What is the primary reason for choosing incisional biopsy over excisional biopsy for larger extremity sarcomas?

Choosing incisional biopsy over excisional biopsy for larger extremity sarcomas primarily revolves around the principle of minimizing tissue disruption while still obtaining sufficient diagnostic material. In cases involving large tumors, performing an excisional biopsy – which entails the complete removal of the tumor along with surrounding tissues – can complicate subsequent surgical interventions if the pathology indicates malignancy.

An incisional biopsy, on the other hand, involves removing only a portion of the tumor. This method allows for adequate histological evaluation while preserving the surrounding tissue architecture and structures. If the biopsy reveals that the tumor is malignant, the surgical team can plan for a more definitive resection that takes into account the tumor margins and necessary reconstructive options without the complications that can arise from prior extensive surgery.

In addition to preserving tissue for optimal planning of definitive surgical management, the approach of keeping tissue disruption to a minimum also helps reduce the likelihood of complications, such as infection, which can be significant in cases of large tumors. Avoiding unnecessary disruption to surrounding tissue enhances the chances for a clean margin during a secondary surgical procedure and may ultimately lead to better functional outcomes for the patient.