What is a bone biopsy?

A biopsy is a procedure 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. It's done to find out if cancer or other abnormal cells are present. A bone biopsy is done on the outer layers of bone, unlike a bone marrow biopsy, which is done in the inner part of the bone.

There are 2 types of biopsy:

• Needle biopsy. After you are given a local anesthetic, your healthcare provider makes a small cut (incision) in your skin. They insert the special biopsy needle into your bone to get a sample.

• Open biopsy. After you are given a general anesthetic, 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:

• Look for the cause of bone pain

• Examine 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?

Any surgery has a risk of complications. Risks of bone biopsy 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

You may have other risks, depending on your health. Talk 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.

• You will be asked to sign a consent form. This gives your permission to do the procedure. Read the form carefully. Ask questions if something is not clear.

• Your healthcare provider will ask about your health history. They may give you a complete physical exam. This is to make sure you are in good health before having 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. Tell them 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 think you could be, tell your healthcare provider.

• You may be asked to not eat for about 8 hours before the procedure, generally starting 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, 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.

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 your clothing and will be given a medical gown to wear.

2. An IV (intravenous) 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 prick when the anesthetic is injected. This may cause a brief stinging sensation. If general anesthesia is used, you will be put to sleep using IV (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. They 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 testing.

What happens after a bone biopsy?

Your recovery process will vary, depending on the type of anesthesia you had. 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 go home.

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

The biopsy site may be sore for several days after the bone biopsy. Take a pain reliever for soreness as your healthcare provider advises. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only approved medicines.

Tell your healthcare provider if you have:

• Fever or chills

• Redness, swelling, bleeding, or other fluid leaking 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 stay away from strenuous physical activity for a few days.

Your healthcare provider may give you more instructions after the procedure.

Next steps

Before you agree to the test or 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 you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure