To biopsy or not to biopsy? That is the question.

This afternoon I met with Dr. Nyen Chong, a Kaiser Permanente thoracic surgeon, about performing a biopsy of my tumor. (Kaiser's Interventional Radiologists have said that a guided FNA not an option for this new tumor location.) We reviewed the location of the tumor, its proximity to 4 different veins, some lymphatic ducts, and nerve bundles. Dr. Chong explained that the tumor location would be very difficult although not impossible to access. He believed he could successfully perform a robotic-assisted biopsy, but that the risks of serious complications (serious bleeding or nerve damage causing paralysis) were about 10%. Regarding scheduling, he would not be able to perform the biopsy until mid-June. I understood him to opine that that he would recommend proceeding with the biopsy only if the odds of it providing information that would change the course of therapy exceeded the odds of the risks.

As I understand it, the odds that this new tumor is anything other than mets BC are very low, i.e., the low single digits. I have sent the following three questions to my three oncologists (Dr. Ferrera at Kaiser, Dr. Apolo at NIH, and Dr. Hahn at Hopkins):

1. Do you agree with Dr. Chong's assessment?

2. In view of the biopsy risks, would you recommend proceeding with the immediate resumption of nivolumab without having a biopsy? 

3. Or, would you insist on having the biopsy prior to my resuming therapy?

I'm leaning away from having the biopsy due to both the risks and the passage of time, but want to hear hear how oncologists answer my questions. Of course, either Dr. Ferrera or Dr. Hahn will have to agree to resume treatment without a biopsy, and for me to enter Dr. Apolo's cabo/nivo/ipi trial, I'll have to first resume nivolumab, then have tumor progression. I'll likely follow their consensus.