Biopsy in

Sarcoma:
Pitfalls
D R R M AM AN AB DURAHMAN, SPB (K)ONK

• Ketua Tim Penanggulangan Kanker RSUP dr Hasan

Sadikin Bandung
• Ketua PERABOI Jawa Barat
Sarcoma
• Forgotten cancer.
• Sarcoma: Soft tissue sarcoma and Bone sarcoma
• Soft tissue tumor derived from Mesoderm: fat, smooth muscle,
myofibroblast, striated muscle, vascular endothelium, fibroblast,
lymph vessel, peripheral nerve, etc.
• More than 100 types
• <1% adult malignancy, 15-21% malignancy in children
• Signs and symptoms: soft tissue mass, pain from compression the
adjacent structures often noticed after minor trauma to area of masses.
Biopsy
▪ Many sarcomas improperly surgically removed
▪ Biopsy is the removal of a small amount of tissue for
examination under a microscope
Biopsy is critical, because the tissues that are removed during biopsy allow
physicians to make a definite diagnosis.

A physical exam, patient history, and imaging studies might suggest that a
patient has a certain subtype of sarcoma, but that diagnosis can only be made
after a pathologist examines the tumor's cells.
Biopsy
Type of Biopsy
•Fine needle aspiration biopsy +/-
guided
•Core needle biopsy +/- guided
•Incisional biopsy
•Excisional biopsy
Biopsy
Type of Biopsy
•Fine needle aspiration biopsy +/- ➢Advantages
guided ➢Disadvantages
•Core needle biopsy +/- guided
•Incisional biopsy The biopsy site, approach and guiding
imaging modality are chosen based on
•Excisional biopsy prebiopsy diagnostic studies
Needle Biopsy
Welker JA, Henshaw RM,
Jelinek J, Shmookler BM,
Malawer MM, Cancer Vol 80
No 12, 2000
Incisional Biopsy

Good surgical technique

Direct approach
Proper orientation of incision
Avoid extensive retraction
Adequate visualization
Hemostasis, avoid hematoma
Key Practice Points
▪Optimal prebiopsy characterization of suspected tumors with plain
radiography and cross-sectional imaging is essential for successful patient
selection and tissue sampling
▪The biopsy site, approach and guiding imaging modality are chosen based on
prebiopsy diagnostic studies
▪Immediate assessment of the FNA specimen by a cytopathologist determines
appropriate sampling of the tumor
▪Soft tissue tumors are best sampled by large (14-gauge) cutting-type needles
▪ Biopsy is a key step in the diagnosis of bone and soft-tissue tumors.
▪ Inadequately performed biopsy: not proper diagnosis, less survival, more
morbid treatment
▪ For any biopsy prior to limb-salvage surgery, anatomically based guidelines
should be followed such that the surgeon can resect the biopsy track using a
standard incision, without the need for additional soft tissue resection
 RSUP dr. Hasan Sadikin / FK UNPAD

Terima Kasih