Surgeon led biopsy of musculoskeletal tumours

Surgeon led biopsy of musculoskeletal tumours. Robert U. Ashford Stanley W. McCarthy S. Fiona Bonar Richard A. Scolyer Rooshdiya Z. Karim Paul D. Stalley NSW Bone & Soft Tissue Sarcoma Service. “Poorly performed biopsies compromise limb salvage surgery and patient survival”.
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Surgeon led biopsy of musculoskeletal tumoursRobert U. Ashford Stanley W. McCarthyS. Fiona Bonar Richard A. ScolyerRooshdiya Z. Karim Paul D. StalleyNSW Bone & Soft Tissue Sarcoma Service“Poorly performed biopsies compromise limb salvage surgery and patient survival” Mankin JBJS 1982Biopsy of Musculoskeletal Tumours
  • Tertiary Centre is best & core biopsy preferred
  • Fraught with complications
  • Mankin (1982 & 1986) :
  • 23% error rate
  • 17% complication rate
  • 5% amputation rate because of biopsy
  • Our experience
  • Pollock & Stalley 2004
  • 38% of biopsies performed elsewhere hindered Rx
  • 17% amputation rate
  • Biopsy of Suspicious Lesions
  • CT guided biopsy for all ?
  • 127 Biopsies
  • 20% non-correlation rate (25 patients)
  • 10 Non-diagnostic CT Bx (6/10 malignant)
  • 1 Major error: CT Bx – Schwannoma ; Excision - synovial sarcoma
  • Altuntas et al (2004): ANZ J SurgSydney to Venice 16304 kmDistanceSydney to Albury 560km Bega 420km Bourke 775km Broken Hill 1159km Coffs Harbour 572km Dubbo 407km Grafton 618km Wagga 470km London to Venice 1139 kmLondon to Geneva 740 kmNew York to Washington 328 kmToronto to New York 831 kmRPAH Protocol
  • MDT Sarcoma Clinic Assessment
  • Completion of imaging
  • Biopsy
  • Surgeon (Consultant / Fellow)
  • GA
  • Core Biopsy (Trucut)
  • Frozen Section with surgeon present
  • Repeat Biopsy Core or open if 4 not representative
  • Study
  • Retrospective review of all biopsies performed at RPAH under the care of the senior author for 2 years (July 2003 – June 2005)
  • Comparison of core, core proceed to open and open biopsies
  • Analysis of accuracy and non-diagnostic rates
  • Comparison with CT core biopsies from literature
  • Biopsy TechniqueBone TumoursSoft Tissue TumoursResults
  • 104 protocol biopsies
  • No non-diagnostic biopsies
  • 11/104 (10.6%) necessary to proceed to open biopsy
  • 27% of ultimately benign lesions
  • 23% of soft tissue lesions
  • AccuracyOne Error
  • 62 Female with thigh mass
  • Non-diagnostic imaging
  • F/S diagnosis: lymphoid tissue favour Hodgkin’s Disease
  • Final diagnosis: B cell lymphoma
  • No alteration in surgical management
  • Discussion
  • Tertiary centre is best
  • Core biopsy is often appropriate
  • Adding frozen section eradicates risk of non-diagnostic biopsy
  • Open biopsy if core non-diagnostic
  • A good pathologist is obligatory
  • Before doing a biopsy …….. think
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