Abstract
Background/Aims: Biopsy of musculo-skeletal tumours is hazardous and, when poorly performed, may compromise limb salvage surgery and patient survival. The aim of this paper is to examine the early management of such patients referred to our unit with particular reference to the biopsy.
Methods: We conducted a prospective audit of all patients referred to our musculo-skeletal tumour service during 2002. Inclusion criteria were patients with primary tumours of the musculo-skeletal system. Patients with metastases were excluded. We compared the outcome of patients biopsied prior to referral with that of patients biopsied in a recognised treatment centre. Statistical analysis was performed using the chi-squared test and accepting a p value of 0.05 as significant.
Results: One hundred and forty two patients were included. There were 72 men and 70 women with a mean age of 40 years (6–88). The referring surgeon performed biopsies in 29 cases of which 20 were malignant lesions. The senior author biopsied the remaining 113 cases of which 57 were malignant. In 38% of patients biopsied by the referring surgeon definitive treatment was hindered by a badly performed biopsy. In 25 % the definitive treatment had to be changed either to a more radical procedure than would have originally been necessary or to palliative rather than curative intent. Three patients underwent unnecessary amputation. Patients biopsied elsewhere were more likely to a non-diagnostic biopsy (p< 0.0001), more likely to have an incomplete excision (p< 0.0001), more likely to require amputation (p< 0.03) and more likely to require adjuvant radiotherapy (p< 0.05) than those biopsied in our unit.
Conclusions: There is a high complication rate when patients with musculo-skeletal tumours are biopsied by surgeons inexperienced in the management of such lesions. These patients are best served by early referral to a specialist centre where the biopsy can be performed quickly, safely and accurately and definitive treatment can be administered.
The abstracts were prepared by Mr Roger Tillman. Correspondence should be addressed to BOOS at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PN
