In an adult over about 40, a destructive lytic bone lesion is most likely a metastasis or myeloma, but it may be a primary sarcoma. A poorly placed biopsy can contaminate tissue planes and compromise later limb salvage. Before biopsy, take a history for previous cancer, examine the breast, prostate, thyroid and abdomen, and request blood tests including serum protein electrophoresis and calcium, imaging of the whole bone, and staging CT of the chest, abdomen and pelvis. If the lesion could be a primary bone tumour, refer to a sarcoma service and let them plan the biopsy track.
- Ask about previous cancer and examine breast, prostate, thyroid and abdomen.
- Send calcium and serum protein electrophoresis with free light chains.
- Image the whole bone and request staging CT before biopsy.
- Refer possible primary bone tumours to a sarcoma service before any biopsy or fixation.
Why it matters
An unplanned biopsy or fixation of a primary sarcoma can turn a limb-salvage case into an amputation.
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