Surgical biopsy with intra-operative frozen section : An accurate and cost-effective method for diagnosis of musculoskeletal sarcomas

• Published in: Journal of bone and joint surgery. British volume Vol. 88; no. 9; pp. 1207 - 1211
• Main Authors: ASHFORD, R. U, MCCARTHY, S. W, SCOLYER, R. A, BONAR, S. F, KARIM, R. Z, STALLEY, P. D
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01-09-2006; British Editorial Society of Bone & Joint Surgery
• Edition: British volume
• Subjects: Biological and medical sciences; Biopsy - economics; Biopsy - methods; Biopsy, Needle - methods; Bone Neoplasms - economics; Bone Neoplasms - pathology; Bone Neoplasms - surgery; Clinical Protocols; Cost-Benefit Analysis; Diagnostic Errors; Diseases of the osteoarticular system; Female; Humans; Medical Audit; Medical sciences; Middle Aged; Muscle Neoplasms - economics; Muscle Neoplasms - pathology; Muscle Neoplasms - surgery; Orthopedic surgery; Retrospective Studies; Sarcoma - economics; Sarcoma - pathology; Sarcoma - surgery; Soft Tissue Neoplasms - economics; Soft Tissue Neoplasms - pathology; Soft Tissue Neoplasms - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tomography, X-Ray Computed; Surgical biopsy; Costs; Orthopedic surgery; Treatment; Sarcoma; Health economy; Malignant tumor; Diagnosis; Public health
• ISSN: 0301-620X; 2049-4394; 2044-5377; 2049-4408
• DOI: 10.1302/0301-620X.88B9.17680

The most appropriate protocol for the biopsy of musculoskeletal tumours is controversial, with some authors advocating CT-guided core biopsy. At our hospital the initial biopsies of most musculoskeletal tumours has been by operative core biopsy with evaluation by frozen section which determines whether diagnostic tissue has been obtained and, if possible, gives the definitive diagnosis. In order to determine the accuracy and cost-effectiveness of this protocol we have undertaken a retrospective audit of biopsies of musculoskeletal tumours performed over a period of two years. A total of 104 patients had biopsies according to this regime. All gave the diagnosis apart from one minor error which did not alter the management of the patient. There was no requirement for re-biopsy. This protocol was more labour-intensive and 38% more costly than CT-guided core biopsy (AU$1804 vs AU$1308). However, the accuracy and avoidance of the anxiety associated with repeat biopsy outweighed these disadvantages.