Bone tumors: Diagnosis and biopsy techniques
- Francis J Hornicek, MD, PhD
Francis J Hornicek, MD, PhD
- Associate Professor of Orthopaedic Surgery
- Harvard Medical School
- Miriam Bredella, MD
Miriam Bredella, MD
- Associate Professor of Radiology
- Harvard Medical School
- Massachusetts General Hospital
- Section Editors
- Thomas F DeLaney, MD
Thomas F DeLaney, MD
- Section Editor — Bone and Soft Tissue Tumors
- Professor of Radiation Oncology
- Harvard Medical School
- Alberto S Pappo, MD
Alberto S Pappo, MD
- Section Editor — Pediatric Oncology
- Head of Solid Malignancies Program
- St. Jude Children's Research Hospital
Most bone tumors are benign, although the true incidence of benign bone tumors is unknown because most are asymptomatic and are usually discovered as an incidental lesion. As a rough estimate, they may occur more than 100 times more often than primary malignant tumors of bone. (See "Benign bone tumors in children and adolescents: An overview".)
Primary malignant bone tumors are uncommon but are a significant cause of cancer morbidity and mortality, especially among young people. Although relatively rare in childhood, primary malignant bone tumors represent the sixth most common neoplasm in children, while in adolescents and young adults, they are the third most frequent, exceeded only by leukemias and lymphomas [1,2]. In the United States, it is estimated that approximately 3300 primary malignant bone tumors (excluding malignancies arising in the bone marrow) are diagnosed annually, and approximately half as many deaths result .
Primary malignant bone tumors are classified according to their cytologic features and cellular products (table 1). For many of these tumors, most notably osteosarcoma and the Ewing sarcoma family of tumors (EFT), remarkable progress in surgical techniques and multidisciplinary management over the last 40 years has resulted in significant improvements in the likelihood of cure and limb salvage.
The initial work-up and staging evaluation of a patient with a suspected primary bone tumor, particularly the diagnostic biopsy, is a critical component of successful management. Here we will discuss the diagnostic evaluation and biopsy techniques for primary tumors of bone. The classification, epidemiology, and clinical features of specific types of bone tumors, and the evaluation and management of patients with complete and impending pathologic fractures in the setting of metastatic bone disease, myeloma, and lymphoma are considered elsewhere.
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- CLINICAL PRESENTATION
- DIAGNOSTIC AND STAGING WORK-UP
- Radiographic imaging
- - Differential diagnosis
- Evaluation of the rest of the skeleton
- Staging system
- INDICATION FOR BIOPSY
- Doubtful diagnosis
- Metastatic disease
- Planning the biopsy
- BIOPSY TECHNIQUES
- Needle biopsy
- - FNA biopsy
- - Core biopsy
- - Technique
- - Anesthesia
- - Accuracy of needle biopsy
- - Complications
- Operative biopsy
- Specimen handling
- - Special handling requirements
- INFORMATION FOR PATIENTS