Objective: The purpose of this study was to design and use an algorithm for selection of the most appropriate biopsy technique.
Materials and methods: An algorithm was designed to maximize the tissue sampling and diagnostic accuracy of musculoskeletal tumor biopsy. We used fine-needle aspiration to sample small ( < 3 cm) soft-tissue masses, an 18-gauge automated Biopty Gun to sample large ( > 3 cm) soft-tissue masses, a bone-cutting core biopsy needle to sample sclerotic bone tumors, and a combination technique to sample lytic bone tumors with an intact bony shell. We reviewed the results of 46 consecutive biopsies obtained with this algorithm.
Results: The overall diagnostic accuracy was 96%, with one inadequate biopsy and one inaccurate biopsy. The diagnostic accuracies within subgroups of tumor types were: primary malignant tumors (n = 15), 93%; primary benign tumors (n = 9), 100%; secondary malignant tumors (n = 11), 100%; secondary benign tumors (n = 8), 88%; and infections (n = 3), 100%.
Conclusion: This algorithm allows selection of the biopsy procedure most likely to safely provide adequate and accurate biopsy samples.