PRE-OPERATIVE BIOPSY TRACT IDENTIFICATION USING INDIA INK SKIN TATTOO IN TUMOUR SURGERY: A NOVEL TECHNIQUE FROM STANMORE

Introduction Local recurrence of tumours along the biopsy tract is a known complication of percutaneous closed needle biopsy. Correct surgical management requires preoperative identification and excision of the biopsy tract at time of surgery. These tracts become increasingly difficult to identify with time, leading to risk of inadequate excision of the biopsy tract and recurrence of the tumour at the biopsy site. Materials/Methods In a prospective study conducted at our institution, 22 of the 45 patients with musculoskeletal tumours (49%) had unidentifiable biopsy sites, with a mean duration between biopsy and definite surgery being 98 days (range 13–164 days). We concluded that identification of the biopsy site was more difficult after 50 days. Radiotherapy related scar formation and the longer time duration between biopsy and definite surgery in patients requiring neoadjuvant therapy made identification more unlikely. Consequently, all patients received India ink skin tattoo to mark the biopsy site at the time of the needle biopsy. 56 patients were then prospectively reviewed on the day of surgery to identify the biopsy site. Results The biopsy tract was easily identifiable in all 56 patients (100%) by junior and senior orthopaedic surgeons. The mean duration between the skin tattoo and surgery was 68 days (range 12–299 days). Radiotherapy and chemotherapy did not influence the identification of the tattoo site. Conclusions Tattooing the skin with India ink enabled the surgeon to accurately excise the biopsy tract. We recommend this technique of tattooing the biopsy site with India ink as it is safe, easily recognisable and aids in accurate excision of the tract and the tattoo site.