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:
|
Location of sample |
Extraosseus component:
|
Recommended Biopsy |
Core biopsy:
|
Biopsy scar |
Should be placed so it can be excised at a later date if necessary:
|
Adverse effects of a poor biopsy |
Delay in diagnosis due to insufficient material
Complications:
|
