Bone Biopsy

What is a bone biopsy?

A biopsy is a procedure done to remove tissue or cells from the body to be looked at under a microscope. A bone biopsy is a procedure in which bone samples are removed (with a special biopsy needle or during surgery) to find out if cancer or other abnormal cells are present. A bone biopsy involves the outer layers of bone, unlike a bone marrow biopsy, which involves the innermost part of the bone.

There are 2 types of biopsy:

• Needle biopsy. After a local anesthetic is given, your healthcare provider makes a small cut (incision) in your skin. He or she inserts the special biopsy needle into your bone to get a sample.
• Open biopsy. After a general anesthetic is given, your healthcare provider makes a larger incision in your skin and surgically removes a piece of bone. Depending on the lab findings, you may need more surgery.

Other related procedures that may be used to help diagnose bone problems include CT scan, X-ray, MRI of the bones, and bone scan.

Why might I need a bone biopsy?

Bone biopsies may be done to:

• Evaluate bone pain or tenderness
• Investigate an abnormality seen on X-ray
• Find out if a bone tumor is cancer (malignant) or not cancer (benign)
• Find the cause of an unexplained infection or inflammation

Your healthcare provider may have other reasons to recommend a bone biopsy.

What are the risks of a bone biopsy?

As with any surgical procedure, complications can happen. Some possible complications may include:

• Bruising and discomfort at the biopsy site
• Bone fracture
• Prolonged bleeding from the biopsy site
• Infection near the biopsy site or in the bone

Other risks may exist, depending on your specific health condition. Be sure to discuss any concerns with your healthcare provider before the procedure.

How do I get ready for a bone biopsy?

• Your healthcare provider will explain the procedure to you. This is the time 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 health history, your healthcare provider may do a complete physical exam. This is to make sure you are in good health before undergoing the procedure. You may have blood tests or other diagnostic tests.
• Tell your healthcare provider if you are allergic to any medicines, latex, tape, or anesthesia (local and general).
• Tell your healthcare provider about all medicines you take. This includes prescribed and over-the-counter medicines, and herbal supplements.
• Tell your healthcare provider if you have a history of bleeding disorders, or if you take any blood-thinner (anticoagulant) medicines, aspirin, or other medicines that affect blood clotting. You may need to stop taking these medicines before the procedure.
• If you are pregnant or suspect that you are pregnant, tell your healthcare provider.
• You may be asked to fast for 8 hours before the procedure, generally beginning at midnight of the previous day. This is most likely if you are to have general anesthesia for the procedure.
• You may get a sedative before 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 on your health condition, your healthcare provider may have other instructions for how to prepare.

What happens during a bone biopsy?

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

In addition, some biopsies may be done using local anesthesia to numb the area. Others may be done under general or spinal anesthesia. If spinal anesthesia is used, you will have no feeling from your waist down. Your healthcare provider 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 your healthcare provider 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 medicine.
6. If local anesthesia is used to numb the area, you will need to lie still during the procedure.
7. The provider will make a small cut (incision) over the biopsy site. He or she will insert the biopsy needle into your bone.
8. If you are awake, you may feel discomfort or pressure when your healthcare provider takes 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. Your healthcare provider will close the opening in your skin with stitches or skin adhesive strips, if needed.
11. A sterile bandage or dressing will be applied.
12. The bone sample will be sent to the lab for examination.

What happens after a bone biopsy?

Your recovery process will vary, depending on 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 healthcare provider 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 your healthcare provider recommends. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines.

Tell your healthcare provider if you have:

• Fever or chills
• Redness, swelling, bleeding, or other drainage from the biopsy site
• Increased pain around the biopsy site

You may go back to your usual diet and activities unless your healthcare provider advises you otherwise. Your provider may ask you to avoid strenuous physical activity for a few days.

Your healthcare provider may give you additional or alternate instructions after the procedure, depending on your particular case.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications are
• What would happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or problems
• How much will you have to pay for the test or procedure