho
p
aed
ic on
co
logy f
i
eld
s
. Th
is p
r
o
c
ed
ur
es are less
invasi
ve and
have lower m
o
rbidity rate com
p
ared with
open bi
opsy. If
sufficient
m
a
terial is succes
sfully
o
b
t
ain
e
d
,
d
i
agn
o
s
is can
b
e
m
a
d
e
i
n
8
0
t
o
98% of t
h
e cases, th
erefo
r
e it beg
a
n to con
s
titu
te th
e go
ld st
an
d
a
rd
[3]
.
I
n
a
d
di
t
i
on, t
h
e acc
u
r
ac
y
of
p
e
rc
ut
ane
ous
bi
o
p
sy
t
o
di
f
f
ere
n
ci
at
e
beni
gn
t
u
m
o
r
vers
us
sarc
om
a a
n
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
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6
Accur
a
t
i
o
n
of
Fi
ne N
eedl
e
As
pi
rat
i
o
n Bi
op
s
y
i
n
M
u
sc
ul
osk
e
l
e
t
a
l
Tu
mo
ur
i
n
..
.. (
R
ah
a
d
y
a
n
M
aget
s
ari
)
13
5
sarcom
a vers
u
s
ot
he
r m
a
l
i
gnanci
e
s are
rel
a
t
i
v
el
y
hi
g
h
.
Do
m
a
nski et al stated that th
e
co
m
b
in
atio
n
o
f
clin
ical
eval
uat
i
o
n, ra
d
i
ol
ogi
c dat
a
, and t
h
e
resul
t
o
f
fi
ne nee
d
l
e
aspi
rat
i
o
n bi
o
p
s
y
(FNAB
) are
suf
f
i
c
i
e
nt
t
o
d
eci
de
next
t
r
eat
m
e
nt
pr
oce
d
u
r
es
[4]
.
Howe
ver, the
r
e are se
veral
factors t
h
at
affe
ct the decision to do
pe
rcuta
n
eous
n
eed
le
b
i
op
sy.
Tho
s
e factors
are th
e exp
e
rien
ce of th
e op
erato
r
and
th
e
p
a
tien
t
’s con
d
ition
,
in
cl
u
d
i
n
g
p
a
tien
t
s
coagulation sta
t
e, the c
h
aracte
r
istics
of each l
e
sion, the
acce
ss route
[5].
In t
h
e cases o
f
m
u
scul
oskel
e
t
a
l
beni
g
n
l
e
si
on, de
fi
ni
t
e
di
ag
nosi
s
oft
e
n ca
n
not
be m
a
de
. On the ba
sis
of the e
v
aluati
on of
FNAB a
l
one, precise c
l
assificati
o
n
o
f
th
e m
u
scu
l
o
s
k
e
letal tu
m
o
r is d
i
fficu
lt to
mak
e
,
t
h
eref
o
r
e, co
nf
i
r
m
a
t
i
on and e
v
al
uat
i
o
n o
f
t
h
e hi
st
o
p
at
h
o
l
ogi
cal
exam
i
n
at
i
on i
s
essent
i
a
l
.
Howe
ve
r, on t
h
e
ot
he
r si
de, F
N
AB
of
b
one l
e
si
ons
has m
a
ny
adva
nt
ages.
The p
r
oced
ure
s
are sim
p
l
e
, l
e
ss ri
sky
,
i
n
e
x
pen
s
i
v
e,
and i
t
o
n
l
y
nee
d
a q
u
i
c
k
out
p
a
t
i
e
nt
pr
oced
ur
e. In t
h
e cases
of i
n
a
d
e
quat
e
m
a
t
e
ri
al
bei
ng
aspi
rat
e
d
or t
h
ere are
d
oub
t in
t
h
e exa
m
in
atio
n
result, th
e sam
p
les can
b
e
retak
e
n
o
n
d
i
fferen
t
[6
]
.
This resea
r
ch
was carried out to
evaluate
the diagnosti
c accuracy
of fine nee
d
le aspiration in
m
u
scu
l
o
s
k
e
let
a
l tu
m
o
u
r
in Sardj
ito
Ho
sp
ital
fro
m
2
0
1
0
un
til 2
014
.
2.
