The hazards of biopsy in patients with malignant primary bone and soft-tissue tumors

Gerrand, CH; Rankin, K

doi:10.1007/978-1-4471-5451-8_129

The hazards of biopsy in patients with malignant primary bone and soft-tissue tumors

Lookup NU author(s): Craig Gerrand, Dr Kenneth Rankin ORCiD

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Abstract

© 2014 Springer-Verlag London. All rights are reserved. This study was performed by the Musculoskeletal Tumour Society using questionnaires to assess the following: • The accuracy of biopsy in making a diagnosis • The incidence of complications associated with the biopsy procedure • The effects of errors in diagnosis and of complications on the treatment of patients • Whether these problems occurred with greater frequency when the initial biopsy was performed in a referring institution or in a specialist treating centre Each member of the Society submitted data on 20 sequential, unselected, newly diagnosed patients with malignant primary tumours of bone or soft tissue who underwent a biopsy and then a defi nitive procedure. The study received data from 20 orthopedic surgeons in 16 treating centres. Information on 329 patients included a wide range of diagnoses (but generally conforming to the distribution of these tumours in the general population). The mean age of the patients was 36.5 years (range, 2 weeks to 83 years). Two hundred and twenty two lesions were bone primaries and 107 were derived from soft tissue. One hundred and forty three tumours were biopsied in the referring institution and 171 in the treating centre. The authors demonstrated 60 (18.2 %) major errors in diagnosis and 34 (10.3 %) non-representative or technically poor biopsies. Fifty-seven patients (17.3 %) encountered problems in the skin, soft tissue, or bone following biopsy and the optimum treatment plan had to be altered as a result of problems related to the biopsy in 60 patients (18.2 %). In 15 patients (4.5 %) an unnecessary amputation was performed as a result of problems with the biopsy, and in 28 patients (8.5 %) the prognosis and outcome were considered to have been adversely affected. Patients undergoing a biopsy at the referring institution experienced biopsy-related problems three to fi ve times more frequently than those undergoing biopsy at a treating centre. Given these fi ndings, the authors recommend that the biopsy should be planned as carefully as defi nitive surgery. In particular, careful attention should be paid to the following: • Asepsis, skin-handling, haemostasis, and wound closure • Precise skin incision placement, which will not compromise subsequent surgery. • The tissue obtained should be suffi cient in volume and suffi ciently representative of the lesion that the pathologist can provide a defi nitive diagnosis. If the surgeon or the institution is not prepared to perform accurate diagnostic studies or proceed with defi nitive treatment for these patients, patients should be referred to a treating centre prior to biopsy.