Comparative accuracy of core-needle and open biopsy in diagnosis, subtyping, and grading of head and neck bone and soft tissue sarcomas.
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Head and neck sarcomas are rare and diverse tumours with limited published literature. Choosing a precise biopsy technique is vital for accurate diagnosis and therapeutic decisions. This study aimed to compare the accuracy of two commonly used techniques, core needle biopsy (CNB) and open biopsy (OB), in histological diagnosis (benign versus malignant), subtyping, and grading of bone and soft tissue sarcomas. In this retrospective study, sarcoma cases discussed at head and neck multidisciplinary team (MDT) meetings between January 2018 and April 2024 were reviewed. Inclusion criteria were cases performed with either CNB or OB, with available diagnostic and final histopathology reports. Ninety cases were included in the study. The accuracy of OB in determining benign versus malignant diagnosis, histological type, and subtype was 95%, 90%, and 85%, respectively. There was no statistically significant difference when compared with CNB, with results of 86%, 76 % and 76%, respectively. OB was significantly superior to CNB in terms of tumour grading (87% vs 62%) and this was statistically significant (p = 0.007). While OB may be preferable for bone sarcoma due to sampling challenges, CNB is a feasible, less invasive first-line option for soft tissue sarcomas. Biopsy tract excision or targeted radiotherapy is recommended to minimise the risk of tumour cell seeding. Optimal sample quality and sarcoma specialist histopathology opinion further enhances diagnostic accuracy. CNB is an accurate, minimally invasive, and safe diagnostic modality in cases of head and neck bone and soft tissue sarcoma. The authors recommend a non-inferiority trial to definitively establish this in comparison with OB.