A Review of Core Biopsies in Musculoskeletal Oncology

Biopsy as a procedure is technically simple but conceptually a challenge. The principles of biopsy have remained more or less the same for 3 decades. With the advent of imaging, hospital facilities, and pathology modalities, we feel it is important that these principles are revisited. Uncertainties are spread across the literature regarding this very important first step in the care of an oncology patient. A surgeon planning the biopsy should be equipped with an MRI for planning. A biopsy has to be considered even for a benign-looking lesion. Even though literature is not clear on what kind of biopsy a surgeon should undertake, it is, without doubt, core biopsy has the edge that fine needle biopsies fail to reproduce. Image guidance for a biopsy is paramount for the accuracy of the sample. Pre-biopsy embolization has to be an option in the toolbox of a surgeon. Biopsy samples from an open biopsy or expensive or difficult interventional radiologist-assisted biopsy should undergo a rapid assessment to reduce the error of sample collection and thereby avoid subjecting the patient to a repeat procedure. Even though clean procedures do not require antibiotic prophylaxis, in view of major endoprosthetic implantations in the future, antibiotic use may be justified. An appropriate biopsy set and methodology as per institution experience are described in the paper.