Stacy Joan UyBico MD, Presenter: Nothing to Disclose

Kambiz Motamedi MD, Abstract Co-Author: Nothing to Disclose

Leanne Louise Seeger MD, Abstract Co-Author: Nothing to Disclose

Michelle Chiemi Omura MD, Abstract Co-Author: Nothing to Disclose

Scott D. Nelson, Abstract Co-Author: Nothing to Disclose

Fritz C. Eilber, Abstract Co-Author: Nothing to Disclose

Jeffrey Eckardt, Abstract Co-Author: Nothing to Disclose

Anatomic compartment based guidelines for performing core needle biopsies of musculoskeletal tumors are present in the literature based on the theoretical possibility of tumor seeding if the biopsies violate vital structures and multiple compartments that are incongruent with the eventual surgical resection path. As our institution does not routinely adhere to these guidelines, this study aims to investigate whether there is a causal relationship between biopsy technique violations and tumor recurrence.

All thigh biopsies performed by the musculoskeletal radiologists at our institution from 2002-2008 were data abstracted for the following information: lesion depth, size, location, compartments and detailed anatomy violated by the biopsy needle, pathology, surgical treatment, and presence of tumor recurrence.

Of the 231 thigh biopsies, 160 (69%) were soft tissue lesions and 71 (31%) were intraosseous. There were 138 (60%) malignant and 93 (40%) benign lesions. The most common of the malignant tumors were diverse subtypes of sarcomas (95/138=69%). There were 40 (17%) violations of “vital structures” (as termed by the literature) and 16 (7%) violations of more than one anatomical compartment. With very strict published guidelines for the exact path to biopsy intraosseous lesions in particular, 62 of these 71 biopsies violated these recommendations (87%). Interestingly, none of these violations led to a tumor recurrence that could be attributed to tumor seeding along a biopsy track. Of the 231 thigh biopsies, there were a total of 16 tumor recurrences found in computerized patient records, but only 6 of these had their primary core biopsy performed at our institution. Of these 6, the recurrences were clearly not caused by our biopsy technique as they occurred in an entirely different path or location to that of the biopsy needle.

It is our experience that there is no causal relationship with tumor recurrence along the biopsy track.

Radiologists performing musculoskeletal biopsies do not have to be limited to strict anatomical compartment guidelines if there is no real risk of tumor recurrence or seeding in the biopsy track.  

UyBico, S, Motamedi, K, Seeger, L, Omura, M, Nelson, S, Eilber, F, Eckardt, J, Relevance of Compartmental Anatomical Guidelines for Biopsy of Musculoskeletal Tumors: Our Experience in an Academic Center.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8013436.html