Bone Biopsy

Test Overview

A bone biopsy is a procedure in which a small sample of bone is taken from the body and looked at under a microscope for cancer, infection, or other bone disorders. The sample of bone can be removed by:

A bone biopsy can be taken from any bone in the body. It is easiest to get the biopsy samples from bones that are close to the skin surface and away from any internal organs or large blood vessels.

A bone biopsy is often done on bone areas that show problems on an X-ray. Computed tomography (CT scan) or a bone scan may be used to guide the biopsy needle.

Why It Is Done

A bone biopsy is done to:

• Confirm the diagnosis of a bone disorder (such as Paget's disease, a disease that may look like bone cancer, or bone cancer) that was found by another test, such as an X-ray, CT scan, bone scan, or a magnetic resonance imaging (MRI) scan.
• Tell the difference between a noncancerous (benign) bone mass, such as a bone cyst, and bone cancer, such as multiple myeloma.
• See what is causing a bone infection (osteomyelitis) or if an infection is present.
• Find the cause of ongoing bone pain.
• Check bone problems seen on an X-ray.

An open bone biopsy allows your doctor to do surgical treatment at the same time, if needed.

How To Prepare

Before having a bone biopsy:

• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your test. Your doctor will tell you if you should stop taking any of them before the test and how soon to do it.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your test. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.

Ask your doctor if you will be getting sedation (to help you relax) or general anesthesia (to make you sleep). These medicines aren't usually needed for needle biopsies. If you will be getting sedation or general anesthesia, follow your doctor's instructions about when to stop eating and drinking, or your surgery may be canceled. If your doctor has instructed you to take your medicines on the day of surgery, please do so using only a sip of water.

Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.

How It Is Done

Closed or needle biopsy

A closed or needle biopsy is done in a hospital or clinic by a doctor who specializes in X-ray tests (radiologist) or by a surgeon who specializes in conditions of the bone (orthopedic surgeon).

• Right before the procedure, you will be asked to remove most or all of your clothes. You will be given a gown to use.
• You'll probably be awake for the procedure. You may be given a sedative through an I.V. in your arm to help you relax. And you'll be given a medicine (local anesthetic) to numb your skin.
• It's important to lie very still during the procedure. Tell your doctor if you need to move or get more comfortable.
• The doctor will put a long, thin needle through the skin into the bone. Then your doctor will remove a small amount of bone through the needle.
• After the biopsy, the area will be cleaned and bandaged.
• You will stay for a short time after the biopsy until your doctor says it's okay for you to go.

Open biopsy

An open biopsy is done in an operating room by a surgeon.

• You will be given general anesthesia or medicine to block feeling in the area where the skin cut is made. You will have an intravenous (I.V.) line in a vein in your arm for medicines and fluids.
• The surgeon makes a cut to see the bone and take out a small piece.
• Then the cut is cleaned and closed with staples, stitches, tape or glue. A bandage is put on the area. If stitches or staples were used to close the cut, your doctor will tell you when they will be removed.
• You may need to stay overnight in the hospital.

Sometimes a special test of your bone tissue (frozen section) is done while you are having an open biopsy. The bone taken for a frozen section is quickly frozen, thinly sliced, and looked at under a microscope. If cancer cells are seen, your surgeon may take out some more of the bone during the procedure.

How long the test takes

A needle bone biopsy takes 15 to 30 minutes. An open bone biopsy takes 30 to 60 minutes.

How It Feels

Closed or needle biopsy

You may feel a brief pinch or sting from the numbing medicine. You may feel pressure or a brief, sharp pain as the needle enters the bone. You may also feel an aching pain or pressure when the bone tissue sample is taken out. After the procedure, the biopsy site may be sore and tender for up to a week.

Open biopsy

You will be asleep or the area will be numb so you will not feel any pain. After the biopsy, you may feel sleepy for about 2 hours. The biopsy site may be sore and tender for up to a week.

Risks

Problems from a bone biopsy are rare. There is a very small chance that the biopsy needle may break the bone or injure a nerve, blood vessel, or organ near the biopsy site. Surgery may be needed to treat the problem.

There is a very small chance for a skin infection or for the bone to become infected (osteomyelitis) or to not heal well. In rare cases, the bone may become weak and break at a later time.

Results

It may take several days to get the results because the bone sample needs to be specially prepared for study.

Bone biopsy

Normal:	The biopsy sample shows normal bone tissue.
Abnormal:	Bone tissue may show signs of infection, cancer, or another bone disorder (including Paget's disease, osteomyelitis, a bone cyst, or a noncancerous [benign] bone growth called an osteoma). The bone tissue may also show osteoporosis or osteomalacia, which means the bones are weak.
	Most cancer of the bone spreads (metastasizes) to the bone from another part of the body, such as the breast, lungs, prostate, or other organs. But bone cancer can also start in the bone itself (such as osteosarcoma or Ewing's sarcoma).