TY - JOUR
T1 - Examining the Impact of Biopsy Technique on Clinical and Pathologic Outcomes in Dermatofibrosarcoma Protuberans
T2 - An International, Multi-Institutional Study
AU - Winer, Leah K
AU - Fredette, Jordan D
AU - Hasler, Jill
AU - Akumuo, Rita
AU - Greco, Stephanie H
AU - von Mehren, Margaret
AU - Bartholomew, Alex J
AU - Blazer, Dan G
AU - Gabrielova, Lucie
AU - Adamkova, Dagmar
AU - Bernard-Bedard, Ericka
AU - Nessim, Carolyn
AU - Kollár, Attila
AU - Olariu, Radu
AU - Cencelj-Arnez, Romi
AU - Hompes, Daphne
AU - Ford, Samuel J
AU - Cardona, Kenneth
AU - Sato, Kenji
AU - Iwata, Shintaro
AU - Farma, Jeffrey M
AU - Villano, Anthony M
N1 - Publisher Copyright:
© Society of Surgical Oncology 2025.
PY - 2025/5
Y1 - 2025/5
N2 - BACKGROUND: The National Comprehensive Cancer Network (NCCN) guidelines recommend preoperative biopsy for diagnosing dermatofibrosarcoma protuberans (DFSP) but limited data support this approach. We characterized DFSP diagnostic practices and compared clinical outcomes based on technique.METHODS: Data were collected for adult patients who underwent resection for initial DFSP presentation between 2003 and 2021 at 10 international institutions. Patients were categorized by excisional versus preoperative biopsy (incisional, punch, core needle biopsies, or fine needle aspiration), and univariate and multivariable analyses were performed.RESULTS: The cohort included 321 patients, with excisional biopsy performed in 51.4% and preoperative biopsy performed in 48.6% of patients. Biopsy type was stable throughout the study period (p = 0.08). There were no differences in sex, disease presentation, or preoperative imaging. In unadjusted analysis, biopsy varied by practitioner specialty, with general surgeons performing nearly 50% of excisional biopsies. Despite similar planned circumferential margins and anatomic location, preoperative biopsy was associated with higher index R0 rate (60.1% vs. 78.6%), fewer total excisions, and fewer complications (38.2% vs. 25.6%, all p < 0.05). However, adjuvant radiotherapy (11.7% vs. 6.0%) and final R0 rates (91.5% vs. 88.4%) were comparable regardless of technique (p > 0.05). In adjusted analysis, excisional biopsy was associated with extremity tumors (odds ratio [OR] 1.79, confidence interval [CI] 1.21-2.66, p = 0.004), treatment in non-academic settings (OR 2.28, CI 1.10-4.73, p = 0.03), and inversely with preoperative imaging (OR 0.47, CI 0.24-0.93, p = 0.03).CONCLUSION: Preoperative biopsy is associated with margin-negative resection, fewer re-excisions, and reduced complications. Clinical suspicion of DFSP is paramount, and preoperative imaging may critically inform biopsy selection prior to index resection.
AB - BACKGROUND: The National Comprehensive Cancer Network (NCCN) guidelines recommend preoperative biopsy for diagnosing dermatofibrosarcoma protuberans (DFSP) but limited data support this approach. We characterized DFSP diagnostic practices and compared clinical outcomes based on technique.METHODS: Data were collected for adult patients who underwent resection for initial DFSP presentation between 2003 and 2021 at 10 international institutions. Patients were categorized by excisional versus preoperative biopsy (incisional, punch, core needle biopsies, or fine needle aspiration), and univariate and multivariable analyses were performed.RESULTS: The cohort included 321 patients, with excisional biopsy performed in 51.4% and preoperative biopsy performed in 48.6% of patients. Biopsy type was stable throughout the study period (p = 0.08). There were no differences in sex, disease presentation, or preoperative imaging. In unadjusted analysis, biopsy varied by practitioner specialty, with general surgeons performing nearly 50% of excisional biopsies. Despite similar planned circumferential margins and anatomic location, preoperative biopsy was associated with higher index R0 rate (60.1% vs. 78.6%), fewer total excisions, and fewer complications (38.2% vs. 25.6%, all p < 0.05). However, adjuvant radiotherapy (11.7% vs. 6.0%) and final R0 rates (91.5% vs. 88.4%) were comparable regardless of technique (p > 0.05). In adjusted analysis, excisional biopsy was associated with extremity tumors (odds ratio [OR] 1.79, confidence interval [CI] 1.21-2.66, p = 0.004), treatment in non-academic settings (OR 2.28, CI 1.10-4.73, p = 0.03), and inversely with preoperative imaging (OR 0.47, CI 0.24-0.93, p = 0.03).CONCLUSION: Preoperative biopsy is associated with margin-negative resection, fewer re-excisions, and reduced complications. Clinical suspicion of DFSP is paramount, and preoperative imaging may critically inform biopsy selection prior to index resection.
KW - Circumferential margins
KW - Dermatofibrosarcoma protuberans (DFSP)
KW - Excisional biopsy
KW - Preoperative biopsy
KW - Unplanned excision
UR - http://www.scopus.com/inward/record.url?scp=86000058969&partnerID=8YFLogxK
U2 - 10.1245/s10434-025-17011-7
DO - 10.1245/s10434-025-17011-7
M3 - Article
C2 - 40014211
SN - 1068-9265
VL - 32
SP - 3752
EP - 3762
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 5
M1 - e35468
ER -
