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Examining the Impact of Biopsy Technique on Clinical and Pathologic Outcomes in Dermatofibrosarcoma Protuberans: An International, Multi-Institutional Study

LK. Winer, JD. Fredette, J. Hasler, R. Akumuo, SH. Greco, M. von Mehren, AJ. Bartholomew, DG. Blazer, L. Gabrielova, D. Adamkova, E. Bernard-Bedard, C. Nessim, A. Kollár, R. Olariu, R. Cencelj-Arnez, D. Hompes, SJ. Ford, K. Cardona, K. Sato, S....

. 2025 ; 32 (5) : 3752-3762. [pub] 20250227

Language English Country United States

Document type Journal Article, Multicenter Study

Persistent link   https://www.medvik.cz/link/bmc25015941

Grant support
P30CA006927 NCI NIH HHS - United States
P30CA006927 NCI NIH HHS - United States

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.

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$a 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.
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$a Fredette, Jordan D $u Division of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, PA, USA
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$a Hasler, Jill $u Division of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, PA, USA
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$a Akumuo, Rita $u Department of General Surgery, Temple University Hospital, Philadelphia, PA, USA
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$a von Mehren, Margaret $u Division of Hematology and Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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$a Olariu, Radu $u Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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$a Cencelj-Arnez, Romi $u Division of Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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