| Indications for Biopsy |
- Indications
- aggressive bone or soft tissue lesions
- soft tissue lesions larger than 5cm, deep to fascia, or overlying bone/neurovascular structures
- unclear diagnosis in a symptomatic patient
- solitary bone lesions in a patient with history of carcinoma
- When a biopsy is not indicated
- asymptomatic latent bone lesion or a symptomatic active bone lesion which appear entirely benign on imaging don't necessarily need a biopsy
- soft tissue lesion which are completely benign on MRI don't necessarily need a biopsy (e.g. lipoma, hemangioma)
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| Types of Biopsy |
- Fine Needle Aspiration (FNA)
- provides cytologic (cellular) specimen
- frequently used for carcinoma
- not typically used for sarcoma
- Core biopsy (Tru-cut)
- allow for tumor structural examination
- can evaluate both the cytologic and stromal elements of the tumor
- frequently used for sarcoma
- Incisional biopsy
- small surgical incision carefully placed to access tumor without contamination of critical structures
- Excisional biopsy
- select indications: small, superficial soft tissue masses
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| Principles of the Open Incisional Biopsy |
- Incision
- use longitudinal incision in the extremities
- allows for extension of the incision for definitive management
- Approach
- do not expose neurovascular structures
- all tissue exposed during the biopsy is considered contaminated with tumor
- maintain meticulous hemostasis
- post-operative hematomas are considered contaminated with tumor
- release tourniquet prior to wound closure
- Biopsy
- perform thru the involved compartment of the tumor
- for bone lesions with a soft tissue mass, it is ok to perform the biopsy using the soft tissue mass
- Closure
- ff using a drain, bring drain out of the skin in line with surgical incision
- allows drain site to be removed with definitive surgical extensile incision
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