CT or ultrasound-guided bone and / or soft tissue biopsy is a new technique, currently not performed in many hospitals, which allows a much more accurate and less invasive diagnosis of sarcoma. In the opinion of Dr. Sergio Serrano, of the Department of Interventional Radiology at MD Anderson Madrid and one of the few radiologists who performs this technique in Spain, this procedure, which takes between 20-30 minutes, is "less invasive, faster and, as there is no need to go into the operating room, the risk of complications is reduced".
Thanks to CT or ultrasound guidance, the doctor can follow the whole procedure live, in real time, from the injection with the needle to the incision and the subsequent extraction. "We are going to a previously chosen area and, in addition, thanks to the imaging techniques, we can see directly where we want to puncture and where we want to go", Dr. Serrano explains. In addition, compared to the most commonly used technique, surgical biopsy, which requires general anesthesia and hospital admission, this type of biopsy allows local anesthesia or sedation, which facilitates the patient’s going home on the same day.
Likewise, observing the procedure as it happens in great detail means "that the samples taken are more viable for subsequent analysis by the pathologist, so the percentage of samples from which the pathologist cannot reach a correct diagnosis is greatly reduced", says Dr. Serrano. But coordination is not only greater with the Anatomic Pathology Service, but also with the Oncology Traumatology Service. "It is important to agree the area and route of this procedure with the traumatologist because the area where the sample is obtained will also be the site for subsequent tumor extraction, in the case surgery is finally necessary," explains Dr. Serrano.
In fact, multidisciplinary work is especially important in this procedure, something that, the specialist states, is very easy in a center like MD Anderson Madrid, dedicated to the comprehensive care of cancer patients. Thus, in addition to Anatomic Pathology and Oncology Traumatology, coordination with the Medical Oncology Service, which plays a key role in choosing the correct treatment, is also very important. During the intervention it is important to have a technician or a nurse assistant present and, in cases where sedation is required, an anesthesiologist. "For a more global vision of the patient, it is crucial to work with a multidisciplinary team of professionals", says the specialist.
Furthermore, the World Health Organization (WHO) currently recognizes more than 150 different varieties of sarcoma, each of which requires a specific approach and treatment, adding even more value to this technique, which increases the specificity of the diagnosis thanks to its greater accuracy in obtaining the sample.
Other indications for CT or ultrasound-guided biospy
But, although mainly used for diagnostic purposes and in choosing a first line of treatment in sarcoma (surgery or prior treatment with chemotherapy, radiotherapy or immunotherapy), this procedure may also be indicated for the analysis of bone metastases in other types of cancer and to follow up on and / or monitor the evolution of the patient with sarcoma over time". In cases where the patient does not respond to treatment, we can perform this type of biopsy to see if the type of tumor has changed and, then, we must go to another line of treatment", explains Dr. Serrano.
In addition, this technique can be used for partial or total treatment of some specific injuries. "In those cases in which metastasis causes a lot of pain, it may be burned partially or totally, reducing its size, to relieve the patient's pain", says Dr. Serrano, who also points out its possible use in reducing the size of the tumor to be able to perform more localized surgery or in the complete treatment of benign lesions.