Zusammenfassung
Obwohl die Biopsie den „Schlüsselschritt“ in der Diagnose von Knochentumoren darstellt, wird sie nach wie vor als „kleiner Eingriff“ aufgefasst, der von jedem chirurgisch Tätigen ambulant oder „einmal schnell“ als dazwischen geschobener Operationspunkt „abgearbeitet“ werden kann. Nicht selten wird die Biopsie als sog. „Anfängereingriff“ deklariert und auf „Zuruf“ assistiert. Auch wenn der Eingriff selbst technisch einfach erscheinen mag, so erfordert bereits die Biopsie in Kenntnis der erforderlichen definitiven operativen Versorgung eine vorgezogene Planung des adäquaten Zugangsweges. Eine unsachgemäß durchgeführte Biopsie liefert günstigenfalls nicht repräsentatives Gewebe („sampling error“), kann jedoch die onkologische Resektabilität beeinträchtigen bis hin zur Erfordernis einer Amputation und letztendlich eine Verschlechterung der Heilungschancen des Patienten bedeuten. Im Nachfolgenden werden die Prinzipien der Zugangsplanung und Techniken einer angemessenen und sicheren Biopsie bei primären Knochentumoren verschiedener anatomischer Lokalisationen dargestellt.
Abstract
Although biopsies are a key step in the diagnosis of bone tumors, they are often still referred to as a minor intervention which can be carried out by any surgeon as an outpatient procedure or quickly carried out between other more important tasks. A biopsy should, however, be regarded as the final part of the diagnostic procedure preceded by careful evaluation of the clinical course and analysis of the required imaging studies. Although the biopsy procedure seems technically simple to perform, an incorrectly performed biopsy can become an obstacle to correct tissue analysis (sampling error) and adequate tumor resection and may reduce the patient’s chances of survival. The principles by which an adequate and safe biopsy of bone tumors should be planned and executed are reviewed and the surgical approaches to different anatomical locations are presented.
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Interessenkonflikt. M. Panzica, U. Lüke, P. Mommsen und C. Krettek geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Panzica, M., Lüke, U., Mommsen, P. et al. Biopsie und Zugangswege bei Knochentumoren. Unfallchirurg 117, 501–509 (2014). https://doi.org/10.1007/s00113-013-2471-5
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DOI: https://doi.org/10.1007/s00113-013-2471-5