Aims and objectives
Several retroperitoneal masses (well-differentiated liposarcomas,
adrenal adenomas) have a relatively pathognomic imaging findings that obviate the need for biopsies while others are indeterminate by imaging.
While the radiological appearance of a retroperitoneal mass plays a significant role in management,
the histologic diagnosis may be the most helpful in guiding treatment.
The purpose of this study is to assess whether prior knowledge of the histological diagnosis of a surgically resected unknown retroperitoneal mass would have changed clinical management.
Methods and materials
Patient population: Patients that underwent biopsy and/or surgical resection of retroperitoneal masses at a single institution from 01/2009 to 12/2017 were included in this study.
All patients underwent a pre-surgical MRI or CT study.
Pre-procedural chemotherapy or radiotherapy was not performed.
Data acquisition: Patient age and sex,
preoperative history and physical examination,
and pathology data were collected.
The histological diagnosis of the resected mass was compared to the radiologic and surgical differential diagnosis prior to resection.
Evaluation: All cases were anonymized...
170 patients underwent biopsy and/or resection of a retroperitoneal mass,
of whom 44 (25.9%) patients went directly to surgical resection without a pre-surgical biopsy (Fig 1).
5/44 (11.4%) (p = 0.000974) patients would have had a change in clinical management if the histology of the mass was known prior to resection.
These 5 patients had on average a 7.6 (SD 6.4) day length of hospital stay and had on average a 40.3 (SD 25.7) day delay to receiving appropriate therapy (Table 1).
Two representative cases...
Retroperitoneal masses that are not consistent with a well-differentiated liposarcoma based on imaging should be biopsied prior to surgery.
There was a significant change in clinical management if the retroperitoneal mass histologic diagnosis was known prior to resection.
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