Your first office visit may be overwhelming because we are attempting to confirm a diagnosis for you.
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Determining Diagnosis: Biopsy & Staging Studies
Primary Malignant Tumors
Types of Treatment
Determining Diagnosis: Biposy Your first office visit may be overwhelming because we are attempting to confirm a diagnosis for you. You meet many members of our staff, hear quite a bit of information and may have a number of tests performed. Your first visit maybe tiring, somewhat confusing and stressful depending on your situation.
If you brought blood results, MRI, bone or CT scans, we review all of them. If you have had a biopsy, we consult with our pathologists to review your pathology slides. If you have not had any of these studies done, we attempt to schedule all of them during your first visit.
Plain x-rays, CT scans of the tumor area and of your chest, MRI, PET and bone scans are called staging studies. These are the common studies performed to 'workup' a patient with a questionable tumor of the soft tissues or bone. They assist us in determining whether your tumor is benign or malignant, and whether the malignant ones (sarcomas) have traveled to other sites of your body. When a sarcoma has traveled, this is called a metastasis. If sarcomas metastasize, the most common site is the lung.
We will also schedule a biopsy that day if deemed necessary. A biopsy is a needle aspirate or surgical removal of a small piece of tissue for microscopic examination. There are four types of biopsies which are done to make a diagnosis:
- Fine needle aspiration (FNA): Performed in the office by pathologists from the FNA Biopsy Service. It takes about 10-15 minutes, uses a very small needle and usually the results are ready during your visit. A Band-Aid is placed at the biopsy site.
- Tru-cut needle biopsy: Performed in the office by one of the surgeons. A local anesthetic is used to numb your skin and a larger needle is used to get several samples of tissue. You may have some discomfort or pressure like sensation when a sample is taken. Samples are taken to our pathologists and preliminary results are ready in an hour or so. Many times results take 24 hours or longer. A pressure dressing is applied to the biopsy site.
- CT scan or ultrasound-guided needle biopsy: Performed in the Musculoskeletal Radiology Department by one of the radiologists. It may take one hour. The CT is used to guide the radiologist to position the needle into the tumor and get several samples of tissue. Some patients have stated that the procedure is painful despite local anesthetics. A small bandage or larger pressure dressing is applied at the site. Results usually take 24 hours or longer. Radiologists prefer that you not eat or drink 6 hours before the procedure, and have someone with you to take you home. You will be medicated for the procedure, thus driving or taking public transportation is not advised.
- Open biopsy: A surgical procedure usually requiring general anesthesia in which a small incision is made to take an adequate tissue sample to be examined by the pathologist. Tumor diagnosis determines treatment plan. Thus, an open biopsy is performed when any of the other needle biopsies can not confirm a diagnosis or in children when this type of biopsy maybe more appropriate. An open biopsy can not be done on the same day as the office visit since it requires booking operative time and preadmission testing. Results may be ready following the procedure, but usually it takes 24 hours or longer.
Staging Studies In addition to the two major categories of benign or malignant, bone and soft tissue tumors are further classified or staged. The stage of a lesion depends on three factors:
- The grade of the tumor which is a microscopic evaluation of the tumor cell's biologic behavior and aggressiveness, that is, its ability to grow and extend beyond its natural barrier (capsule).
- Whether the tumor stops in its area (compartment) or grows and penetrates out of the compartment.
- Whether or not there are metastases.
A biopsy which involves the microscopic evaluation of the tumor cell's biologic behavior will determine the grade. Pathologists grade malignant tumors ranging from low grade (1) to high grade (3). Low grade tumors are made of cells whose behavior is not aggressive, that is they seldom spread beyond their local site (Grade 1/3). Intermediate to high grade tumors are made of cells that behave very aggressive and most often than not spread to other parts of the body (Grade 2 or 3).
Patients must undergo many scans (MRI, CT, bone or PET) called staging studies. These scans are done to evaluate the extent of the tumor, locally or at distant sites. The tumor is then staged which helps determine the best treatment plan for that type of tumor. Many of these imaging studies need to be done prior to the biopsy. In most circumstances the biopsy is the last part of the staging process.
Many of our patients have expressed confusion about staging and grading of tumors because of information read in books or found on the internet. Hopefully the above information will help you understand how tumors are staged and graded.