Biopsy tract seeding in musculoskeletal sarcomas: myth or reality?
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20233268Keywords:
Biopsy tract, Tumor seeding, Limb salvageAbstract
Background: It is a common practice in oncology in general and musculoskeletal oncology that the biopsy tract must be resected together with the tumor while performing limb-sparing surgery. Our study aims to assess the need for routine excision of biopsy scars in musculoskeletal malignancies by analyzing the presence of tumor in the biopsy tracts.
Methods: We conducted a prospective study from January 2021 to April 2023, including 48 soft tissue and bone sarcoma patients. Neoadjuvant chemotherapy was administered to all cases of Ewings sarcoma and osteosarcoma. All of them underwent surgical resection with appropriate reconstruction. Biopsy tracts were sent separately and analyzed for tumor infiltration.
Results: Two of the 48 patients included in the study had tumor deposits in their biopsy tracts. One patient with undifferentiated pleomorphic sarcoma and another patient with high-grade myxoid liposarcoma had tumor seeding in their biopsy tracts.
Conclusions: The rate of biopsy tract seeding in our study was 4.2% (2 out of 48). Even though this might seem very less, it is still significant considering the rarity of bone and soft tissue sarcomas. Despite the low risk of tumor seeding, it is advisable to continue routinely excising the biopsy tract. Whether inappropriately placed biopsy tracts warrant an amputation instead of limb salvage is a question that will be best answered in the future with large-scale prospective randomized studies.
References
Oliveira MP, Lima PMA, Silva HJ, Mello RJV. Neoplasm seeding in the biopsy tract of the musculoskeletal system. a systematic review. Acta Ortop Bras. 2014;22(2):106-10.
UyBico SJ, Motamedi K, Omura MC, Nelson SD, Eilber FC, Eckardt J, et al. Relevance of compartmental anatomic guidelines for biopsy of musculoskeletal tumors: retrospective review of 363 biopsies over a 6-year period. J Vasc Interv Radiol. 2012;23(4):511-8.
Seeger LL. Revisiting tract seeding and compartmental anatomy for percutaneous image-guided musculoskeletal biopsies. Skeletal Radiol. 2019;48(4):499-501.
Davies NM, Livesley PJ, Cannon SR. Recurrence of an osteosarcoma in a needle biopsy track. J Bone Joint Surg Br. 1993;75(6):977-8.
Cannon SR. Relationship of the site of open biopsy of malignant bone tumors to local recurrence following resection and prosthetic replacement. J Bone Joint Surg. 1987;69:492.
Mohana R, Faisham W, Zulmi W, Nawfar AS, Effat O, Salzihan MS. The Incidence of Malignant Infiltration in the Biopsy Tract of Osteosarcoma. Malaysian Orthop J. 2007;1(2):7-10.
Ribeiro MB, Oliveira CRG, Filippi RZ, Baptista AM, Caiero MT, Saito CF, et al. Histopathological study on biopsy track in malignant musculoskeletal tumors. Acta Ortop Bras. 2009;17(5):279-81.
Barrientos-Ruiz I, Ortiz-Cruz EJ, Serrano-Montilla J, Bernabeu-Taboada D, Pozo-Kreilinger JJ. Are Biopsy Tracts a Concern for Seeding and Local Recurrence in Sarcomas? Clin Orthop Relat Res. 2017;475(2):511-8.
Binitie O, Tejiram S, Conway S, Cheong D, Temple HT, Letson GD. Adult soft tissue sarcoma local recurrence after adjuvant treatment without resection of core needle biopsy tract. Clin Orthop Relat Res. 2013;471(3):891-8.
Siddiqi MA, Kim HS, Jede F, Han I. Association of core needle biopsy tract resection with local recurrence in extremity soft tissue sarcoma. Skeletal Radiol. 2017;46(4):507-12.
Saghieh S, Masrouha KZ, Musallam KM, Mahfouz R, Abboud M, Khoury NJ, et al. The risk of local recurrence along the core-needle biopsy tract in patients with bone sarcomas. Iowa Orthop J. 2010;30:80-3.
Berger-Richardson D, Swallow CJ. Needle tract seeding after percutaneous biopsy of sarcoma: Risk/benefit considerations. Cancer. 2017;123(4):560-7.
Cates JM. Utility of Examination of Biopsy Tracts in Osteosarcoma Resection Specimens. Am J Clin Pathol. 2016;146(3):324-7.
