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Review Question - QID 213056

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QID 213056 (Type "213056" in App Search)
A 45-year-old woman presents with concerns of a painful knee that has rapidly progressed in the last 9 months. Axial T1 and T2 MRI images are depicted in Figures A and B. The treating surgeon elects to proceed with a biopsy. How should the biopsy be performed?
  • A
  • B

Fine needle biopsy through posterior approach

2%

42/2090

Transverse incisional biopsy through anterior approach

2%

45/2090

Transverse incisional biopsy through posterior approach

1%

28/2090

Longitudinal incisional biopsy through medial approach

91%

1902/2090

Longitudinal incisional biopsy through lateral approach

3%

63/2090

  • A
  • B

Select Answer to see Preferred Response

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Biopsies should be performed for aggressive appearing soft tissue lesions. Of the options above, a carefully planned open incisional biopsy along the longitudinal axis of the limb through the medial approach to the proximal calf without contamination of adjacent compartments is the best next step.

The purpose of a biopsy is to confirm a suspected diagnosis. A core needle or open biopsy may be performed and can evaluate for both cytologic and stromal features of the tumor. When a percutaneous biopsy is insufficient and open biopsy is undertaken, it should be performed in line with an extensile approach through one compartment, minimizing contamination of other compartments.

Barrientos-Ruiz et al. performed a retrospective study to determine whether biopsy tracts seed and cause local recurrence in sarcoma. They reported that open biopsies were associated with an increased risk of tumoral seeding of the biopsy site and that local recurrence-free survival was significantly longer for patients without contaminated tracts than for those with biopsy tract seeding. They recommended a percutaneous biopsy with neoadjuvant or adjuvant therapy as the preferred method of biopsy at their center.

Mankin et al. performed a study on the hazards and complications on performing biopsies. They reported that errors, complications, and changes in the course and outcome were significantly greater when the biopsy was done in a referring institution instead of in a treatment center. As such, they concluded that whenever possible, biopsies should be performed in a treatment center rather than in a referring institution.

Incorrect Answers:
Answer 1: Frequently used for carcinomas, fine needle biopsies provide cytologic, but not histologic analysis of the mass. Thus, it is generally not favored for the diagnosis of sarcoma.
Answer 2: If an open biopsy is performed, a transverse incision will increase the risk of contamination of surrounding structures.
Answer 3: A transverse posterior approach would contaminate this compartment.
Answer 5: A longitudinal lateral approach would contaminate this compartment.

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