Bone biopsy

Definition

Bone biopsy is the removal of a piece of bone for laboratory examination and analysis.

Purpose

Bone biopsy is used to distinguish between malignant tumors and benign bone disease such as osteoporosis and osteomyelitis. This test may be ordered to determine why a patient's bones ache or feel sore, or when a mass or deformity is found on an x ray, CT scan, bone scan, or other diagnostic imaging procedure.


Precautions

The patient's doctor and the surgeon who performs the bone biopsy must be told about any prescription and over-the-counter medications the patient is taking, and about allergies or reactions the patient has had to anesthetics or pain relievers. Special care must be taken with patients who have experienced bleeding problems.



Description

A bone biopsy involves using a special drill or other surgical instruments to remove bone from the patient's body. The procedure usually lasts about 30 minutes and may be performed in the hospital, a doctor's office, or a surgical center.

A drill biopsy is generally used to obtain a small specimen. After the skin covering the bone has been cleansed with an antiseptic and shaved, the patient is given a local anesthetic. The doctor will not begin the procedure until the anesthetic has numbed the area from which the bone is to be removed, but the patient may feel pressure or mild pain when the needle pierces the bone. The surgeon turns the needle in a half-circle to extract a sample from the core, or innermost part, of the bone. The sample is drawn into the hollow stem of the biopsy needle. The sample is then sent to a laboratory where it is examined under a microscope.

An open biopsy is used when a larger specimen is needed. After the area covering the bone has been cleansed with an antiseptic and shaved, the patient is administered a general anesthetic. After the anesthetic takes effect and the patient is unconscious, the surgeon makes an incision and removes a bone specimen. The specimen is sent to the laboratory for immediate analysis. Results of that analysis may indicate that additional surgery should be performed right away.

Preparation

No special preparation is needed for a drill biopsy, but a patient must fast for at least 12 hours before an open biopsy.

Some patients who are taking anticoagulants, aspirin and/or other products containing salicylates, some herbs, and nutritional supplements may be asked by their health care provider to discontinue taking the medications/products for a specified number of days prior to the procedure.

Aftercare

Pain medication is prescribed after a biopsy, and vital signs are monitored until they return to normal. Most patients can go home in about an hour. If bone was removed from the spine, the patient may stay in the hospital overnight. Sutures may be necessary to close the biopsy site. The surgical site must be kept clean and dry for 48 hours, and the patient's doctor should be notified if any of these symptoms appear:

  • fever
  • headache
  • pain on movement
  • inflammation or pus near the biopsy site
  • bleeding through the bandage at the biopsy site

Some patients may be prescribed a course of antibiotics after discharge from the health care facility. Antibiotics should be taken as prescribed and the entire course of antibiotic therapy should be completed by the patient.

Risks

Risks include bone fracture, injury to nearby tissue, and infection. Bleeding is a rare complication. Factors that increase risk include:

  • stress
  • obesity
  • poor nutrition
  • chronic illness
  • some medications
  • mind-altering drugs

Results

Normal bone is made up of collagen fibers and bone tissue.

Abnormal results

Bone biopsy can reveal the presence of benign disease, infection, or malignant tumors that have spread to the bone from other parts of the body.

Results of this test are considered reliable, but may be affected by a failure to obtain an adequate specimen or delayed microscopic examination or laboratory analysis.