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Biopsy Considerations

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Metastatic Bone Disease

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Abstract

The diagnosis of metastatic bone disease must be confirmed histologically prior to surgical intervention for an impending or realized pathologic fracture. Even in a patient with a known history of metastatic carcinoma it is appropriate to obtain a biopsy to rule out other potential etiologies of osseous lesions. Failure to obtain a confirmatory biopsy creates the potential for errantly operating on a primary bone sarcoma, the consequences of which can be devastating.

A biopsy is a component of a complete preoperative diagnostic evaluation. It should be preceded by a clinical and radiographic evaluation, enabling the determination of the tissue of origin and burden of skeletal disease. Regardless of whether the biopsy is performed in an open or percutaneous manner, the general principles of musculoskeletal biopsies are the same and must be respected for optimal patient outcome.

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References

  1. Kasraeian S, Allison DC, Ahlmann ER, Fedenko AN, Menendez LR. A comparison of fine-needle aspiration, core biopsy, and surgical biopsy in the diagnosis of extremity soft tissue masses. Clin Orthop Relat Res. 2010;468(11):2992–3002.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Bickels J, Dadia S, Lidar Z. Surgical management of metastatic bone disease. J Bone Joint Surg Am. 2009;91(6):1503–16.

    Article  PubMed  Google Scholar 

  3. Clayer M, Duncan W. Importance of biopsy of new bone lesions in patients with previous carcinoma. Clin Orthop Relat Res. 2006;451:208–11.

    Article  PubMed  Google Scholar 

  4. Duckworth AD, Beggs I, Salter DM, Patton JT, Porter DE. Multifocal primary bone sarcoma in the elderly: a rare case and review of the literature. Scott Med J. 2012;57(1):60.

    Article  CAS  PubMed  Google Scholar 

  5. Bacci G, Picci P, Ferrari S, Mercuri M, Briccoli A, Donati D, et al. Synchronous multifocal osteosarcoma: results in twelve patients treated with neoadjuvant chemotherapy and simultaneous resection of all involved bones. Ann Oncol. 1996;7(8):864–6.

    Article  CAS  PubMed  Google Scholar 

  6. Krajca-Radcliffe JB, Nicholas RW, Lewis JM. Multifocal epithelioid hemangioendothelioma in bone. Orthop Rev. 1992;21(8):973–5. 8.

    CAS  PubMed  Google Scholar 

  7. Ladenstein R, Potschger U, Le Deley MC, Whelan J, Paulussen M, Oberlin O, et al. Primary disseminated multifocal Ewing sarcoma: results of the Euro-EWING 99 trial. J Clin Oncol. 2010;28(20):3284–91.

    Article  CAS  PubMed  Google Scholar 

  8. Arkader A, Huvos AG, Healey JH. Multifocal synchronous low-grade intramedullary and juxtacortical osteogenic sarcoma. Clin Orthop Relat Res. 2007;465:265–70.

    PubMed  Google Scholar 

  9. Dupuy DE, Rosenberg AE, Punyaratabandhu T, Tan MH, Mankin HJ. Accuracy of CT-guided needle biopsy of musculoskeletal neoplasms. Am J Roentgenol. 1998;171(3):759–62.

    Article  CAS  Google Scholar 

  10. Didolkar MM, Anderson ME, Hochman MG, Rissmiller JG, Goldsmith JD, Gebhardt MG, et al. Image guided core needle biopsy of musculoskeletal lesions: are nondiagnostic results clinically useful? Clin Orthop Relat Res. 2013;471(11):3601–9.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Rougraff BT, Kneisl JS, Simon MA. Skeletal metastases of unknown origin. A prospective study of a diagnostic strategy. J Bone Joint Surg Am. 1993;75(9):1276–81.

    CAS  PubMed  Google Scholar 

  12. Orita Y, Sugitani I, Matsuura M, Ushijima M, Tsukahara K, Fujimoto Y, et al. Prognostic factors and the therapeutic strategy for patients with bone metastasis from differentiated thyroid carcinoma. Surgery. 2010;147(3):424–31.

    Article  PubMed  Google Scholar 

  13. Kickuth R, Waldherr C, Hoppe H, Bonel HM, Ludwig K, Beck M, et al. Interventional management of hypervascular osseous metastasis: role of embolotherapy before orthopedic tumor resection and bone stabilization. Am J Roentgenol. 2008;191(6):W240–7.

    Article  Google Scholar 

  14. Rehak S, Krajina A, Ungermann L, Ryska P, Cerny V, Talab R, et al. The role of embolization in radical surgery of renal cell carcinoma spinal metastases. Acta Neurochir. 2008;150(11):1177–81. discussion 81.

