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Biopsy for soft tissue sarcoma

What is a biopsy?

During a biopsy, a doctor removes a sample of tissue or fluid from the body. A pathologist inspects the cells under a microscope to see if they are cancerous. If the cells are found to be cancerous, a biopsy can help determine whether the cancer began at the site of the biopsy, or if it started somewhere else in the body and spread to the biopsy site.

Some biopsies are performed under image guidance, such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI). This allows your doctor to collect cells from deeper inside the body. Depending on the type of biopsy performed, you will receive an anesthetic to minimize any pain.

Compared with other diagnostic tests for cancer, biopsies often provide a more definitive diagnosis. A biopsy can help determine whether the cancer began at the site of the biopsy sample, or if it started somewhere else in the body and spread to the site of the biopsy sample.

Some sites that are commonly biopsied include the breast, skin, bone marrow, GI tract, lung, liver, bladder, colon and lymph nodes. Our doctors determine the most appropriate method of biopsy based on several factors, such as the size, shape, location, and characteristics of the abnormality.

Biopsy medical animation

Video: Biopsy Medical Animation

Medical animation

Biopsy for soft tissue sarcoma

The two most common techniques used for performing a soft tissue sarcoma biopsy are: needle biopsy and open surgical biopsy. In rare cases, a sentinel lymph node biopsy may also be necessary.

  • Needle biopsy: For this procedure, your doctor will numb the area of the planned biopsy with a local anesthetic before inserting a needle into the tumor to retrieve a sample of cells. A CT or ultrasound scan may be used to help guide the biopsy needle, especially if the lump is not near the surface of your body. Since there are so many types of sarcomas, a large “core” needle is used whenever possible, as this allows for a larger tissue sample. A needle biopsy may be especially useful for tumors that are hard to reach, such as a retroperitoneal sarcoma (a sarcoma located deep within the abdomen or pelvis) or a sarcoma deep within the thigh.
  • Surgical biopsy: Because of the nature of managing sarcomas, an open surgical biopsy is only performed by an experienced surgical oncologist who has worked with sarcomas before. This procedure is usually performed under general anesthesia, because the surgeon will remove a relatively large sample of the tumor. With soft tissue sarcomas, the surgeon must be careful not to disrupt the tumor, as it could cause the cancer cells to spread. A surgical biopsy for soft tissue sarcoma takes careful planning, and there are two important steps that your surgeon will take:
    • Create a longitudinal (“lengthwise”) incision for extremity tumors.
    • Place the incision in such a fashion that after the biopsy, the surgical oncologist will be able to completely remove the entire tumor, as well as the previous surgical biopsy scar.
  • Sentinel lymph node biopsy: Certain types of soft tissue sarcomas will spread to the lymph nodes, such as angiosarcoma, epithelioid sarcomas and synovial sarcomas. Cases that spread to the lymph nodes only account for about 2 to 3 percent of all soft tissue sarcomas. During a sentinel lymph node biopsy, a radioactive substance and/or a colored dye is injected near the tumor site. Then, the first lymph nodes that pick up the dye (the sentinel lymph nodes) are removed and reviewed by a pathologist to check for the presence of cancer cells.
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