Categories: Orthopaedics

Biopsy

What is a biopsy?

A biopsy is a procedure in which we take the sample from an abnormal mass, which was examined by a pathologist to diagnose the disease.

In which disease we use biopsy for diagnosis?

In all those diseases where tissue diagnosis is needed for further management.

Types of biopsy relating to orthopaedic oncology?

FNAC: In this procedure, a sample is taken from 22 – 20 gauze needle. Only cells were taken out and then slides were prepared for the examination. Accuracy is only 60%. There is no role of FNAC in primary Diagnosis in Orthopaedic Oncology. Because for diagnosis tissue architecture is needed but FNAC provides only cells. It has a role only to confirm the recurrence or involvement of lymph nodes.

Core needle Biopsy/Trucut Biopsy: In this procedure, we take a tissue sample with a specially designed needle, in which the core of tissue was taken out and examined further for diagnosis. This procedure is done with a very small incision, less contamination of another compartment can be done in local anaesthesia. Have 90-95% accuracy.

Incisional Biopsy: In this procedure, we make an incision and take a sufficient amount of sample for pathological examination. Should always be done with precaution, so that minimal contamination of another compartment. Regional or general anaesthesia needed. Have 99% accuracy.

Excisional Biopsy: In this procedure, we resect the whole tumor with an intact capsule and send it for pathological examination. Only smaller than 3 cm, and the superficial lesion should be examined by this technique. Excision should be done by following the oncological principle of resection.

Planning of biopsy

It is a very important step in the diagnosis and management of sarcoma.

Need the following investigation in hand to plan

  1. Clinical history and examination
  2. Full limb length x-rays
  3. Full limb length contrast MRI

How sarcoma surgeon plans for a biopsy?

After getting history, examination, and radiology, the surgeon has some differentials in his mind and keeping future plan for management, guide him to do a proper biopsy.

Biopsy should always be done by a treating sarcoma surgeon.

The harm of the wrong biopsy?

  1. Contamination of another compartment possible
  2. May lead to unnecessary amputation
  3. May lead to unnecessary additional procedures like Flap or tissue graft.
  4. May lead to repeat biopsy.

How MRI helps, to guide biopsy?

MRI needs to be studied meticulously, it shows the area of necrosis and extension of lesion and position of neurovascular bundle in relation to the lesion. The surgeon should not take a biopsy from necrotic areas and should avoid injury to nerve and vessels.

Is it possible, that we may need a repeat biopsy even after done by a sarcoma specialist?

Yes, sometimes there is chances of repeat biopsy even in the hand of experts.

Is it possible that in some cases we don’t need a biopsy?

Yes, there are some ‘do not touch’ lesions, where biopsy should not be taken. In those cases history, examination and radiology are sufficient for diagnosis, but with close follow-up.

Consequences of the wrong Biopsy?

I need to understand that, while resecting tumor, we need to resect the biopsy scar along with tumor, en bloc. For that biopsy, a scar should be present in the way of the incision line of surgery. Sometimes, non-sarcoma surgeon doesn’t know about this and they did a biopsy, without planning and may lead to unnecessary

Dr. Lokesh Garg, Consultant – Orthopaedics, Orthopaedic Oncology / Musculoskeletal Oncology, Dharamshila Narayana Superspeciality Hospital, Delhi

Narayana Health

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