For incisional biopsies, the incision and dissection tract are planned such that they can be excised during the definitive limb-salvage procedure. Incisional biopsies are also often performed when a needle biopsy result is nondiagnostic. Incisional biopsy is generally recommended for suspected benign lesions that can be treated definitively at the time of biopsy or in cases where greater volumes of tissue may be required to perform special staining or molecular diagnostics than can be obtained with a needle biopsy ( Video 22-1).
Open biopsy can be categorized as either incisional (the tumor capsule is intentionally violated as part of the procedure, and a portion of the mass or lesion is removed) or excisional (the entire tumor is removed). 44, 47 Sentinel node biopsy may offer a safe and less invasive means of lymph node evaluation for extremity and truncal lesions, although its role in RMS is yet to be determined but will soon become the focus of a clinical trial. Open biopsy is recommended however, fine-needle aspiration or core needle biopsy of lymph nodes may be performed at the discretion of the surgeon's judgment and pathologist's recommendations. 46 Clinical and radiographic positive lymph nodes should be confirmed pathologically. Image guidance with ultrasonography may increase the accuracy of sampling while helping to avoid inadvertent puncture of surrounding structures. This smaller volume of tissue may prevent the performance of adequate molecular biology studies. 44, 45 Although less invasive than open biopsy, core needle biopsy obtains a smaller tissue sample, which increases sampling error and the number of inconclusive findings. For small lesions in areas that will be treated with chemotherapy and radiation or for metastatic disease, core needle biopsy may be appropriate for diagnosis.
Care should be taken to obtain adequate specimens for pathologic, biological, and treatment protocol studies. Open biopsy of a mass suspected to be RMS should be performed to confirm the diagnosis. Rodeberg, in Pediatric Surgery (Seventh Edition), 2012 Biopsy 10 It is noted that relevant current knowledge is based mainly on retrospective studies. 9 Currently, the question is, which is more appropriate: fine needle aspiration cytology (FNAC) or core needle biopsy (CNB)? In some centers, frozen section (FS) is standard practice for parotid neoplasms. If malignant, the tumor type and grade are important, as selected low-grade carcinomas may not require total parotidectomy.
3–8 To avoid an inadequate operation, it is important to know if the lesion is malignant. New surgical procedures for benign tumors such as extracapsular dissection, partial superficial parotidectomy, or deep lobe parotidectomy with preservation of the superficial lobe have been introduced. Facial nerve injury, wound infection, salivary fistula, or sialocele are reported after open biopsies in addition, a curative parotid surgery can be complicated by a previous open biopsy. Open biopsies are contraindicated because of the risk of tumor cell seeding, which increases the risk of recurrence of both malignant neoplasms and pleomorphic adenomas. Peter Zbären, in Surgery of the Salivary Glands, 2021 Introduction
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