Sensitivity, Specificity, and Predictive Values of Tru-Cut(®) Biopsy in Grading Primary Localized Myxoid Liposarcomas of the Extremities

SIMPLE SUMMARY: Biopsy is an essential step in the diagnosis of myxoid liposarcoma (MLs) since the histological grade is a strong determinant of the appropriate treatment in the management of this pathology. The aim of our retrospective study was to investigate the diagnostic accuracy of Tru-cut(®) biopsy (TCB) and the potential impact on a patient’s survival in the case of misdiagnosis. We established that in MLs, diagnosis with TCB might differ from that of surgical specimens, with a histological grade concordance rate of 64% (Kappa 0.30). Neoadjuvant treatments were associated with pathological downgrading with a lower effect of chemotherapy alone compared to neoadjuvant-combined treatments, although such discordance did not modify the prognosis. In the group of patients not treated in neoadjuvant settings, the sensitivity and specificity of TCB were 57% and 100%, respectively. TCB results are useful in leading the clinician in the diagnostic pathway thought; the diagnosis of MLs should be supported by other diagnostic techniques. ABSTRACT: (1) Background: Histological diagnosis and tumor grading are major prognostic and predictive factors in soft tissue sarcomas (STS), as they dictate the treatment strategies with a direct impact on patient survival. This study aims to investigate the grading accuracy, sensitivity, and specificity of Tru-Cut(®) biopsy (TCB) in primary localized myxoid liposarcomas (MLs) of the extremities and its impact on patient prognosis. (2) Methods: Patients with ML undergoing TCB and a subsequent tumor resection between 2007 and 2021 were evaluated. Concordance between the preoperative assessment and definitive histology was calculated with a weighted Cohen’s kappa coefficient. Sensitivity, specificity, and diagnostic accuracy were calculated. (3) Results: Of 144 biopsies, the histological grade concordance rate was 63% (Kappa 0.2819). Neoadjuvant chemotherapy and/or radiotherapy impacted concordance with a downgrading effect in high-grade tumors. Among forty patients not treated in neoadjuvant settings, the sensitivity of TCB was 57%, the specificity was 100%, and the overall predictive values of positive and negative TCB were 100% and 50%, respectively. Misdiagnosis did not impact overall survival. (4) Conclusions: TCB may underestimate ML grading due to tumor heterogeneity. Neoadjuvant ChT and/or radiotherapy are associated with pathological downgrading; however, discordance in diagnosis does not modify patient prognosis because systemic treatment decision-making also includes other variables.