    Article  CAS  PubMed  Google Scholar 

  15. Kato S, Murakami H, Takeuchi A, Demura S, Yoshioka K, Kawahara N, et al. Fifteen-year survivor of renal cell carcinoma after metastasectomies for multiple bone metastases. Orthopedics. 2013;36(11):e1454–7.

    Article  PubMed  Google Scholar 

  16. Lin PP, Mirza AN, Lewis VO, Cannon CP, Tu SM, Tannir NM, et al. Patient survival after surgery for osseous metastases from renal cell carcinoma. J Bone Joint Surg Am. 2007;89(8):1794–801.

    Article  PubMed  Google Scholar 

  17. Coleman RE. Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res. 2006;12(20 Pt 2):6243s–9s.

    Article  PubMed  Google Scholar 

  18. Clark CR, Morgan C, Sonstegard DA, Matthews LS. The effect of biopsy-hole shape and size on bone strength. J Bone Joint Surg Am. 1977;59(2):213–7.

    CAS  PubMed  Google Scholar 

  19. Mankin HJ, Mankin CJ, Simon MA. The hazards of the biopsy, revisited. Members of the Musculoskeletal Tumor Society. J Bone Joint Surg Am. 1996;78(5):656–63.

    CAS  PubMed  Google Scholar 

  20. den Heeten GJ, Oldhoff J, Oosterhuis JW, Schraffordt KH. Biopsy of bone tumours. J Surg Oncol. 1985;28(4):247–51.

    Article  Google Scholar 

  21. Ashford RU, Scolyer RA, McCarthy SW, Bonar SF, Karim RZ, Stalley PD. The role of intra-operative pathological evaluation in the management of musculoskeletal tumours. Recent Results Cancer Res. 2009;179:11–24.

    Article  PubMed  Google Scholar 

  22. Haubner F, Ohmann E, Pohl F, Strutz J, Gassner HG. Wound healing after radiation therapy: review of the literature. Radiat Oncol. 2012;7:162.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Itshayek E, Yamada J, Bilsky M, Schmidt M, Shaffrey C, Gerszten P, et al. Timing of surgery and radiotherapy in the management of metastatic spine disease: a systematic review. Int J Oncol. 2010;36(3):533–44.

    PubMed  Google Scholar 

  24. Skrzynski MC, Biermann JS, Montag A, Simon MA. Diagnostic accuracy and charge-savings of outpatient core needle biopsy compared with open biopsy of musculoskeletal tumors. J Bone Joint Surg Am. 1996;78(5):644–9.

    CAS  PubMed  Google Scholar 

  25. Kiatisevi P, Thanakit V, Sukunthanak B, Boonthatip M, Bumrungchart S, Witoonchart K. Computed tomography-guided core needle biopsy versus incisional biopsy in diagnosing musculoskeletal lesions. J Orthop Surg. 2013;21(2):204–8.

    Google Scholar 

  26. Hau A, Kim I, Kattapuram S, Hornicek FJ, Rosenberg AE, Gebhardt MC, et al. Accuracy of CT-guided biopsies in 359 patients with musculoskeletal lesions. Skeletal Radiol. 2002;31(6):349–53.

    Article  PubMed  Google Scholar 

  27. Altuntas AO, Slavin J, Smith PJ, Schlict SM, Powell GJ, Ngan S, et al. Accuracy of computed tomography guided core needle biopsy of musculoskeletal tumours. ANZ J Surg. 2005;75(4):187–91.

    Article  PubMed  Google Scholar 

  28. Layfield LJ. Cytologic diagnosis of osseous lesions: a review with emphasis on the diagnosis of primary neoplasms of bone. Diagn Cytopathol. 2009;37(4):299–310.

    Article  PubMed  Google Scholar 

  29. Layfield LJ, Dodd LG, Hirschowitz S, Crabtree SN. Fine-needle aspiration of primary osseous lesions: a cost effectiveness study. Diagn Cytopathol. 2010;38(4):239–43.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, University of Maryland, School of Medicine, 110 S. Paca St, Baltimore, MD, 21201, USA

    Daniel M. Lerman MD

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  1. Daniel M. Lerman MD
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Correspondence to Daniel M. Lerman MD .

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Editors and Affiliations

  1. Huntsman Cancer Institute, The University of Utah, Salt Lake City, Utah, USA

    R. Lor Randall

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Lerman, D.M. (2016). Biopsy Considerations. In: Randall, R. (eds) Metastatic Bone Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5662-9_11

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  • DOI: https://doi.org/10.1007/978-1-4614-5662-9_11

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-5661-2

  • Online ISBN: 978-1-4614-5662-9

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