Biopsy Considerations

The diagnosis of metastatic bone disease must be confirmed histologically prior to surgical intervention for an impending or realized pathologic fracture. Even in a patient with a known history of metastatic carcinoma, it is appropriate to obtain a biopsy to rule out other potential etiologies of osseous lesions. Failure to obtain a confirmatory biopsy creates the potential for errantly operating on a primary bone sarcoma, the consequences of which can be devastating. A biopsy is a component of a complete preoperative diagnostic evaluation. It should be preceded by a clinical and radiographic evaluation, enabling the determination of the tissue of origin and burden of skeletal disease. Regardless of whether the biopsy is performed in an open or percutaneous manner, the general principles of musculoskeletal biopsies are the same and must be respected to ensure optimal patient outcomes.