Biopsy

Biopsy is the gold standard test for the diagnosis of tumors. The tumor is then staged into benign and malignant tumors.

• Biopsy is the gold standard test for the diagnosis of tumors.^[1][2]

Prerequisites for a Biopsy

• CBC, platelets and coagulation studies should be done.
• Cross-sectional imaging to evaluate local anatomy such CT scan and MRI.
• Treatment center carrying out biopsy must be capable of proper diagnosis and treatment.
• The surgeon who performs biopsy should preferably be the one who is later going to do the final excision.

Technique

• Open
• Closed

• The tumor is surgically exposed and biopsy of the tumor is taken.

• A small surgical incision carefully placed to access tumor without contamination of critical structures.

• It is done for small, superficial soft tissue masses.

Incision

• Longitudinal incision in the extremities is taken.
• It should allow for extension of the incision for definitive management.

Approach

• Never expose neurovascular structures during the procedure.
• During the biopsy, all tissue exposed is considered contaminated with tumor.
• Meticulous hemostasis must be carried out.
• Post-surgery hematomas are considered contaminated with tumor.
• Always deflate the tourniquet prior to wound closure.

Biopsy

• Perform through the involved compartment of the tumor.
• For bone lesions with a soft tissue mass, perform the biopsy using the soft tissue mass.

Closure

• If drain is kept, remove the drain out of the skin in line with surgical incision.
• This helps in excising the drain site with definitive surgical extensive incision.

• It provides cytologic specimen.
• It is the most commonly used for carcinoma.
• It is usually not preferred for sarcoma.

• It allows for tumor structural examination.
• It allows evaluation of both the cytologic and stromal elements of the tumor.
• It is frequently used for sarcomas.

• The various investigations must be performed in the following order:

• • X-ray
  • MRI
• Biopsy

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