Biopsy of Musculoskeletal Tumors

  • Jacob Bickels
  • James Jelinek
  • Barry Shmookler
  • Martin Malawer


Biopsy is a key step in the diagnosis of bone and soft-tissue tumors. An inadequately performed biopsy may fail to allow proper diagnosis, have a negative impact on survival, and ultimately necessitate an amputation to accomplish adequate margins of resection. Poorly performed biopsy remains a common finding in patients with musculoskeletal tumors who are referred to orthopedic oncology centers. The principles by which an adequate and safe biopsy of musculoskeletal tumors should be planned and executed are reviewed and a surgical approach to different anatomic locations is emphasized.


Core Needle Biopsy Definitive Surgery Biopsy Incision Musculoskeletal Tumor Biopsy Tract 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Jaffe HL. Introduction: Problems of classification and diagnosis. In: Jaffe HL, editor. Tumors and Tumorous Conditions of the Bones and Joints. Philadelphia: Lea & Febiger; 1958:9–17.Google Scholar
  2. 2.
    Chang AE, Sondak VK. Clinical evaluation and treatment of soft tissue tumors. In: Enzinger FM, Weiss SW, editors. Soft Tissue Tumors. St Louis: CV Mosby; 1995:17–38.Google Scholar
  3. 3.
    Simon MA. Current concepts review: Biopsy of musculoskeletal tumors. J Bone Joint Surg. 1982;64A: 1253–7.Google Scholar
  4. 4.
    Mankin HJ, Lange TA, Spanier SS. The hazards of biopsy in patients with malignant primary bone and soft tissue tumors. J Bone Joint Surg. 1982;64A:1121–7.Google Scholar
  5. 5.
    Mankin HJ, Mankin CJ, Simon MA. The hazards of biopsy, revisited. J Bone Joint Surg 1996;78A:656–63.Google Scholar
  6. 6.
    Enneking WF. General principles of musculoskeletal tumor surgery. In: Enneking WF, editor. Musculoskeletal Tumor Surgery, vol. 2. New York: Churchill-Livingstone; 1983:3–27.Google Scholar
  7. 7.
    Dorfman HD, Czerniak B. General considerations. In: Dorfman HD, Czerniak B, editors. Bone Tumors. St Louis: CV Mosby; 1988:1–33.Google Scholar
  8. 8.
    Frassica FJ, Frassica DA, Sim FH. Carcinoma metastatic to bone: pathogenesis and pathophysiology. In: Simon MA, Springfield D, editors. Surgery for Bone and Soft-Tissue Tumors. Philadelphia: Lippincott-Raven; 1998:615–20.Google Scholar
  9. 9.
    McKenna RJ, Schwinn CP, Soong KY, Higinbotham NL. Sarcomata of osteogenic series (osteosarcoma, fibrosarcoma, chondrosarcoma, parosteal osteosarcoma and sarcomata) arising in abnormal bone: an analysis of 552 cases. J Bone Joint Surg. 1966;48A:1–26.Google Scholar
  10. 10.
    Davies NM, Livesly PJ, Cannon SR. Recurrence of an osteosarcoma in a needle biopsy tract. J Bone Joint Surg. 1993;75B;977–8.Google Scholar
  11. 11.
    Ferrucci Jr JT. Malignant seeding of needle tract after thin needle aspiration biopsy: a previously unrecorded complication. Radiology. 1979;130:345–6.PubMedGoogle Scholar
  12. 12.
    Noria S, Davis A, Kandel R et al. Residual disease following unplanned excision of soft-tissue sarcoma of an extremity. J Bone Joint Surg. 1996;78A:650–5.Google Scholar
  13. 13.
    Schwartz HS, Spengler DM. Needle tract recurrences after closed biopsy for sarcomas: three cases and review of the literature. Ann Surg Oncol. 1997;4:228–36.CrossRefPubMedGoogle Scholar
  14. 14.
    Ayala AG, Ro JY, Fanning CV, Flores JP, Yasco AW. Core needle biopsy and fine needle aspiration in the diagnosis of bone and soft-tissue lesions. Hematol Oncol Clin N Am. 1995;9:633–51.Google Scholar
  15. 15.
    Berardo MD, Powers CN, Wakely Jr PE, Almeida MO, Frable WJ. Fine-needle aspiration cytopathology of malignant fibrous histiocytoma. Cancer. 1997;81:228–37.CrossRefPubMedGoogle Scholar
  16. 16.
    Bommer KK, Ramzy I, Mody D. Fine needle aspiration biopsy in the diagnosis and management of bone lesions: a study of 450 cases. Cancer. 1997;81:148–56.CrossRefPubMedGoogle Scholar
  17. 17.
    Wilľen H. Fine needle aspiration in the diagnosis of bone tumors. Acta Orthop Scand. 1997;273(Suppl.):47–53.Google Scholar
  18. 18.
    Wilľen H, Akerman M, Carľen B. Fine needle aspiration (FNA) in the diagnosis of soft-tissue tumours: a review of 22 years experience. Cytopathology. 1995;6:236–47.PubMedGoogle Scholar
  19. 19.
    Akerman M, Killander D, Rydholm A, Rooser B. Aspiration of musculoskeletal tumors for cytodiagnosis and DNA analysis. Acta Orthop Scand. 1987;58:523–8.PubMedGoogle Scholar
  20. 20.
    Akerman M, Rydholm A, Persson BM. Aspiration cytology of soft tissue tumors. The 10-year experience at an orthopedic oncology center. Acta Orthop Scand. 1985;56:407–12.PubMedGoogle Scholar
  21. 21.
    Akerman M. The cytology of soft tissue tumors. Acta Orthop Scand. 1997;273(Suppl.):54–9.Google Scholar
  22. 22.
    White VA, Fanning CV, Ayala AG et al. Osteosarcoma and the role of fine-needle biopsy: a study of 51 cases. Cancer. 1988;62:1238–46.PubMedGoogle Scholar
  23. 23.
    Costa MJ, Campman SC, Davis RL, Howell LP. Fine-needle aspiration cytology of sarcoma: retrospective review of diagnostic utility and specificity. Diagn Cytopathol. 1996;15:23–32.CrossRefPubMedGoogle Scholar
  24. 24.
    Heslin MJ, Lewis JJ, Woodruff JM, Brennan MF. Core needle biopsy for diagnosis of extremity soft tissue sarcoma. Ann Surg Oncol. 1997;4:425–31.CrossRefPubMedGoogle Scholar
  25. 25.
    Clark CR, Morgan C, Sontegard DA et al. The effect of biopsy hole shape and size on bone strength. J Bone Joint Surg. 1977;59A:213–17.Google Scholar

Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  • Jacob Bickels
  • James Jelinek
  • Barry Shmookler
  • Martin Malawer

There are no affiliations available

Personalised recommendations