Bone Biopsy

(Biopsy-Bone, Bone Lesion Biopsy)

Procedure Overview

What is a bone biopsy?

A biopsy is a procedure performed to remove tissue or cells from the body for examination under a microscope. A bone biopsy is a procedure in which bone samples are removed (with a special biopsy needle or during surgery) to determine if cancer or other abnormal cells are present.

There are two types of biopsy:

• needle biopsy - After a local anesthetic is given, the physician makes a small incision in the skin and inserts the special biopsy needle into the bone to obtain a sample.
• open biopsy - After a general anesthetic is given, the physician makes a larger incision in the skin and surgically removes a piece of bone. Depending upon the lab findings, further surgery may be performed.

Other related procedures that may be used to help diagnose bone problems include computed tomography (CT scan), x-ray, magnetic resonance imaging (MRI) of the bones, and bone scan. Please see these procedures for additional information.

Click Image to Enlarge

What is bone?

Bone is living tissue that makes up the body's skeleton. There are three types of bone tissue:

• compact tissue - the harder, outer tissue of bones.
• cancellous tissue - the sponge-like tissue inside bones.
• subchondral tissue - the smooth tissue at the ends of bones, which is covered with another type of tissue called cartilage. Cartilage is the specialized, gristly connective tissue that is present in adults, and is the tissue from which most bones develop in children.

Bone provides shape and support for the body, as well as protection for some organs. Bone also serves as a storage site for minerals and supplies the marrow from which blood cells are developed and then stored.

Reasons for the Procedure

Bone biopsies may be performed to:

• evaluate bone pain or tenderness
• investigate an abnormality seen on x-ray
• determine if a bone tumor is malignant (cancerous) or benign
• determine the cause of an unexplained infection or inflammation

Types of benign bone tumors include osteochondroma, osteoid osteoma, osteoblastoma, benign giant cell tumor, and fibroma. The most common types of malignant bone tumors are osteosarcoma, multiple myeloma, and Ewing sarcoma.

There may be other reasons for your physician to recommend a bone biopsy.

Risks of the Procedure

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

• bruising and discomfort at the biopsy site
• bone fracture
• prolonged bleeding from the biopsy site
• infection near the biopsy site or in the bone

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the Procedure

• Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• In addition to a complete medical history, your physician may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
• Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
• Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
• Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
• If you are pregnant or suspect that you are pregnant, you should notify your physician.
• You may be asked to fast for eight hours before the procedure, generally after midnight. This is most likely if you are to have general anesthesia for the procedure.
• You may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.
• Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

A bone biopsy may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician’s practices.

In addition, some biopsies may be done using a local anesthetic to numb the area, while others may be done under general or spinal anesthesia. If spinal anesthesia is used, you will have no feeling from your waist down. Your physician will discuss this with you in advance.

Generally, a bone biopsy follows this process:

1. You will be asked to remove clothing and will be given a gown to wear.
2. An intravenous (IV) line may be started in your arm or hand.
3. You will be positioned so that the physician can easily reach the bone that is to be sampled. A belt or strap may be used to hold you in the correct position.
4. The skin over the biopsy site will be cleansed with an antiseptic solution.
5. If a local anesthetic is used, you will feel a needle stick when the anesthetic is injected. This may cause a brief stinging sensation. If general anesthesia is used, you will be put to sleep using intravenous medication.
6. If a local anesthetic is used to numb the area, you will need to lie still during the procedure.
7. A small incision will be made over the biopsy site and the biopsy needle will be inserted into the bone.
8. If awake, you may feel discomfort or pressure when the physician obtains the bone sample.
9. The biopsy needle will be withdrawn and firm pressure will be applied to the biopsy site for a few minutes, until the bleeding has stopped.
10. The physician will close the opening in the skin with stitches or skin adhesive strips, if necessary.
11. A sterile bandage/dressing will be applied.
12. The bone sample will be sent to the lab for examination.

After the Procedure

Your recovery process will vary depending upon the type of anesthesia that is given. You will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home.

Once you are home, it is important to keep the biopsy area clean and dry. Your physician will give you specific bathing instructions. If stitches are used, they will be removed during a follow-up office visit. If adhesive strips are used, they should be kept dry and generally will fall off within a few days.

The biopsy site may be tender or sore for several days after the bone biopsy. Take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Notify your physician to report any of the following:

• fever
• redness, swelling, bleeding, or other drainage from the biopsy site
• increased pain around the biopsy site

You may resume your usual diet and activities unless your physician advises you differently. Your physician may ask you to avoid strenuous physical activity for a few days.

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.