Open, or Incisional, biopsy utilizes a surgical procedure to open the tumor to obtain a large sample of the tissue for analysis.   This technique is rarely required for satisfactory diagnosis, and is overly invasive and riskier than the less invasive needle biopsy techniques described above. Incisional biopsy carries all the risks of surgery and anesthesia including infection, bleeding, and incorrect choice of incision.  As a biopsy technique, it should be utilized only when fine needle and/or core biopsy (performed in an experienced center) cannot accurately diagnose a soft tissue tumor.]  To accurately diagnose and classify most sarcomas, an expert sarcoma pathologist to examine the specimen is paramount.

Many patients suffer poor outcomes as a direct result of open biopsy (eg, local recurrences, extensive unnecessary reconstructions, and amputations in cases that were potentially amenable to limb-salvage resection).  Admittedly, better surgical biopsy planning and technique could have prevented some of these adverse events; however, virtually all may have been avoided by the use of fine needle or core needle biopsy instead of open biopsy. [11]

However, to obtain an adequate amount of tissue if testing of the tumor for various treatment markers, chemoresistance, or DNA or RNA microarray is desired, only complete excision or open biopsy can provide the amount of tissue needed for testing. [17]
