Chordoma experts answer the question: When is a biopsy appropriate for chordoma …
Biopsy is appropriate for chordoma when
it's unclear whether or not the tumor is
chordoma or not. Many times we will
approach a tumor, a chordoma, in the skull base
with the philosophy that we'll
biopsy at the time of surgery.
If it is clear that the tumor is chordoma then we would go ahead and resect at that point.
However if it's unclear it is often
wise to wait for biopsy.
The skull base is treated much differently than the spine where a lot of times a biopsy
has to be considered and done in a certain fashion to ensure there's not seeding.
The risk of seeding along the track of a biopsy – if it's done, for example, endonasally – is lower.
I personally feel that the
biopsy should be done in every patient
who has a suspected diagnosis of a chordoma and there are several reasons for that.
One is that the patient may
may be thought to have chordoma but
another diagnosis can emerge. I can
tell from my own experience that many
patients have been referred to me with a presumed diagnosis of chordoma
and imaging studies were highly
suggestive of that, the patient age was appropriate,
the location was appropriate,
and yet we do a biopsy and the tumor
comes back as lymphoma which requires an entirely different type of treatment
not even surgery in some cases. Or the
diagnosis comes back myxopapillary ependymoma
that looks like a chordoma, and
I have beautiful slides of that
that I typically use in our courses to
emphasize the point that just based on
the imaging alone you cannot make the
diagnosis of a chordoma.
For that reason I feel very strongly that we should do a biopsy in every case.
The other reason to do a biopsy is that this chordoma requires, at least in my view,
in certain locations very specific surgical
procedure, and that procedure can lead to
very significant functional loss for the
patient. I cannot, you know, consciously
subject the patient to such a
procedure unless I know a hundred percent
that that's the diagnosis and
that's the type of surgical
treatment that patient has to have and
so forth. For all those reasons I feel
that the biopsy is absolutely a must in
every patient with a suspected diagnosis of chordoma.

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