Biopsy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Synonyms and Keywords: Bone biopsy, Soft tissue biopsy, Biopsy in musculoskeletal system, Biopsy of organs

Overview

Biopsy is the gold standard test for the diagnosis of tumors. The tumor is then staged into benign and malignant tumors.

Biopsy

Prerequisites for a Biopsy

Technique

  • Open
  • Closed

Open Technique

  • The tumor is surgically exposed and biopsy of the tumor is taken.

Types

Incisional biopsy

  • A small surgical incision carefully placed to access tumor without contamination of critical structures.

Excisional biopsy

Incision

  • Longitudinal incision in the extremities is taken.
  • It should allow for extension of the incision for definitive management.

Approach

  • Never expose neurovascular structures during the procedure.
  • During the biopsy, all tissue exposed is considered contaminated with tumor.
  • Meticulous hemostasis must be carried out.
  • Post-surgery hematomas are considered contaminated with tumor.
  • Always deflate the tourniquet prior to wound closure.

Biopsy

Closure

  • If drain is kept, remove the drain out of the skin in line with surgical incision.
  • This helps in excising the drain site with definitive surgical extensive incision.

Closed Technique

Types

Fine Needle Aspiration (FNA)

Core biopsy (Tru-cut Biopsy)

Sequence of Diagnostic Studies
  • The various investigations must be performed in the following order:

References

  1. Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
  2. Czerniak, Bogdan (2016). Dorfman and Czerniak's bone tumors. Philadelphia, PA: Elsevier/Saunders. ISBN 9780323023962.

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