SURGEON-LED BIOPSY WITH INTRAOPERATIVE FROZEN SECTION IS AN ACCURATE AND COST EFFECTIVE METHOD FOR INITIAL EVALUATION OF MUSCULOSKELETAL SARCOMAS.

Introduction: The most appropriate protocol for biopsying musculoskeletal tumours is controversial. Some authors advocate the use of CT-guided core biopsy. At the Royal Prince Alfred Hospital, Sydney, Australia, initial biopsies of most musculoskeletal tumours involve a surgeon-led operative core biopsy technique with frozen section evaluation. The latter is used to determine whether diagnostic tissue has been obtained and, if possible, to establish a definitive diagnosis. Aims: To determine the accuracy and cost effectiveness of a surgeon-led biopsy protocol for biopsying musculoskeletal tumours. Methods: A retrospective audit of biopsies of musculoskeletal tumours performed in the bone and soft tissue sarcoma unit at the Royal Prince Alfred Hospital over a two year period was performed. Results: One hundred and four patients had biopsies performed under the protocol. There were no non-diagnostic biopsies and one minor error resulting in no change in the patient’s management. There was no requirement to re-biopsy any of the patients. A surgeon-led operative core biopsy with frozen section evaluation was 38% more costly than a CT-guided core biopsy (AU$1804 versus AU$1308). Conclusions: Surgeon-led biopsy with intra-operative frozen section evaluation is effective and accurate and, despite being labour intensive, the reduction in the need for repeat biopsies justifies its use. Whilst the technique is approximately 38% more costly, there is no requirement for re-biopsy and anxiety associated with the need for this is allayed.