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

Freih Abu Hassan

Jordan University

Pillars of the Dx. A. Clinical Hx. & Exam.

B. Imaging.

C. Blood tests.

D. Biopsy

Freih Abu Hassan

Jordan University

Freih Abu Hassan

Jordan University

Will confirm the Dx.

Guide to the R/

Freih Abu Hassan

Jordan University

= Myositis Ossificans

= Stress #

Bx read as Osteosarcoma

Freih Abu Hassan

Jordan University

Searching for 1ry tumor

with obvious bone mets.

Freih Abu Hassan

Jordan University

Why we still doing it wrongly ?

Freih Abu Hassan

Jordan University

Most biopsies are simple.

Freih Abu Hassan

Jordan University

Poor & Bad biopsy

Freih Abu Hassan

Jordan University

1.Taking Bx. away of the site

of possible future Surgery

Freih Abu Hassan

Jordan University

2. Dissection and opening I.M

planes, joint cavity ---etc.

Tumor contamination.

Freih Abu Hassan

Jordan University

3. Hematoma spread of

tumor cells.

4. large incision Open Bx.

Freih Abu Hassan

Jordan University

Freih Abu Hassan

Jordan University

Freih Abu Hassan

Jordan University

Bx of the tumor surface

interpreted as Osteochondroma.

Paraosteal O.Sarcoma

Freih Abu Hassan

Jordan University

OPD aspiration

Freih Abu Hassan

Jordan University

Freih Abu Hassan

Jordan University

597 Patients

Major errors in Dx. = 13.5%.

Complication rate =15.9%.

Unnecessary amputations = 3%.

Mankin et al ,JBJS, 1996.

Freih Abu Hassan

Jordan University

Which biopsy technique

* Incisional biopsy !!! ??

* Needle biopsy (Trucut).

* Trocar biopsy.(Jamshidi)

* Excisional biopsy.

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.

Freih Abu Hassan

Jordan University

Bx. should be done by

the Surgeon who is

going to do the final R

Freih Abu Hassan

Jordan University

1- Careful studying of the

imagings

2- Small longitudinal incision.

3- Sharp dissection.

4- Plug bone by PMMA.

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.

Freih Abu Hassan

Jordan University

5- Drain tract in incision line.

6- Close in layers.

7- Subcuticular skin.

Freih Abu Hassan

Jordan University

Freih Abu Hassan

Jordan University

Freih Abu Hassan

Jordan University

Freih Abu Hassan

Jordan University

Freih Abu Hassan

Jordan University

Freih Abu Hassan

Jordan University

Freih Abu Hassan

Jordan University

Freih Abu Hassan

Jordan University

General Surgeon

Freih Abu Hassan

Jordan University

Freih Abu Hassan

Jordan University

Freih Abu Hassan

Jordan University

Freih Abu Hassan

Jordan University

Freih Abu Hassan

Jordan University

Potentially malignant. T.

Freih Abu Hassan

Jordan University

Only in obvious benign lesions.

Freih Abu Hassan

Jordan University

The only benign soft

tissue lesions.

Hematoma, Lipoma

Freih Abu Hassan

Jordan University

Unnecessary Bx or oper.

on asymp. benign lesions

Freih Abu Hassan

Jordan University

Freih Abu Hassan

Jordan University

Freih Abu Hassan

Jordan University

Ignoring the team approach

Freih Abu Hassan

Jordan University

Oncologist

Radiologist

Surgeon

Histopathologist

psychiatrist

Nursing &

Support staff

Cytopathologist

Freih Abu Hassan

Jordan University

Bx were performed

through a large incision

with contamination of

tissues. !!!!!!!

Freih Abu Hassan

Jordan University

قطع االعناق وال قطع االرزاق

قطع االعناق وال بتر االطراف

Freih Abu Hassan

Jordan University

Conclusion

1- Easy but bad sequale

2- Bx. by the definitive

Surgeon.

3- At the end of staging.

Freih Abu Hassan

Jordan University

4-Careful studying of the imagings

5-Risk of unnecessary amputation.

6-Limb salvage

Freih Abu Hassan

Jordan University