Publication:

Biopsy tract seeding in musculoskeletal sarcomas: myth or reality?

Background It is a common practice in oncology in general and musculoskeletal oncology that the biopsy tract must be resected together with the tumor while performing limb-sparing surgery. Our study aims to assess the need for routine excision of biopsy scars in musculoskeletal malignancies by analyzing the presence of tumor in the biopsy tracts.

Methods We conducted a prospective study from January 2021 to April 2023, including 48 soft tissue and bone sarcoma patients. Neoadjuvant chemotherapy was administered to all cases of Ewings sarcoma and osteosarcoma. All of them underwent surgical resection with appropriate reconstruction. Biopsy tracts were sent separately and analyzed for tumor infiltration.

Results Two of the 48 patients included in the study had tumor deposits in their biopsy tracts. One patient with undifferentiated pleomorphic sarcoma and another patient with high-grade myxoid liposarcoma had tumor seeding in their biopsy tracts.

Conclusions The rate of biopsy tract seeding in our study was 4.2% (2 out of 48). Even though this might seem very less, it is still significant considering the rarity of bone and soft tissue sarcomas. Despite the low risk of tumor seeding, it is advisable to continue routinely excising the biopsy tract. Whether inappropriately placed biopsy tracts warrant an amputation instead of limb salvage is a question that will be best answered in the future with large-scale prospective randomized studies.