Bone biopsy results in patients with a history of malignancy: a case series of 378 patients
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SCIENTIFIC ARTICLE
Bone biopsy results in patients with a history of malignancy: a case series of 378 patients Rhys Morris 1 & Karen Shepherd 1 & Gillian Cribb 1 & Jaspreet Singh 2 & Prudencia Tyrrell 2 & Paul Cool 1,3 Received: 13 July 2020 / Revised: 13 October 2020 / Accepted: 13 October 2020 # ISS 2020
Abstract Objective The value of a bone biopsy in patients who present with a bone lesion and past medical history of malignancy is uncertain. The objective of this study was to evaluate the outcome of bone biopsies in patients with a history of a malignancy undergoing bone biopsy of a lesion in a regional bone tumour unit. Secondary outcomes include the assessment of survival in the different outcome groups. Materials and methods This was a retrospective study of patients, with a previous malignancy and suspicious bone lesions, who underwent bone biopsy for final diagnosis between March 2010 and September 2019. Results of the biopsy were summarized into 3 groups: confirmed original malignancy, confirmed benign diagnosis, and confirmed new malignancy. Survival analysis of each group was also undertaken. Results A total of 378 patients met the inclusion criteria (mean age 64 years, 216 females (57%)). In 250 cases (66%), the original malignancy was confirmed on the bone biopsy; in 128 cases, an alternative diagnosis was confirmed (benign diagnosis in 69 (18%)), and 59 had a new malignancy (16%). Survival was significantly greater for those in whom a benign diagnosis was confirmed (logrank test p = 0.0100). Conclusion This study shows that for patients presenting with a suspicious bone lesion, together with a history of malignancy, in a third of cases, the bone biopsy will confirm an alternative diagnosis of a benign lesion or a new malignancy. Survival of these patients will vary significantly depending on the biopsy outcome. Keywords Metastatic bone disease . Bone biopsy . Bone lesion . Cancer
Introduction Advances in the early detection and treatment of cancer have contributed to improved survival rates in many countries [1, 2]. However, this growing population of cancer survivors creates new challenges for clinicians including orthopaedic surgeons. Bone is the third most common site of distant metastases [3], and around 80% of patients with metastatic disease will have metastatic bone disease (MBD) [4]. The increase in the prevalence of MBD will inevitably
* Rhys Morris [email protected] 1
Montgomery Unit, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG, UK
2
Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG, UK
3
Keele University, Newcastle, Staffordshire ST5 5BG, UK
result in an increased burden of disease for the orthopaedic and oncological communities [5]. One key dilemma facing orthopaedic surgeons is how to manage patients with a history of cancer and a new finding of a suspicious bone lesion. UK guidance from British Orthopaedic Oncology Surgery (BOOS) [6] advises consideration of a bone biopsy in c
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