Tumor Contamination in the Biopsy Path of Primary Malignant Bone Tumors

Abstract

Objective: To study factors possibly associated with tumor contamination in the biopsy path of primary malignant bone tumors. Method: Thirty-five patients who underwent surgical treatment with diagnoses of osteosarcoma, Ewing's tumor and chondrosarcoma were studied retrospectively. The sample was analyzed to characterize the biopsy technique used, histological type of the tumor, neoadjuvant chemotherapy used, local recurrences and tumor contamination in the biopsy path. Results: Among the 35 patients studied, four cases of contamination occurred (11.43%): one from osteosarcoma, two from Ewing's tumor and one from chondrosarcoma. There was no association between the type of tumor and presence of tumor contamination in the biopsy path (p = 0.65). There was also no association between the presence of tumor contamination and the biopsy technique (p = 0.06). On the other hand, there were associations between the presence of tumor contamination and local recurrence (p = 0.01) and between tumor contamination and absence of neoadjuvant chemotherapy (p = 0.02). Conclusion: Tumor contamination in the biopsy path of primary malignant bone tumors was associated with local recurrence. On the other hand, the histological type of the tumor and the type of biopsy did not have an influence on tumor contamination. Neoadjuvant chemotherapy had a protective effect against this complication. Despite these findings, tumor contamination is a complication that should always be taken into consideration, and removal of the biopsy path is recommended in tumor resection surgery.

Tumor cell seeding in the biopsy tract and its clinical significance in osteosarcomas

“…There are different views about the preventive effect of neoadjuvant chemotherapy on tumor seeding. Some of the published studies suggest that chemotherapy has a positive effect on the control of tumor seeding . However, in line with the study of Barrientos‐Ruiz et al, we did not find a correlation between tumor seeding and neoadjuvant chemotherapy administration or the level of chemotherapy response.…”

“…Davies et al reported a local recurrence of an osteosarcoma in the biopsy tract in 1993 and drew attention to the removal of biopsy tracts during the final resection of sarcomas. Some other studies announcing tumor seeding along the biopsy tract and the necessity of tract removal in bone and soft tissue sarcomas followed this study . In line with these publications, removal of the biopsy tract is a widely accepted and advised practice today .…”

“…Matrix formation is another issue that was discussed in previous publications. Oliveira et al studied tumor seeding in osteosarcomas, Ewing Sarcomas, and chondrosarcomas. They found less tumor seeding in matrix‐producing tumors.…”

“…It is remarkable that the number of published cohort studies in the medical literature about the tumor seeding in bone and soft tissue sarcomas and its clinical importance is few. The published studies advocating the clinical importance of tumor seeding are performed usually retrospectively, in heterogeneous diagnostic groups or in low numbers of cases . In addition, there are some studies declaring no clinical significance of tumor seeding in sarcomas .…”

Needle tract seeding after percutaneous biopsy of sarcoma: Risk/benefit considerations

“…47 Oliveira et al published an additional cohort study on this topic. [48][49][50][51][52] However, among 30 patients who underwent surgical resection of the primary tumor without resection of the biopsy tract, there were no cases of disease recurrence noted within the in situ needle tract or other local recurrence after >4 years follow-up (pooled results of 2 studies). [48][49][50][51][52] However, among 30 patients who underwent surgical resection of the primary tumor without resection of the biopsy tract, there were no cases of disease recurrence noted within the in situ needle tract or other local recurrence after >4 years follow-up (pooled results of 2 studies).…”