Biopsies for Humerus Enchondromas Are Typically Performed by Orthopedic Oncologists
Biopsies for humerus enchondromas should be performed by orthopedic oncologists, not general surgeons, due to the specialized expertise required for proper biopsy planning and execution. 1
Rationale for Orthopedic Oncology Management
Enchondromas are benign cartilaginous tumors that require specialized management. The approach to these lesions involves:
- Orthopedic oncologists have specific training in bone tumor management and biopsy techniques
- Proper biopsy placement is critical for future surgical planning if the lesion requires removal
- Biopsy tract contamination must be considered in the overall treatment plan
Biopsy Procedure and Considerations
The NCCN guidelines emphasize several key points regarding bone tumor biopsies:
- Core needle biopsy is the preferred approach for diagnosis, with accuracy rates of 88-96% when adequate samples are obtained 1
- Open biopsy may be necessary in some cases but carries higher complication rates and costs 1
- The biopsy must be performed at the center that will provide definitive treatment 1, 2
- A multidisciplinary approach including the radiologist and orthopedic oncologic surgeon should be followed 1
Importance of Proper Biopsy Planning
Improper biopsy planning can have serious consequences:
- The biopsy tract must be placed where it can be resected with the tumor during definitive surgery 1
- Inappropriate biopsy placement can lead to altered treatment plans in up to 19% of patients 1
- Unnecessary amputations have occurred due to improper biopsy procedures 1
Management of Enchondromas
Enchondromas typically require:
- Initial evaluation with plain radiographs to identify bone pathology 2
- MRI to define tumor extent within bone and soft tissues 2
- Most enchondromas are asymptomatic and found incidentally 3
- Asymptomatic enchondromas can often be managed conservatively with serial radiological follow-ups 4
- Symptomatic cases may require surgical intervention, typically performed by orthopedic oncologists 5
Common Pitfalls to Avoid
- Performing biopsies at institutions without extensive experience in sarcoma treatment leads to higher complication rates 6
- Failure to plan the biopsy route in collaboration with the surgeon who will perform definitive treatment 1
- Misdiagnosis of enchondromas as more aggressive lesions, leading to unnecessary referrals and procedures 3
In conclusion, while both orthopedic surgeons and general surgeons may technically be able to perform biopsies, the specialized nature of bone tumors and the potential complications of improper biopsy technique make orthopedic oncologists the most appropriate specialists to perform biopsies for humerus enchondromas.