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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 9, 1207-1211.
doi: 10.1302/0301-620X.88B9.17680  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Surgical biopsy with intra-operative frozen section

AN ACCURATE AND COST-EFFECTIVE METHOD FOR DIAGNOSIS OF MUSCULOSKELETAL SARCOMAS

R. U. Ashford, FRCS(Trauma & Orth), Fellow in Orthopaedic Oncology1; S. W. McCarthy, FRCPA, Anatomical Pathologist2; R. A. Scolyer, FRCPA, Anatomical Pathologist2; S. F. Bonar, FRCPA, Anatomical Pathologist3; R. Z. Karim, FRCPA, Anatomical Pathologist2; and P. D. Stalley, FRACS, Consultant Orthopaedic Oncologist1

1 Department of Orthopaedics
2 Department of Anatomical Pathology, New South Wales Bone & Soft Tissue Sarcoma Service, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales 2050, Australia.
3 New South Wales Bone & Soft Tissue Sarcoma Service, Douglass Hanly Moir, Pathology, 95 Epping Road, North Ryde, New South Wales 2133, Australia.

Correspondence should be sent to Mr R. U. Ashford; e-mail: robert.ashford{at}virgin.net

The most appropriate protocol for the biopsy of musculoskeletal tumours is controversial, with some authors advocating CT-guided core biopsy. At our hospital the initial biopsies of most musculoskeletal tumours has been by operative core biopsy with evaluation by frozen section which determines whether diagnostic tissue has been obtained and, if possible, gives the definitive diagnosis. In order to determine the accuracy and cost-effectiveness of this protocol we have undertaken a retrospective audit of biopsies of musculoskeletal tumours performed over a period of two years.

A total of 104 patients had biopsies according to this regime. All gave the diagnosis apart from one minor error which did not alter the management of the patient. There was no requirement for re-biopsy. This protocol was more labour-intensive and 38% more costly than CT-guided core biopsy (AU$1804 vs AU$1308). However, the accuracy and avoidance of the anxiety associated with repeat biopsy outweighed these disadvantages.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General