This document discusses best practices for performing biopsies in musculoskeletal tumors. It notes that biopsies should be done by the surgeon performing the final surgery, after carefully studying imaging results. The biopsy should be a small incision or needle biopsy to avoid complications and unnecessary amputations. Following biopsy, a multidisciplinary team approach is important for diagnosis, staging, and determining the best treatment plan.

1. Freih Abu Hassan
Jordan University
Biopsy in Musculo-Skeletal Tumors.
Freih Odeh Abu Hassan,
F.R.C.S.(Eng.), F.R.C.S. (Tr.& Orth.)
Professor of Orthopedics
University of Jordan

2. Freih Abu Hassan
Jordan University
Pillars of the Dx.
A. Clinical Hx. & Exam.
B. Imaging.
C. Blood tests.
D. Biopsy

3. Freih Abu Hassan
Jordan University

4. Freih Abu Hassan
Jordan University
Will confirm the Dx.
Guide to the R/

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Jordan University
= Myositis Ossificans
= Stress #
Bx read as Osteosarcoma

6. Freih Abu Hassan
Jordan University
Searching for 1ry tumor with obvious bone mets.

7. Freih Abu Hassan
Jordan University
Why we still doing it wrongly ?

8. Freih Abu Hassan
Jordan University
Most biopsies are simple.

9. Freih Abu Hassan
Jordan University
Poor & Bad biopsy

10. Freih Abu Hassan
Jordan University
1.Taking Bx. away of the site
of possible future Surgery

11. Freih Abu Hassan
Jordan University
2. Dissection and opening I.M
planes, joint cavity ---etc.
 Tumor contamination.

12. Freih Abu Hassan
Jordan University
3. Hematoma  spread of tumor cells.
4. large incision Open Bx.

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Jordan University

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Jordan University

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Jordan University
Bx of the tumor surface  interpreted as Osteochondroma.
Paraosteal O.Sarcoma

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Jordan University
OPD aspiration

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Jordan University

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Jordan University
597 Patients
Major errors in Dx. = 13.5%.
Complication rate =15.9%.
Unnecessary amputations = 3%.
Mankin et al ,JBJS, 1996.

19. Freih Abu Hassan
Jordan University
Which biopsy technique
* Incisional biopsy !!! ??
* Needle biopsy (Trucut).
* Trocar biopsy.(Jamshidi)
* Excisional biopsy.

20. Freih Abu Hassan
Jordan University
Who should do the Biopsy?.
= Not the radiologist. Except.!!
= Not the resident Dr.
= Not the Dr. who thinks always
amputation for tumors
= Not the Dr. in the peripheral H.
= Not the Dr. who is not dealing
regularly with Tumors.

21. Freih Abu Hassan
Jordan University
Bx. should be done by the Surgeon who is going to do the final R

22. Freih Abu Hassan
Jordan University
1- Careful studying of the
imagings
2- Small longitudinal incision.
3- Sharp dissection.
4- Plug bone by PMMA.

23. Freih Abu Hassan
Jordan University
Site of the biopsy
Extra Osseous Component
of the Tumor, Why????
* >Dx (Center necrosed)
* To avoid #.
* F.S. can be done quickly.

24. Freih Abu Hassan
Jordan University
5- Drain tract in incision line.
6- Close in layers.
7- Subcuticular skin.

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University
General Surgeon

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University
Potentially malignant. T.

38. Freih Abu Hassan
Jordan University
Only in obvious benign lesions.

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Jordan University
The only benign soft tissue lesions.
Hematoma, Lipoma

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Jordan University
Unnecessary Bx or oper. on asymp. benign lesions

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Jordan University

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Jordan University

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Jordan University
Ignoring the team approach

44. Freih Abu Hassan
Jordan University
Oncologist
Radiologist
Surgeon
Histopathologist
psychiatrist
Nursing &
Support staff
Cytopathologist

45. Freih Abu Hassan
Jordan University
Bx were performed through a large incision with contamination of tissues. !!!!!!!

46. Freih Abu Hassan
Jordan University
قطع الاعناق ولا قطع الارزاق
قطع الاعناق ولا بتر الاطراف

47. Freih Abu Hassan
Jordan University
Conclusion
1- Easy but bad sequale
2- Bx. by the definitive Surgeon.
3- At the end of staging.

48. Freih Abu Hassan
Jordan University
4-Careful studying of the imagings
5-Risk of unnecessary amputation.
6-Limb salvage

49. Freih Abu Hassan
Jordan University