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Biopsy

A biopsy is a surgical procedure done to obtain a sample of tumor tissue for examination under a microscope. There are 2 different types of biopsies: the needle (closed) biopsy, and the open biopsy.

Needle biopsies can be performed with either fine (thin) or core (thick) needles, depending on the size and placement of the tumor. Fine needles remove very small fragments of tissue, while thick needles remove a larger core of tissue from the tumor. Although needle biopsies can potentially quicken the diagnostic process, because it can be performed as an outpatient procedure, they are not recommended in children and can cause some complications in osteosarcoma patients.

During open biopsies, the tumor is actually exposed and a slice of the tumor is removed and examined. Since the tumor is exposed, more tissue is accessible during an open biopsy. The more tissue there is for a pathologist to look at, the better the chances are for a more accurate identification and diagnosis of the disease. This procedure is done in an operating room by an orthopedic surgeon. Open biopsies is the procedure done most often in osteosarcoma patients.

Biopsies are extremely important and mandatory in determining the diagnosis of osteosarcoma. A diagnosis should never be made from a single study, such as lab tests or imaging test. Imaging studies help determine the size and location of the tumor, so that the physician can know exactly how to perform the biopsy.

It is strongly recommended that biopsies be performed by the surgeon who will perform the definitive operation so that the biopsy tract can be excised with the planned resection. Also, biopsies should only be performed in specialized centers. Once a tumor has been biopsied and determined to be osteosarcoma, chemotherapy is usually given to try to shrink the tumor.