If limb sparing surgery is to be performed, what should be considered regarding bone biopsy?

• A. The biopsy tract must be positioned so it can be removed en bloc at surgery or biopsy should be avoided entirely
• B. The biopsy tract should be left in place during surgery
• C. Biopsy should be taken after definitive surgery
• D. Biopsy is unnecessary if imaging is conclusive

Answer: (A)

In limb-sparing bone tumor surgery, preventing seeding of tumor cells from the biopsy is crucial. A biopsy tract can act as a conduit for tumor cells to contaminate surrounding tissues or the future reconstruction, making it harder to achieve clean oncologic margins. Therefore, the tract should be planned so that it can be removed en bloc with the tumor during the definitive surgery. If that isn’t feasible, it’s best to avoid the biopsy altogether to minimize the risk of seeding. This approach allows the entire tract and any tumor cells along it to be included in the surgical specimen, helping to preserve limb function while maintaining oncologic control. Leaving the biopsy tract in place during surgery increases the chance of local contamination and recurrence, so it’s not appropriate. Histology is still necessary for diagnosis and planning, which is why waiting to biopsy after definitive surgery isn’t a viable option, and imaging alone cannot substitute for tissue diagnosis.