A 14-year-old boy has a destructive lesion of the proximal tibia suspicious for osteosarcoma on imaging. Core needle biopsy is planned at a referral centre. Which technical principle must be followed so that the definitive limb salvage resection is not compromised?

• A Biopsy tract placed transversely across the limb to minimise soft tissue contamination
• B Longitudinal incision oriented along the long axis of the limb, with the tract sited so it can be excised en bloc at definitive surgery ✓
• C Multiple sampling tracts from different portals to increase diagnostic yield
• D Drain placement through the same incision to prevent haematoma formation

Explanation

A biopsy for a suspected sarcoma should be made through a longitudinal incision along the axis of the limb, and the biopsy tract must lie within the plane of future resection so it can be removed en bloc with the specimen. Transverse tracts contaminate compartments and may force an amputation. Multiple tracts, drains away from the tract, and haematoma all spread tumour cells. This is a core principle in musculoskeletal tumour surgery.

Reference: Campbell's Operative Orthopaedics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.