Biopsy Issues for Bone and Cartilage Tumors

Abstract

Biopsy of soft tissue and osseous musculoskeletal lesions is the final step in the staging workup of an unknown tumor, and the first step in therapeutic management.^4,10,19,21 Because of this overlapping role, biopsy is arguably the most critical process in the management of musculoskeletal tumors.^4,10,14,15 Inappropriate biopsies result in the need for more extensive surgical procedures than initially required, and can be the direct cause of death in patients with musculoskeletal tumors.^9,13,14,15 Two well-documented reports in the literature spaced 14 years apart^13,14 show that biopsies for musculoskeletal tumors continue to be inappropriately planned, placed, and utilized. When this occurs, patients with malignant musculoskeletal tumors need limb amputations instead of salvage procedures for appropriate tumor control, and 4.5% of the time, the ill-planned and executed biopsy is the direct cause of amputation of the patient’s limb and can contribute to the patient’s death.^{4,11,13,14,18} For these reasons, it is important to revisit the issue of the biopsy, focusing on the types of biopsy, appropriate evaluations prior to the biopsy, technical aspects of this procedure, and consequences of the ill-planned or executed biopsy. At the end of this chapter, an outline for appropriate uses of this important tool is provided.