New Guidelines for Bone Cancer Biopsy
Two consortia have issued best practice recommendations for tissue sampling in osteosarcoma and Ewing sarcoma
Michael Schubert, PhD, is a veteran science and medicine communicator. He holds graduate degrees in biochemistry and molecular biology with a research focus on chromatin structure and function and has written on subjects from subspeciality pathology to fictional science. In addition to writing and editing, he is co-director of the Digital Communications Fellowship in Pathology and Course Trainer at the Lightyear Foundation, an initiative aimed at making science accessible to all.
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Although osteosarcoma and Ewing sarcoma are the two most common bone tumors of childhood and adolescence, survival rates remain low, especially in older children and those with metastatic disease. In a statement issued on July 15 in Clinical Cancer Research, a group of scientists from the Fight Osteosarcoma Through European Research and Euro Ewing consortia highlighted the lack of high-quality samples for research and clinical trials, pointing to issues such as the overall rarity of these cancers, challenges with tissue collection and processing, and the absence of standardized protocols for sampling these tumors.
These obstacles have led to significant gaps in experts’ understanding of the molecular biology that underlies bone tumors’ heterogeneity, treatment resistance, and progression. As a result, it can be difficult to stratify patients according to their risk or select the most appropriate treatment for their specific disease.
To tackle the issue, the consortia collaborated on a set of guidelines and recommendations for bone tumor biopsy. These include the following:
- Obtaining treatment-naive core or open biopsies from all suspected cases (fine-needle aspiration alone is considered insufficient).
- Taking, processing, and storing fresh and snap-frozen tissue in addition to formalin-fixed, paraffin-embedded (FFPE) samples.
- Obtaining a minimum of five samples, with two designated for research unless needed for diagnostic purposes.
- Having all samples taken by a specialist surgeon or a muscular or interventional radiologist with bone tumor experience (and ensuring that the surgeon performing the tumor resection is involved in the biopsy process).
- If metastases are present at diagnosis, these should also be considered for biopsy.
- In the event of disease recurrence, snap-frozen and fresh/fixed tumor tissue samples should be obtained for omics analysis, research, and biobanking.
During tumor resection, the consortia also recommend obtaining samples of the primary tumor, matched adjacent normal tissue, and any metastases. In order of priority, these should be:
- FFPE samples for treatment decision-making.
- Snap-frozen samples.
- Fresh samples stored in RNA-preserving medium.
- Fresh samples stored in culture-compatible medium.
Finally, the groups also recommend liquid biopsy at diagnosis, pre- and post-surgery, and at follow-up. Blood samples can be used for diagnostic or disease monitoring purposes but can also contribute to biomarker research—and for patients participating in trials that require ongoing monitoring, liquid biopsy offers a minimally invasive option to reduce risk and maximize comfort for the patient.