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Who should undergo biopsy of a bone lesion

Patient selection for a biopsy is important: It is intended to confirm the radiologic diagnosis in patients with potential active, aggressive, or malignant bone tumors.

  • If the analysis of the patient's clinical symptoms and radiographs has been appropriate, the clinician should correctly anticipate the diagnosis in most cases.
  • The biopsy is done to confirm the initial diagnostic impression and to permit accurate grading of the lesion.

For many patients referred for consultation regarding a bone tumor, a biopsy is not necessary for diagnosis and may be contraindicated; it could even be detrimental to their care.

  • Most patients with incidental lesions and painless bony masses do not need a biopsy. As long as the patient has no symptoms caused by the lesion and the clinician is certain that the patient does not have an aggressive or malignant lesion, it is not necessary to confirm the exact histological diagnosis.
  • Bone biopsy often requires a cortical window or hole to be made in the bone, which may put the patient at risk for pathologic fracture through the biopsy site.
  • Unnecessary biopsy of the incidental lesion also carries a risk of infection, phlebitis, and associated peri-operative complications.

There is one further risk of biopsy in incidental lesions: Patients with asymptomatic benign cartilage tumours are at risk for misdiagnosis if biopsied.

  • Differentiation of benign and low-grade malignant cartilage tumors can be difficult on histological assessment alone. The clinician and the patient may face a very difficult decision regarding further surgery if the incidental lesion is biopsied and diagnosed as low-grade chondrosarcoma on histological analysis.
  • The best way to differentiate benign and low-grade cartilage tumors is a careful analysis of history, physical, and serial plain Xrays.
  • Biopsy of an asymptomatic cartilage lesion causes post-operative changes in the Xray that complicates the comparison of serial radiographs, and the biopsy itself may cause symptoms in the operative site.
  • If the lesion is asymptomatic and shows no radiological evidence of growth or erosive changes, the prudent course is radiographic and clinical follow up rather than biopsy.

Other Issues Related to Biopsy and Staging

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