A frequent question I hear from people undergoing a work-up for a new lesion is, “will letting air to the tumor cause it to spread?” There is certainly concern for local contamination of tissues with many types of biopsies and this is especially the case with sarcomas because they are transplantable. But the belief that the shear act of doing a biopsy results in spread of a tumor and a worse prognosis is an “old wives tale.”
The origin of this false belief dates back to before we had the diagnostic imaging tools we have today. MRI became available in the 1980s and CT scans were available in the 1970s. Prior to this we just could not detect many cancers until they were more advanced. A classic example of this would be a 48-year-old woman who goes to her doctor with several months of abdominal pain and a mass. Prior to CT scans general surgeons would take patients to the operating room to do an exploratory laparotomy (open up the belly and see what is in there). Many times the patient would be feeling OK at the time of the procedure and when the surgeon does the procedure they find a large ovarian mass that has already spread all over the abdomen. The woman has a fairly rapid decline in her health and many associate the surgery as the reason for the spread of the tumor. “She was feeling OK until they opened her up and let the air to it.”
When dealing with any mass or tumor it is critical to perform a safe and adequate biopsy. It is the analysis of these critical cells and matrix that allow all the treating physicians to prescribe the correct treatment for each individual tumor type. Treatment protocols from one tumor type to another can be vastly different. For sarcomas it is best for the biopsy to be performed at a center familiar and experience in dealing with musculoskeletal tumors.