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Symposium: Selected Papers Presented at the 2008 Meeting of the Musculoskeletal Tumor Society

Biopsy of Soft Tissue Masses: Evidence-based Medicine for the Musculoskeletal Tumor Society

Bruce T. Rougraff¹, Albert Aboulafia², J. Sybil Biermann³ and John Healey⁴

(1)	Indiana Orthopaedic Hospital, 8450 Northwest Boulevard, Indianapolis, IN 46278, USA

(2)	Sinai Hospital Cancer Institute, Baltimore, MD, USA

(3)	University of Michigan Medical Center, Ann Arbor, MI, USA

(4)	Memorial Sloan Kettering Cancer Center, New York, NY, USA

Received: 3 March 2009 Accepted: 17 June 2009 Published online: 14 July 2009

Abstract The literature contains a number of controversies regarding key questions: (1) When is a biopsy indicated? (2) How should the biopsy be placed? (3) How should the biopsy be performed and which has the greatest diagnostic accuracy? (4) Who should perform the biopsy? (5) What clinical parameters present the greatest diagnostic difficulty? Using PubMed and Google Scholar we performed English-language literature searches of clinical studies reporting biopsy of soft tissue masses. Thirty-two studies met the inclusion criteria but were only able to address three of the five questions the authors had hoped to evaluate. Available evidence suggests open biopsy has the highest diagnostic accuracy over core needle biopsy, which was higher than fine needle aspiration. There was no evidence to address who is best suited to perform the biopsy (general surgeon, orthopaedic surgeon, radiologist, pathologist) in terms of accuracy of diagnosis. Frozen section at the time of biopsy may improve diagnostic accuracy. Diagnostic difficulty was associated with myxoid and round cell neoplasms, infections, and tumors located in the paraspinal region. The limited number of references addressing these issues demonstrated the need for more Level I research in the area of biopsy of soft tissue masses.

Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

This work was performed at Indiana Orthopaedic Hospital, Indianapolis, IN.

Bruce T. Rougraff
Email: brougraff@aol.com

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