In patients with breast cancer and concern for bone-only metastases on imaging but with non-diagnostic IR biopsies, do you pursue surgical bone resection for diagnosis or treat empirically for metastatic disease based on pathology from breast lesion?  

The preferred approach would be to have confirmed tissue diagnosis and receptors repeated on the metastatic lesion, so if feasible/accessible, I would pursue that prior to treatment. If risks of biopsy outweigh benefits then treating empirically based on pathology from primary lesion sounds reasonab...