Biopsy can either be:
- An incisional biopsy under general anaesthesia or
- A core needle biopsy performed with image guidance and local anaesthesia
Core biopsies are more cost-effective and have a lower risk to the patient. However, they rely on highly skilled musculoskeletal pathologists to interpret and are occasionally non-diagnostic, leading to a second (usually open) biopsy to get a diagnosis. Each specialist centre will have their own preferred biopsy protocol depending on their resources.
Fine needle aspirates have no role in any bone or soft tissue tumour, and only serve to contaminate surrounding tissues.
Biopsy Placement is Critical. Poorly placed biopsies jeopardize opportunities for limb salvage and can affect the chance of cure.
No attempt at biopsy should be made prior to referral
Osteosarcoma cells are highly transplantable and all tissues along the biopsy tract are potentially contaminated.
At the time of surgery the biopsy tract is excised in continuity with the specimen. For this reason the biopsy must be placed along the line of definitive resection incision.
All biopsies should be done under the supervision of the surgeon who will do the definitive resection, who will know where the definitive surgical incision is going to be (not always intuitive).