Biopsy of Tumors of the Musculoskeletal System

Introduction: Malignant tumors of the musculoskeletal system are rare, and their symptoms are non-specific. The diagnosis of primary malignant tumors of bone or soft tissue by tissue biopsy is necessary before multimodal treatment with chemo- and/or radiotherapy and resection can be provided. These biopsies are straightforward surgical procedures; they must, however, be performed according to the guidelines if high rates of error and complications are to be avoided.

Methods: Selective literature review.

Results: Biopsies are either incisional or excisional. There are guidelines for the performance of both kinds. The biopsy channel is inevitably contaminated with tumor cells and thus must be completely removed together with the tumor. Excisional biopsies are indicated only for the histopathological diagnosis of small (< 5 cm), epifascial soft-tissue tumors and small, slowly growing bony tumors that are considered most likely to be benign. If in doubt, an incision biopsy should be performed.

Discussion: The complication rate of tumor biopsies is known to be higher when they are performed in an institution without extensive experience in the treatment of sarcoma. Thus, patients with musculoskeletal tumors that are suspected of being malignant should be referred to a suitable tumor center for biopsy.