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Multicenter Study
. 2025 May;32(5):3752-3762.
doi: 10.1245/s10434-025-17011-7. Epub 2025 Feb 27.

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

Leah K Winer  1 , Jordan D Fredette  2 , Jill Hasler  2 , Rita Akumuo  3 , Stephanie H Greco  1 , Margaret von Mehren  4 , Alex J Bartholomew  5 , Dan G Blazer  5 , Lucie Gabrielova  6 , Dagmar Adamkova  6 , Ericka Bernard-Bedard  7 , Carolyn Nessim  7 , Attila Kollár  8 , Radu Olariu  9 , Romi Cencelj-Arnez  10 , Daphne Hompes  11 , Samuel J Ford  12 , Kenneth Cardona  13 , Kenji Sato  14 , Shintaro Iwata  14 , Jeffrey M Farma  1 , Anthony M Villano  15
Affiliations
Multicenter Study

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

Leah K Winer et al. Ann Surg Oncol. 2025 May.

Abstract

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.

Keywords: Circumferential margins; Dermatofibrosarcoma protuberans (DFSP); Excisional biopsy; Preoperative biopsy; Unplanned excision.

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Conflict of interest statement

Disclosure: Margaret von Mehren reports Advisory Board participation and support from Deciphera LLC, Boerhinger Manheim, GSK, and Exegesis. Leah K. Winer, Jordan D. Fredette, Jill Hasler, Rita Akumuo, Stephanie H. Greco, Alex J. Bartholomew, Dan G. Blazer, Lucie Gabrielova, Dagmar Adamkova, Ericka Bernard-Bedard, Carolyn Nessim, Attila Kollár, Radu Olariu, Romi Cencelj-Arnez, Daphne Hompes, Samuel J. Ford, Kenneth Cardona, Kenji Sato, Shintaro Iwata, Jeffrey M. Farma, and Anthony M. Villano have no disclosures to report that may be relevant to the contents of this study.

References

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