Surgery without incisional biopsy in skeletal tumours

Excerpt

Treatment of malignant skeletal tumours, up to the 70 s in the last century, was amputation. Following the development of large tumour prostheses [1, 2], salvage surgeries for extremities became popular, though a large portion of the extremities had to be sacrificed because detailed information regarding the extent of the tumour was not available. Because of bone scintigraphy, computer tomography, and magnetic resonance imaging, step by step, the amount of resected healthy tissue could be spared. Today, with improved diagnostic tools (18F-FDG PET CT) [3] with high sensitivity for malignancy (up to 100%) and high specificity for the tumour (96%) [3], an introduction of less invasive diagnostic methods such as core needle biopsy [4] and liquid biopsy [5] can reduce the necessity of incisional biopsy [6]. Excisional biopsy without primary diagnosis presently is recommended for soft tissue tumours (up to 2 cm). With more precise preoperative information, primary resections can be used with larger masses also. …