Bone biopsy removes a small sample of bone for laboratory analysis; several techniques may be used. Percutaneous core needle biopsy uses a special drill needle to bore into the bone and withdraw a specimen under the guidance of real-time x-rays (fluoroscopy) or CT imaging. Open biopsy is a surgical procedure that removes a larger sample through a small incision. Bone biopsy is either performed to analyze a known lesion such as a tumor, or to obtain a representative sample in order to diagnose a systemic bone disease (the pelvic bone is often selected because it is close to the skin’s surface).
Purpose of Bone Biopsy
- To distinguish between benign and cancerous bone tumors
- To obtain a bone specimen in patients with bone pain and tenderness, particularly if a mass or deformity was detected on an imaging test such as a nuclear scan, CT scan, or x-ray
- To diagnose systemic bone disease, such as osteoporosis (a decrease in bone mass) or osteomalacia (a disease that causes soft and brittle bones), when the results of imaging tests are inconclusive
- To identify the microorganism that is causing a bone infection such as osteomyelitis
Who Performs Bone Biopsies
- Core needle biopsy is conducted by an orthopedic surgeon and a radiologist.
- Open biopsy is performed by an orthopedic surgeon and a surgical team.
Special Concerns about Bone Biopsy
- This procedure should be performed with caution in people with blood clotting disorders. Coagulation studies may be needed before the biopsy is done.
- Open biopsy, which requires general anesthesia, is performed less frequently than core needle biopsy. The advantage of this technique is that it provides a larger specimen of bone and improves the chances for a definitive diagnosis.
Before Bone Biopsy
- Tell your doctor if you regularly take anticoagulants or nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen, or naproxen). You will be instructed to discontinue them for some time before the test. Also mention any other medications, herbs or supplements that you take.
- In some cases (such as a biopsy to detect osteoporosis), you may be given the antibiotic tetracycline for 3 weeks beforehand, including a dose just before the biopsy. The tetracycline binds to the calcium in your blood and can be used to determine the rate at which calcium is absorbed by your bones.
- Do not eat or drink anything for 8 hours before the biopsy. (Fasting is required before core needle biopsy in case there is a need for immediate surgical intervention.)
- Empty your bladder before the test.
- Tell your doctor if you are pregnant or may be pregnant.
- You will be asked to disrobe and put on a hospital gown.
- An intravenous (IV) needle or catheter is inserted into a vein in your arm immediately before the test begins. A sedative is usually administered before a core needle biopsy, and general anesthesia is given before an open biopsy.
What You Experience during Bone Biopsy
Core needle biopsy:
- The biopsy site is shaved and cleansed with an antiseptic, and a local anesthetic is injected to numb the area. (In some cases, the anesthetic is injected on the surface of the bone itself.) You may still experience some discomfort and pressure as the needle enters the bone.
- The doctor makes a very small incision in the skin and inserts the biopsy needle into the bone. Fluoroscopy or CT scanning may be used to guide placement of the needle.
- The biopsy needle is rotated 180º and then reversed, obtaining a small core of bone, and then withdrawn.
- The procedure takes about 30 minutes.
- The biopsy site is shaved and cleansed with an antiseptic.
- The doctor makes a small incision and removes a piece of bone with surgical instruments. The sample is sent to a laboratory for microscopic examination.
- The incision is sutured closed.
- The procedure takes about 30 minutes.
Risks and Complications
- Possible complications include bone fracture; bleeding, bruising and discomfort at the biopsy site; damage to nearby tissue; and, rarely, infection.
- Open biopsy carries all the risks associated with general anesthesia.
After Bone Biopsy
- After a core needle biopsy, pressure is placed on the incision site until bleeding has stopped, the site is cleaned, and a small bandage is applied. You may leave in about an hour if there is no bleeding and your vital signs are normal. (You may need to remain in the hospital for at least 24 hours if a biopsy was taken from the spine.)
- After an open biopsy, you will stay in a recovery room for 1 to 2 hours. During this time, your vital signs will be monitored and you will be observed for any signs of complications. You will then be transferred to a hospital room for 24 hours.
- Arrange for someone to drive you home.
- The biopsy site may be sore and tender for several days. Your doctor may prescribe a pain-relieving medication.
- Keep the biopsy site covered and dry for 48 hours following the procedure. You may take showers, but not baths, for 10 days.
- Inform your doctor immediately if you experience bleeding through the bandage or symptoms of infection (such as fever, pain when moving, and redness, swelling, or pus at the biopsy site).
Bone Biopsy Results
- Bone samples are sent to a pathology laboratory and examined under a microscope for unusual cells. They are usually also sent to a microbiology laboratory and cultured for infectious organisms.
- This test usually results in a definitive diagnosis. Treatment will be initiated, depending on the specific problem.
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media