Bone Tumors in the Knee: Biopsy, Surgery, and Recurrence Risks

There is a tumor on the right patella?

Can the biopsy determine whether a tumor is benign or malignant? How is a biopsy performed? Since the tumor is located in the bone, is surgery still necessary? I read online about articles related to bone tumors in the knee, and there seems to be a method that uses some kind of imaging to reduce the surgical area before proceeding with surgery.
Does this result in a smaller incision, and is it better for the surgery on the tumor? I've also read that even after the tumor is removed, there is still a possibility of recurrence.

Sophie, 20~29 year old female. Ask Date: 2013/11/26

Dr. Chen Yongxue reply Orthopedics

Hello, because the surgical methods and extent differ between benign and malignant tumors, if a biopsy is not performed first, there is a risk of misidentifying a malignant tumor as benign.
Insufficient surgical margins may lead to poorer healing outcomes.
Conversely, misidentifying a benign tumor as malignant could result in unnecessary amputations or loss of joints, which are irreversible outcomes and very unfair to the patient.
To determine whether a bone tumor is benign or malignant, pathological examination through biopsy is the most standard and direct method.

In your letter, you mentioned reducing the surgical extent after radiation treatment, which likely refers to malignant tumors.
Before surgery, radiation therapy (commonly known as radiotherapy) can be used to shrink the tumor, and after a certain period, the entire tumor can be surgically removed.
The benefit of this approach is that it allows for the preservation of more limb tissue.
In addition to radiation, preoperative chemotherapy can also be utilized to achieve similar goals, depending on the type of malignant tumor.

As for postoperative recurrence, it is possible in cases of malignant tumors.
Therefore, after surgery, adjuvant chemotherapy or radiation therapy may be administered to reduce the likelihood of recurrence or metastasis.

Orthopedic Specialist, Chen Yong-Hsueh

Reply Date: 2013/11/26

More Info

Understanding bone tumors, particularly in the knee, involves several critical steps, including biopsy, surgical intervention, and assessing the risks of recurrence. Let's break down these components to provide a comprehensive understanding.

Biopsy: Determining Benign vs. Malignant
A biopsy is a medical procedure used to determine whether a tumor is benign (non-cancerous) or malignant (cancerous). There are different types of biopsies, including:
1. Needle Biopsy: A thin needle is inserted into the tumor to extract a small sample of tissue. This method is less invasive and can often be done under local anesthesia.

2. Open Biopsy: This involves a surgical procedure where a larger section of the tumor is removed for analysis. This is typically done if the needle biopsy is inconclusive or if the tumor is deep within the bone.

The tissue sample is then examined under a microscope by a pathologist, who can identify the type of cells present and determine the nature of the tumor.

Surgical Intervention
If a tumor is confirmed to be malignant, surgery is often necessary. The surgical approach can vary based on the tumor's size, location, and type. In cases of bone tumors in the knee, the following options may be considered:
1. Traditional Surgery: This involves making a larger incision to access the tumor and remove it along with a margin of healthy tissue. This method ensures complete removal but may result in a larger scar and longer recovery time.

2. Minimally Invasive Techniques: Advances in surgical technology have led to the development of techniques such as arthroscopy, where small incisions are made, and a camera is used to guide the surgery. This can result in smaller scars and potentially quicker recovery. Additionally, techniques like laser surgery or radiofrequency ablation may be used to shrink tumors before surgical removal, reducing the size of the incision needed.

Recurrence Risks
After surgery, the risk of recurrence depends on several factors, including:
- Type of Tumor: Certain tumors, like parosteal osteosarcoma, have different recurrence rates based on their histological grade. Higher-grade tumors generally have a higher risk of recurrence.

- Surgical Margins: If the tumor is completely removed with clear margins (no cancer cells at the edges of the removed tissue), the risk of recurrence is lower.

- Adjuvant Therapy: In some cases, additional treatments such as chemotherapy or radiation may be recommended to reduce the risk of recurrence, especially for high-grade tumors.

Post-Surgical Recovery
Recovery after surgery can vary significantly. Patients may experience pain, swelling, and limited mobility initially. Physical therapy is often recommended to help regain strength and function in the knee. It is important to follow the surgeon's post-operative care instructions closely.

Conclusion
In summary, understanding bone tumors in the knee involves a multi-faceted approach that includes performing a biopsy to determine the nature of the tumor, considering surgical options based on the tumor's characteristics, and being aware of the potential for recurrence. Advances in surgical techniques have made it possible to perform less invasive procedures, which can lead to quicker recovery times and less postoperative pain. However, the risk of recurrence remains a concern, and ongoing monitoring is essential after treatment. Always consult with your healthcare provider for personalized advice and treatment options tailored to your specific situation.

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