How should a CT guided bone biopsy be planned?
Biopsy of a suspected metastasis entails different considerations than that of a primary bone tumor. In the case of a suspected metastasis, the lesion most amenable to biopsy with the lowest risk of complications is preferred because seeding the biopsy track is of lesser concern. The biopsy of a primary bone tumor should be conducted in close consultation with the orthopedic oncologist who will ultimately resect the tumor. The operator should select an approach for biopsy that takes into careful consideration future limb sparing resection and rehabilitation. It is important to avoid contaminating joints, neurovascular structures, or adjacent anatomic compartments. It is also important to take an adequate number of samples to allow the pathologist to make a diagnosis, which varies with the size of the biopsy needle (e.g., with the larger 11 G needle, several cores are usually adequate). All aspirated fluid and clotted blood should also be sent for pathologic evaluation.