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)
- 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.
There are three different types of biopsy:
- Fine needle aspiration biopsy
- Aspiration of cells and tissue fragments through a needle
- unlikely to obtain sufficient pathological material using this
- Core needle biopsy
- A core of tissue obtained through a needle (Tru-cut, or like brand).
- Open incisional biopsy
- Removal of a small wedge of tissue from a larger tumor mass
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 carefully 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 Surgical Biopsy Principles:
| Pre-operative procedure | Identify most accessible area of tumor:
|
Location of sample |
If the tumor has extended to involve bone, biopsy soft tissue mass because:
|
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:
|
References:
Core needle biopsy for diagnosis of extremity soft tissue sarcoma.
Heslin MJ, Lewis JJ, Woodruff JM, Brennan MF.
