Clinical Orthopaedics and Related Research®

, Volume 471, Issue 3, pp 905–914

Using the CUSUM Test to Control the Proportion of Inadequate Open Biopsies of Musculoskeletal Tumors

  • David J. Biau
  • Kurt R. Weiss
  • Rej S. Bhumbra
  • Darin Davidson
  • Chris Brown
  • Jay S. Wunder
  • Peter C. Ferguson
Symposium: Highlights from the First Combined 2011 Meeting of the Musculoskeletal Tumor Society and Connective Tissue Oncology Society

DOI: 10.1007/s11999-012-2544-8

Cite this article as:
Biau, D.J., Weiss, K.R., Bhumbra, R.S. et al. Clin Orthop Relat Res (2013) 471: 905. doi:10.1007/s11999-012-2544-8

Abstract

Background

Biopsies of musculoskeletal tumors lead to alterations in treatment in almost 20% of cases. Control charts are useful to ensure that a process is operating at a predetermined level of performance, although their use has not been demonstrated in assessing the adequacy of musculoskeletal biopsies.

Questions/purposes

We therefore (1) assessed the incidence of and the reasons for inadequate musculoskeletal biopsies when following guidelines for performing the procedure; and (2) implemented a process control chart, the CUSUM test, to monitor the proportion of inadequate biopsies.

Methods

We prospectively studied 116 incisional biopsies. The biopsy was performed according to 10 rules to (1) minimize contamination in the tissues surrounding the tumor; and (2) improve accuracy. A frozen section was systematically performed to confirm that a representative specimen was obtained. Procedures were considered inadequate if: (1) another biopsy was necessary; (2) the biopsy tract was not appropriately placed; and (3) the treatment provided based on the diagnosis from the biopsy was not appropriate.

Results

Five (4.3%) of the 116 incisional biopsy procedures were considered failures. Three patients required a second repeat open biopsy and two were considered to receive inappropriate treatment. No alarm was raised by the control chart and the performance was deemed adequate over the monitoring period.

Conclusions

The proportion of inadequate musculoskeletal open biopsies performed at a referral center was low. Using a statistical process control method to monitor the failures provided a continuous measure of the performance.

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • David J. Biau
    • 1
  • Kurt R. Weiss
    • 2
  • Rej S. Bhumbra
    • 3
  • Darin Davidson
    • 4
  • Chris Brown
    • 5
    • 6
  • Jay S. Wunder
    • 5
    • 6
  • Peter C. Ferguson
    • 5
    • 6
  1. 1.Department of Orthopaedic SurgeryHospital CochinParisFrance
  2. 2.Division of Musculoskeletal Oncology, Department of Orthopaedic SurgeryShadyside Medical CenterPittsburghUSA
  3. 3.London Sarcoma ServiceRoyal National Orthopaedic HospitalStanmoreUK
  4. 4.Department of Orthopaedics and Sports MedicineUniversity of WashingtonSeattleUSA
  5. 5.University Musculoskeletal Oncology UnitMount Sinai HospitalTorontoCanada
  6. 6.Sarcoma Site Group, Department of Surgical OncologyPrincess Margaret HospitalTorontoCanada