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Ewing Sarcoma





Biopsies should be planned and performed very carefully

A poorly placed biopsy leads to many problems:


Complications of a poor biopsy:

  • Delay in diagnosis (insufficient material)
  • Pathologic bone fracture
  • Transverse biopsy scar often results in:
    • Adequate re-excision of the tumor bed is impossible
    • Effective post-operative radiation therapy (RT) is impossible - RT field is too large
  • Extensive contamination of tissue planes by hematoma. 

A core biopsy is usually sufficient to obtain enough material for diagnosis.  It is the best option for potential limb-sparing surgery because there is less local contamination than an open biopsy. 

The biopsy scar should be placed:

  • So that it can be excised at a later date if necessary
  • If RT is planned, the biopsy scar can be included in the RT treatment volume and a longitudinal strip of the limb can still be spared 


Summary of ES Surgical Biopsy Principles:

Preoperative procedure Identify most accessible area of tumor:
    • usually soft tissue mass
      • tumor peripherally is less likely to be necrotic
      • avoid further damage to bone


Location of sample

Extraosseus component:
    • bony defect may not re-ossify if RT is required
    • more likely to fracture after RT


Recommended Biopsy

Core biopsy:
    • generally sufficient to get enough material for diagnosis
    • less local contamination than open biopsy, therefore may be the best option for limb-sparing treatment


Biopsy scar

Should be placed so it can be excised at a later date if necessary:
  • Plan so that a longitudinal strip of the limb may be spared if radiation is planned

Adverse effects of a poor biopsy

Delay in diagnosis due to insufficient material



  • Pathologic bone fracture
  • Transverse scar
  • Extensive contamination of tissue planes by hematoma




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