Staging techniques and biopsy of bone tumors

Optimal conditions for diagnosis and, hence, rational treatment planning require the integration of a comprehensive history, physical examination, and screening radiographic studies to formulate a working differential diagnosis. From this the appropriate laboratory and radiographic staging studies can be selected to narrow the differential diagnosis, obtain precise, surgically oriented anatomic localization of the lesion, and identify any distant disease. Only after this information is obtained can a biopsy be performed with the least risk of compromising subsequent treatment and the greatest accuracy in surgical staging. This is done most easily when the radiographic staging studies and biopsy are under the direction of the surgeon responsible for the definitive surgical procedure.