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Surgeon led biopsy of musculoskeletal tumours

Surgeon led biopsy of musculoskeletal tumours. Robert U. Ashford Stanley W. McCarthy S. Fiona Bonar Richard A. Scolyer Rooshdiya Z. Karim Paul D. Stalley NSW Bone & Soft Tissue Sarcoma Service. “Poorly performed biopsies compromise limb salvage surgery and patient survival”.

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Surgeon led biopsy of musculoskeletal tumours

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  1. Surgeon led biopsy of musculoskeletal tumours Robert U. Ashford Stanley W. McCarthy S. Fiona Bonar Richard A. Scolyer Rooshdiya Z. Karim Paul D. Stalley NSW Bone & Soft Tissue Sarcoma Service

  2. “Poorly performed biopsies compromise limb salvage surgery and patient survival” Mankin JBJS 1982

  3. Biopsy of Musculoskeletal Tumours • Tertiary Centre is best & core biopsy preferred • Fraught with complications • Mankin (1982 & 1986) : • 23% error rate • 17% complication rate • 5% amputation rate because of biopsy • Our experience • Pollock & Stalley 2004 • 38% of biopsies performed elsewhere hindered Rx • 17% amputation rate

  4. Biopsy of Suspicious Lesions • CT guided biopsy for all ? • 127 Biopsies • 20% non-correlation rate (25 patients) • 10 Non-diagnostic CT Bx (6/10 malignant) • 1 Major error: CT Bx – Schwannoma ; Excision - synovial sarcoma Altuntas et al (2004): ANZ J Surg

  5. Sydney to Venice 16304 km

  6. Distance Sydney to Albury 560km Bega 420km Bourke 775km Broken Hill 1159km Coffs Harbour 572km Dubbo 407km Grafton 618km Wagga 470km London to Venice 1139 km London to Geneva 740 km New York to Washington 328 km Toronto to New York 831 km

  7. RPAH Protocol • MDT Sarcoma Clinic Assessment • Completion of imaging • Biopsy • Surgeon (Consultant / Fellow) • GA • Core Biopsy (Trucut) • Frozen Section with surgeon present • Repeat Biopsy Core or open if 4 not representative

  8. Study • Retrospective review of all biopsies performed at RPAH under the care of the senior author for 2 years (July 2003 – June 2005) • Comparison of core, core proceed to open and open biopsies • Analysis of accuracy and non-diagnostic rates • Comparison with CT core biopsies from literature

  9. Biopsy Technique

  10. Bone Tumours

  11. Soft Tissue Tumours

  12. Results • 104 protocol biopsies • No non-diagnostic biopsies • 11/104 (10.6%) necessary to proceed to open biopsy • 27% of ultimately benign lesions • 23% of soft tissue lesions

  13. Accuracy

  14. One Error • 62 Female with thigh mass • Non-diagnostic imaging • F/S diagnosis: lymphoid tissue favour Hodgkin’s Disease • Final diagnosis: B cell lymphoma • No alteration in surgical management

  15. Discussion • Tertiary centre is best • Core biopsy is often appropriate • Adding frozen section eradicates risk of non-diagnostic biopsy • Open biopsy if core non-diagnostic • A good pathologist is obligatory

  16. Before doing a biopsy …….. think

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