Pediatric Bone Sarcoma Biopsy Tract Excision: Is it Safe to Resect Separately?

Background: Biopsy is an essential part of proper diagnostic workup in pediatric bone sarcomas impacting surgical planning, chemotherapeutic treatments, and prognostic determination. Two main biopsy techniques are currently used: closed biopsy (core needle or fine needle aspiration) and open biopsy. Historical oncologic teaching is for resection of the biopsy tract with the tumor specimen due to the theoretical risk for biopsy tract tumor contamination; however, this can restrict surgical planning and increase morbidity. This study evaluates oncologic outcomes at this institution, comparing open versus closed biopsy, and biopsy tract resection with or separate from the main tumor resection.

Methods: Retrospective review of a single institution of all patients treated for bone sarcomas from 2006 through December 2021. Patient and tumor characteristics, biopsy technique, biopsy resection method, and oncologic outcomes were collected. Subgroup statistical analysis was performed comparing closed biopsy and open biopsy techniques, and biopsy tract resection with the main tumor or separately.

Results: A total of 73 patients met the inclusion criteria, including 48 (65.8%) open biopsies and 25 closed biopsies [23 (31.5%) core needle biopsies and 2 (2.7%) fine needle aspirations]. Biopsy tract resection was performed with the main tumor in 36 (49.3%), separate in 37 (50.7%). There were no statistical differences in local recurrence, disease-free survival, metastatic progression, or overall survival between biopsy methodology analysis and biopsy tract removal methods.

Conclusion: This study demonstrates the safety of both approaches for obtaining diagnostic tissues with low rates of biopsy tract seeding in both methods. In addition, it demonstrates that there is no difference in local recurrence, disease-free survival, metastatic progression, or overall survival between biopsy tract resection with or separate from the main tumor. Definitive surgical plan should not vary based on biopsy technique and biopsy tract management, but rather patient, tumor, institutional, and surgeon factors.

Level of evidence: Level III-retrospective chart review. The study was started after the patients were diagnosed and treated.