R
E
SEARC
H M
ETHOD
Th
is was ad
escrip
tiv
e stud
y
in
Sard
j
ito Ho
sp
ital,
Yog
y
ak
arta,
Indo
n
e
sia
fro
m
2
0
1
0
un
til 20
14
. The
data of the s
u
bjects
was
obtained from
the m
e
dical r
ecords of
t
h
e patients.
T
h
e inclusion
c
r
iteriswe
r
e
m
u
scu
l
o
s
k
e
let
a
l tu
m
o
u
r
s i
n
all ag
e lev
e
l; fin
e
n
e
ed
le
aspi
rat
i
on
bi
o
p
sy
h
a
s bee
n
pe
rf
or
m
e
d wi
t
h
s
ubs
eque
n
t
o
p
e
rativ
e treat
men
t
fo
llo
wed b
y
co
nfirm
a
ti
o
n
o
f
h
i
stop
atho
log
i
cal ex
am
i
n
atio
n
i
n
Sardjito
Gen
e
ral Hosp
ital.
The excl
usion criterias were
patients with m
u
sculoske
let
a
l tu
m
our without receivi
ng surgery treatment or
ope
n s
u
r
g
e
r
y
bi
o
p
sy
.
Du
ri
n
g
20
1
0
-
2
01
4,
fi
ne ne
edl
e
as
pi
rat
i
on
bi
o
p
sy
has
been
pe
rf
o
r
m
e
d i
n
12
9
p
a
t
i
e
nt
s
suffer from
musc
ulos
keletal tu
m
o
rs
. The
diagnostic accuracy was c
o
m
p
ared in 41 patients underwe
nt
con
s
ecut
i
v
e
fi
n
e
needl
e
aspi
ra
t
i
on an
d hi
st
o
p
a
t
hol
o
g
i
cal
exa
m
i
n
at
i
on of t
h
e
m
u
scul
os
kel
e
t
a
l
t
u
m
our. Se
x an
d
age
of
t
h
e
pat
i
e
nt
s w
e
re
seen
a
n
d
t
h
e
di
ag
n
o
si
swasc
o
m
p
ared
bet
w
ee
n
ope
n
sur
g
e
r
y
bi
opsy
an
d F
N
AB
res
u
l
t
s
.
3.
RESULTS
A
N
D
DI
SC
US
S
I
ON
Based
on
th
e med
i
cal reco
rds d
a
ta, th
ere are 1
2
9
p
a
tien
t
s with
m
u
scu
l
o
s
k
e
letal tu
m
o
u
r
s treated
in
Sar
d
ji
t
o
Ge
ner
a
l
Hos
p
i
t
a
l
fr
om
201
0 t
o
2
0
1
4
.
Fr
om
t
h
e ret
r
ospe
ct
i
v
e
revi
rew
,
f
o
rt
y
one
pat
i
e
nt
s
wer
e
ope
rat
e
d a
n
d p
e
rf
orm
e
d hi
st
o
p
at
h
o
l
o
gi
cal
exam
i
n
at
i
on. C
onc
o
r
da
nce
di
agn
o
si
s
of
fi
ne
needl
e
as
pi
rat
i
on a
n
d
histopathological exam
inati
o
n
w
a
s
f
oun
d in 86
% cases.
Table
1. T
h
e
c
h
aracteristics
of the
sujects
Characteristics
n
(%)
Sex
M
a
le
20 (
48.
88 %)
Fem
a
le
21 (
51.
22 %)
Age
<20
6 (
14.
63 %)
20-
40
12 (
29.
27 %)
>40
23 (
56.
10 %)
Diagnosis
Osteosar
co
m
a
5 (
12.
20 %)
Giant Cell
T
u
m
o
r
7 (
17.
07 %)
Osteochondr
o
m
a
2 (
4
.
88 %)
Chondr
osar
co
m
a
2 (
4
.
88 %)
Fibr
ous dy
splasia
1 (
2
.
44 %)
M
a
lignant Giant C
e
ll T
u
m
o
r
1 (
2
.
44 %)
M
e
lano
m
a
M
a
lign
a
1 (
2
.
44 %)
M
a
lignant soft tissue
1 (
2
.
44 %)
Rhabdom
y
o
sar
c
o
m
a
1 (
2
.
