The Role of Biopsy Accuracy in the Treatment of Musculoskeletal Tumors

Vollständiger Abstract

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Background: The accurate treatment of Musculoskeletal (MSK) tumors necessitates appropriate timely biopsy of the mass of interest. With regards to malignant neoplasms biopsy plays a crucial role in the direction of treatment courses and patient outcome. Methods: This is a retrospective single-center chart review of 924 biopsies from 2013-2023. Patients included were between 18-85 with MSK tumors that necessitated biopsy and subsequent surgical treatment. Biopsy and final resection histopathology reports were compared to determine the rate of accuracy for each biopsy type: excisional, incisional and needle (core/fine). Excisional biopsies were excluded. This left 687 biopsies to compare: 508 incisional and 168 core-needle biopsies of soft tissue and bone MSK tumors. Results: Open biopsy had an overall accuracy rate of 98% with a 95% Confidence Interval (CI) of 97% to 99% and needle biopsy 88% (95% CI [82%, 92%]). Overall, 26 biopsies were not representative of the final resected tumor: eight incisional biopsies and 18 core-needle biopsies. The inaccuracy of these biopsies resulted in 14 patient’s treatment to be changed. Three required meticulous surveillance due to a more aggressive nature of the tumor. One had an altered outcome due to over aggressive surgery. Nine required further biopsies. Conclusion: This finding differs from previously conducted surveys on the biopsy of MSK tumors. The increased accuracy is due not only to dedicated MSK oncology tumor board specialists reviewing and often repeating the biopsies within the unit but also frequent consultation to MSK oncology units by community orthopaedic surgeons.