A study employing questionnaires, performed by the Musculoskeletal Tumor Society, sought to assess the accuracy of diagnoses made from the findings of biopsies, the incidence of complications associated with the biopsy procedure, the effects of errors in diagnosis and of complications on the patient's course, and whether these problems occurred with greater frequency when the initial biopsy was performed in a referring institution or in a treating center. Each member of the Society was asked to submit data on 20 sequential, unselected, newly diagnosed patients with malignant primary tumors of bone or soft tissue who had had a biopsy and a subsequent definitive procedure. 20 orthopaedic surgeons in 16 treating centers submitted information on 329 patients with a wide range of diagnoses (but generally conforming to the distribution of these tumors in the general population). The mean age of the patients was36.5 years (range, 2 weeks to 83 years). 222 lesions were primary in bone and 107 arose in soft tissue. 143 of the tumors were biopsied in the referring institution and 171, in the treating center. Analysis of the results of the study showed 60 (18.2 per cent) major errors in diagnosis and 34 (10.3 per cent) non-representative or technically poor biopsies. Problems arose in the skin, soft tissue, or bone of the biopsy wounds of 57 patients (17.3 per cent), and the optimum treatment plan had to be altered as a result of problems related to the biopsy in 60 patients (18.2 per cent). In 15 patients (4.5 per cent) an unnecessary amputation was performed as a result of problems with the biopsy, and in 28 patients (8.5 per cent) the prognosis and outcome were considered to have been adversely affected. The biopsy-related problems occurred from 3 to more than 5 times more frequently when the biopsy was performed at a referring institution rather than in a treating center. On the basis of these observations, the Society suggests that the biopsy should be planned as carefully as definitive surgery and that careful attention should be paid to asepsis, skin-handling, hemostasis, and wound closure. The skin incision should be placed in such a manner so as not to compromise subsequent surgery. The tissue obtained should be sufficient in amount and sufficiently representative of the lesion so that the pathologist can provide a definitive diagnosis. If the surgeon or the institution is not prepared to perform accurate diagnostic studies or proceed with definitive treatment for these patients, the patients should be referred to a treating center prior to biopsy.
Copyright remains with the authors and publisher.
A study employing questionnaires, performed by the Musculoskeletal Tumor Society, sought to assess the accuracy of diagnoses made from the findings of biopsies, the incidence of complications associated with the biopsy procedure, the effects of errors in diagnosis and of complications on the patient's course, and whether these problems occurred with greater frequency when the initial biopsy was performed in a referring institution or in a treating center. Each member of the Society was asked to submit data on 20 sequential, unselected, newly diagnosed patients with malignant primary tumors of bone or soft tissue who had had a biopsy and a subsequent definitive procedure. 20 orthopaedic surgeons in 16 treating centers submitted information on 329 patients with a wide range of diagnoses (but generally conforming to the distribution of these tumors in the general population). The mean age of the patients was36.5 years (range, 2 weeks to 83 years). 222 lesions were primary in bone and 107 arose in soft tissue. 143 of the tumors were biopsied in the referring institution and 171, in the treating center. Analysis of the results of the study showed 60 (18.2 per cent) major errors in diagnosis and 34 (10.3 per cent) non-representative or technically poor biopsies. Problems arose in the skin, soft tissue, or bone of the biopsy wounds of 57 patients (17.3 per cent), and the optimum treatment plan had to be altered as a result of problems related to the biopsy in 60 patients (18.2 per cent). In 15 patients (4.5 per cent) an unnecessary amputation was performed as a result of problems with the biopsy, and in 28 patients (8.5 per cent) the prognosis and outcome were considered to have been adversely affected. The biopsy-related problems occurred from 3 to more than 5 times more frequently when the biopsy was performed at a referring institution rather than in a treating center. On the basis of these observations, the Society suggests that the biopsy should be planned as carefully as definitive surgery and that careful attention should be paid to asepsis, skin-handling, hemostasis, and wound closure. The skin incision should be placed in such a manner so as not to compromise subsequent surgery. The tissue obtained should be sufficient in amount and sufficiently representative of the lesion so that the pathologist can provide a definitive diagnosis. If the surgeon or the institution is not prepared to perform accurate diagnostic studies or proceed with definitive treatment for these patients, the patients should be referred to a treating center prior to biopsy.
Copyright remains with the authors and publisher.