Tumor cells seeding in biopsy tracts after open biopsy in three patients with chondrosarcoma-Case reports

The biopsy represents a fundamental step towards diagnosing bone and soft tissue tumors. In the case of open biopsies it is recommended to resect the biopsy tract at wide resection of bone and soft tissue sarcomas (STS); however, nowadays this topic is subject to ongoing debate as a worldwide shift from open to core-needle biopsies may lead to a decreased risk of local recurrence (LR) in the biopsy tract.

We present three patients (male, 69 years; male, 63 years; female 76 years) with chondrosarcomas treated at the Department of Orthopaedics and Trauma, Medical University of Graz: two with sarcomas involving the distal femur and one in the proximal femur. Staging showed no evidence of distant metastases (DM). Wide resection and reconstruction with modular tumor endoprostheses were performed in all three patients with the biopsy tract included in the resection specimen.

In all three patients, histological analysis of the resected specimen revealed viable tumor cell nests in the biopsy tract after an open biopsy technique.

The three presented cases demonstrate that tumor cell seeding occurs in biopsy tracts after an open biopsy in chondrosarcoma cases. Whether the risk of developing LR from these tumor cells differs between open and minimally invasive biopsy techniques or is affected by the use of neoadjuvant chemotherapy and/or radiotherapy for other entities, requires larger cohorts and longer periods of follow-up.