44 %)
Benign so
ft tissue
1 (
2
.
44 %)
Sy
novial Sar
c
o
m
a
1 (
2
.
44 %)
M
i
x L
i
posar
co
m
a
1 (
2
.
44 %)
Pri
m
itive
neuroderm
a
l
1 (2.44 %)
M
B
D
16 (
39.
2 %)
There we
re
2
s
u
bjects out of 5
Oste
osarcom
a
subject
s
th
at h
a
v
e
d
i
fferen
t FNAB
resu
lts. Th
e
resu
lts
were
fi
broplast
i
c osteosarc
o
ma in
one case
and the
r
e
we
re
n
o
t
f
o
un
d
any
m
a
li
gnant
cel
l
s
i
n
a
n
ot
he
r.
F
o
r
2
patients of oste
ochondrom
a,
and
c
hondrosarcom
a
, both cas
es showed
50%
accuracy
of FNAB. Only one
case
was f
o
un
d t
o
be di
ffe
rent
fo
r 7 case
s
o
f
G
i
ant
C
e
l
l
Tum
o
rs
. H
o
weve
r,
t
h
ere
were ca
ses t
h
at
ha
ve
10
0
%
accuracy
of t
h
e
result of the
FNAB.
The
r
e are Maligna
nt
Giant Cell Tum
o
r, Maligna
nt Melanom
a, Maligna
nt
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I
S
SN
:
2
252
-88
06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
1
6
:
13
4 – 1
3
6
13
6
soft
t
i
ssue
,
R
h
abd
o
m
y
osarco
m
a
, B
e
ni
gn
S
o
ft
Ti
ss
ue, Sy
no
vi
al
Sarc
om
a, M
i
x l
i
posa
r
com
a
, and P
r
i
m
i
t
i
v
e
neurode
rm
al for
1 cases
each,
and 16 ca
ses
of m
e
tastatic bone disease.
3.
1.
Discussion
C
o
m
p
ared
wi
t
h
o
p
en
s
u
r
g
i
cal
bi
o
p
sy
,
FN
A
B
ha
ve m
a
ny
adva
nt
age
s
.
The
p
r
oce
d
ures
ca
n
be
d
one
i
n
o
u
t
p
a
tien
t
settin
g, it is easy t
o
p
e
rform
an
d
d
o
e
s
no
t n
e
ed co
m
p
licated
p
r
ep
aratio
n, th
e p
r
o
c
ed
ures can
be
do
ne t
h
e
ve
ry
day
t
h
e
pat
i
e
nt
i
s
re
fer
r
e
d
, a
n
d t
h
e ri
s
k
fo
r
seriou
s co
m
p
li
catio
n
s
is qu
ite lo
w. Based
o
n
the
FNAB ex
am
in
atio
n
,
it is eas
y to
tak
e
m
a
te
rial sa
m
p
les fro
m
d
i
fferen
t
parts o
f
th
e m
u
scu
l
o
s
k
e
lestal tu
m
o
rs,
th
erefore, so
meti
m
e
s th
e h
e
terog
e
n
i
city o
f
t
h
e tu
m
o
r ch
aracteristics can
be ru
le ou
t [7
].
In t
h
e
Uni
t
e
d St
at
es, FN
AB
i
s
com
m
onl
y
use
d
at
m
u
scul
os
kel
e
t
a
l
oncol
ogy
cent
e
rs f
o
r
doc
um
entation of m
e
tastases
and local
recurrences
, es
pecia
lly if prior sa
m
p
les are
availa
ble for com
p
arison.
Howev
e
r, th
e ro
le
of FNAB in
t
h
e evalu
a
tio
n
of
prim
ary soft tissuesa
r
com
a
s re
m
a
ins controversial
an
d
lim
ited
[8
]. Perfo
r
m
e
d
b
e
d
s
id
e, it p
r
o
v
i
d
e
s resu
lts
with
in
30
min
u
t
es an
d
canfacilit
ate ad
d
itio
n
a
l stag
ing
or t
r
eatm
e
nt decisions
duringt
h
e initia
l clinic visit. Although F
NAB
relia
bly distinguis
h
e
s
m
e
senchym
al from
metastat
ic tu
mo
rs, m
a
l
i
g
n
a
n
t
fro
m
b
e
n
i
gn
lesio
n
s
, an
d
h
i
gh- fro
m
lo
w-g
r
ad
e sarco
m
as,some stu
d
y
critic
ized
for its in
ab
ility
to
d
i
fferen
c
iate sub
t
yp
esarcomas p
r
ecisely [2
].
