The general principles governing this procedure are as follows:
- Sufficient tissue for diagnosis must be obtained. If insufficient or non-representative material is obtained, the patient may be treated inappropriately or require a second operation for diagnosis.
- The least traumatic method compatible with obtaining diagnostic tissue should be utilized. It is important to minimize trauma to normal tissues, hematoma, and spread of tumor within the biopsy tract
- The procedure should facilitate, not hinder, the patient’s later definitive management. The surgeon should plan the biopsy with a knowledge of the surgical approach appropriate for both definitive removal of the tumor and optimal maintenance of limb function.
This last issue is the reason that patients with probable primary aggressive or malignant tumors should be referred to a surgical oncologist prior to biopsy. Planning limb salvage surgery depends on a variety of factors pertinent to the lesion, the local anatomy, and the adjuvant treatment likely to be used for the tumor. Without knowledge of these factors, it is difficult for the surgeon to plan the biopsy approach that will best complement definitive surgical care.