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 if you:

  • Are taking any medicines. If you take medicines every day, ask
    your doctor whether you should stop taking these medicines before the
    test.
  • Are allergic to any medicines, such as those used to numb the
    skin (anesthetics).
  • Take a blood thinner, or if you have had bleeding problems.
  • Are
    or might be pregnant.
  • Take any herbal remedies. Some of these
    remedies may thin the blood.

Getting ready for a bone biopsy changes depending on the
type of biopsy that will be done.

  • For a closed biopsy (needle biopsy), you do not
    need to do anything before the procedure. 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 will be awake during the procedure. Arrange to have someone drive you
    home because you may get a medicine (sedative) to help you relax.
  • For an
    open biopsy, your doctor will tell you how soon before surgery to stop eating
    and drinking. Follow the instructions exactly
    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. You can eat your regular diet after the
    procedure. You may need to stay overnight in the hospital after an open biopsy
    is done.

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor about any concerns you
have regarding the need for the biopsy, its risks, how it will be done, or what
the results will mean. To help you understand the importance of this procedure,
fill out the
medical test information form (What is a PDF document?).

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).

During the biopsy, you lie on an examining table
or firm bed. It is important to lie very still during the entire procedure.
Tell your doctor if you need to move or get more comfortable. You may feel
pressure or discomfort during the biopsy. A needle biopsy takes 15 to 30
minutes.

  • Before a needle biopsy, an intravenous (IV)
    line may be put into a vein in your arm. You may be given a sedative to help
    you relax. You will be awake during the biopsy.
  • Your doctor uses a
    special soap to clean the skin over the bone where the biopsy sample will be
    taken. The skin area may need to be shaved. Then your doctor gives you a
    numbing medicine (local anesthetic) in your skin.
  • The radiologist
    or surgeon puts a long, thin needle through the skin into the bone. Your doctor
    may make a small cut in your skin before putting the needle in so the needle
    passes easily. Then your doctor takes out a small amount of bone through the
    needle.
  • After a closed or needle biopsy, a small bandage is placed
    over the area and pressure is put on the area to stop any bleeding. After
    bleeding has stopped, medicine to prevent infection (topical antiseptic
    medicine) may be put on the skin. A clean bandage is put on the
    area.
  • You will stay for a short time after the biopsy until your
    doctor says it is okay for you to go.

Open biopsy

An open biopsy is done in an operating
room by a surgeon. During the biopsy, you lay on an operating bed. An open
biopsy takes 30 to 60 minutes.

  • Before an open biopsy, 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 (IV) line in a vein in your arm for
    medicines and fluids. Before making a skin cut, your surgeon uses a special
    soap to clean the skin over the bone where the biopsy sample will be taken. The
    area may need to be shaved.
  • The surgeon makes a cut to see the bone
    and take out a small piece.
  • After an open biopsy, the cut is
    cleaned and closed with stitches (sutures). A bandage is put on the area. The
    stitches are taken out about 14 days after the biopsy.
  • You may need
    to stay overnight in the hospital after an open biopsy is done.

In rare cases 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 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. Your doctor will talk to
you about pain medicine.

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. Your
doctor will talk to you about pain medicine.

After a bone biopsy

  • If a closed biopsy is done, you may go
    home shortly after the procedure. If you got a sedative, you may need to stay
    longer and have someone drive you home.
  • If an open biopsy is done,
    you may need to stay in the hospital overnight. Arrange to have someone drive
    you to and from the hospital or clinic.
  • A bandage will be placed
    over the biopsy site. You may be told to keep the biopsy site covered and dry
    for 48 hours. A small amount of bleeding from the biopsy site is normal. Ask
    your doctor how much drainage to expect.

Risks

Problems from a bone biopsy are rare. There is
a very small chance that the biopsy needle may break (fracture) 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 (fracture) at a
later time.

After the biopsy

Call your doctor immediately if:

  • The biopsy site continues to bleed.
  • You have signs of infection. These signs may include:
    • Increased pain, swelling, redness, or
      warmth around the affected area.
    • Red streaks spreading from the
      affected area.
    • Drainage of pus from the area.
    • Swollen
      lymph nodes in the neck, armpit, or groin.
    • Fever or chills.

Results

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. 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).

What Affects the Test

Reasons you may not be able to
have the biopsy or why the results may not be helpful include:

  • Not being able to lie still during the
    biopsy.
  • Having a condition that affects your
    immune system. This may increase your chance for an
    infection at the biopsy site.
  • Not getting a good sample of bone
    tissue. A good sample may be hard to get to with a needle.

What To Think About

During a bone biopsy, the doctor
may also take a sample of
bone marrow (bone marrow biopsy). A bone marrow biopsy
is done to check for infection in the bone marrow or to see why the bone marrow
may not be healthy or to check for certain kinds of cancer, such as
leukemia,
lymphoma, or multiple myeloma. To learn more,
see the topic
Bone Marrow Aspiration and Biopsy.

References

Other Works Consulted

  • Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.

Credits

ByHealthwise Staff
Primary Medical Reviewer Adam Husney, MD – Family Medicine
E. Gregory Thompson, MD – Internal Medicine
Specialist Medical Reviewer David Bardana, MD, FRCSC – Orthopedic Surgery, Sports Medicine

Current as ofOctober 9, 2017