Ou
r
dat
a
i
n
vol
vi
n
g
12
9
pat
i
e
nt
s wi
t
h
m
u
scul
os
kel
e
t
a
l
t
u
m
ours dem
ons
t
r
at
ed t
h
at
c
o
n
c
or
da
nce
of
fi
ne nee
d
l
e
as
pi
rat
i
o
n bi
o
p
s
y
wi
t
h
fi
nal
hi
st
opat
hol
ogy
e
x
am
i
n
at
i
on
wa
s
8
6
%.
Ni
net
e
en pat
i
e
nt
wi
t
h
s
o
f
t
t
i
ssue t
u
m
our
per
f
o
r
m
e
d con
s
ecut
i
v
e fi
ne n
eedl
e
aspi
rat
i
o
n an
d fi
nal
hi
st
opat
hol
ogi
cal
e
x
am
i
n
at
i
on wa
s 94%
,
d
i
str
i
bu
te w
i
t
h
d
i
agno
sis accu
r
acy
o
f
g
i
an
t
cell tu
m
o
u
r
86%, synov
ial sar
c
o
m
a 5
0
%
and
lipo
s
ar
co
m
a
5
0
%.
Ten patients
with bone tum
ours the diagnostic
accuracy was 60%, distribute
osteosa
r
com
a
60%
,
ost
e
oc
h
o
n
d
r
o
m
a
50%
an
d c
h
o
n
d
r
o
sa
rcom
a 5
0
%.
Thi
s
res
u
l
t
of t
h
i
s
st
u
d
y
was
conc
o
r
da
nce
w
i
t
h
anot
her st
u
d
y
by
N
g
et
al
. Fi
ne-
n
ee
dl
e aspi
rat
i
o
n i
s
usually accepted for
doc
umentation
of metastases and
lo
cal recurre
nces, especially if prior sam
p
les are
available for c
o
m
p
arison. 16 cases of m
e
tastastic bone
di
sease in this s
t
udy we
re shown t
o
ha
ve positive
resu
lts i
n
th
e FNAB.
Howev
e
r, FNAB is n
o
t
witho
u
t
po
ten
tial p
itfalls th
at can
l
ead
to
missd
iag
n
o
s
is. False neg
a
tiv
e resu
lt
still o
ccu
rs. The p
itfalls also
mig
h
t
b
e
du
e t
o
th
e lim
itat
i
o
n
o
n
th
e ev
al
uatio
n
o
f
tissu
e
arch
itecture, an
d th
e
sam
p
les are in
adequate for a
n
cillary, cytogenic, m
o
l
ecular, or im
m
unohistochem
i
cal studies [9]. Although
the acc
uracy i
s
relatively hi
gh, im
prov
ement is
require
d
to im
prove t
h
e
accuracy of fine nee
d
le
as
piration
bi
o
p
sy
.G
ui
dan
ce usi
n
g com
put
e
d
t
o
m
ogra
phy
d
u
ri
ng sa
m
p
li
ng an
d sa
m
p
l
e
aspi
rat
i
o
n co
ul
d i
m
pro
v
e t
h
e
sen
s
itiv
ity
o
f
fi
n
e
n
eed
le asp
i
ratio
n
b
i
op
sy
[5].
4.
CO
NCL
USI
O
N
Our data showed that accura
cy of
fine nee
d
le aspiration biopsy
for dia
g
nosis of m
u
s
c
ulos
keletal
t
u
m
ours wa
s 8
6
%
wi
t
h
so
ft
t
i
ssue t
u
m
our
9
4
%,
b
one t
u
m
o
u
r
60% a
n
d
ot
he
rs 9
3
%
.
T
h
ere
f
o
r
e,
fi
ne
needl
e
asp
i
ration
b
i
opsy is still i
m
p
o
r
tan
t
d
i
agn
o
s
is
to
o
l
in m
u
scu
l
o
s
keletal tu
m
o
u
r
s.
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NC
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