Why is biopsy required and why can’t treatment be started on the basis of some imaging or reports which the patients are usually carrying with them in our OPD’S? A very common and pertinent question which arises in their minds. The main reason for the same is the common perception in the minds of people that biopsy is painful, extensive and invasive procedure. Also, biopsy may cause displacement of the tumour which in turn may cause the tumour to increase in size and spread to other sites. These are myths and misconceptions.
Now coming on to some facts!! Biopsy is a totally safe procedure in right indications, by the right person with the requisite expertise and by following all the principles of a safe biopsy. Biopsy is still not an option but rather a necessity for making a histopathological diagnosis in many bone and soft tissue cancers. Relying on imaging alone for diagnosis of bone and soft tissue cancers will lead to a wrong diagnosis and subsequently institution of wrong treatment most often than not.
Ideally, biopsy should be performed at a cancer centre with the requisite facilities and ideally by the surgeon or a member of his team who is ultimately going to manage the patient definitively later on. Previously, biopsies were done by giving a generous incision but nowadays biopsies in Bone cancers can be performed by a Core Needle biopsy method with the help of a Jamshidi Needle. Soft tissue cancers are subjected to Trucut biopsy with a Gun Biopsy needle. These techniques are minimally invasive and give a diagnostic yield which is similar in comparison to previous traditional methods. The procedure is performed in Day-care setting under General anaesthesia for young children and can be safely performed in a painless fashion under local anaesthesia for older children and adults. Cancer centres with good Onco-pathological services, the biopsy reports are available after 72 hrs and subsequent treatment can be timely initiated. For difficult to assess sites for biopsy like spine or pelvis, use of image guidance in the form of fluoroscopy/CT-guidance can make the task easier to perform a correct targeted biopsy.
Obtaining the correct diagnosis by proper biopsy is quite essential, since the whole treatment depends on it. A wrongly done biopsy or an incorrect diagnosis can jeopardize the feasibility of a limb-salvage in cases of bone and soft tissue cancers.