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Bone Biopsy

 
Medical Encyclopedia: Bone Biopsy
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Definition

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

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 given 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.

— Maureen Haggerty


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Medical Test: Bone Biopsy
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General information

Where It's DoneWho Does ItHow Long It TakesDiscomfort/Pain
Hospital, doctor's office, or commercial surgical facility.Doctor.20-30 minutes.Minor discomfort associated with needle insertion.

Results Ready WhenSpecial EquipmentRisks/ComplicationsAverage Cost
2-8 weeks.Biopsy needle, collecting tube, adhesive bandage, and fluoroscope or CT scanner.Bleeding from biopsy site (rare); infection (extremely rare if sterile conditions are strictly applied).$$$

Other names

None.

Purpose
  • To diagnose bone diseases such as osteoporosis, osteomalacia, and osteopenia when less invasive tests fail to provide definitive results.
  • To distinguish between benign bone tumors and bone cancer.
  • To determine which organism may be causing osteomyelitis.
How it works

A sample of the bone is removed and sent to a laboratory for analysis.

Preparation
  • For diagnosing suspected cases of osteoporosis, osteomalacia, and osteopenia, you will be given oral tetracycline (an antibiotic) three weeks prior to the procedure. You will be given another dose just before the biopsy.
  • You may not eat or drink on the morning of the procedure.
  • You remove all clothing and don a hospital gown.
Test procedure
  • Local anesthesia is administered at the biopsy site. (Occasionally general anesthesia may be used.) The anesthetic is injected into the skin and sometimes into the portion of the bone itself where the nerve fibers run.
  • A sedative is given intravenously.
  • A hollow needle is introduced into your body and guided to the area of suspected bone abnormality with the help of a fluoroscope or CT scanner.
  • In cases of systemic (affecting the entire body) bone disease, such as osteoporosis, the pelvic bone is usually used because it is close to the surface of the skin. The site is determined by measuring a specific distance from the hip bone, making a scanner unnecessary.
  • A tiny core of bone (a bit more than 1/6 of an inch in diameter) is removed with the help of a ratchetlike device on the needle. A sample of the synovium, the lining covering bone cartilage, may also be removed.
  • Bone tissue obtained during the biopsy is sent to a laboratory for analysis.
After the test
  • A pressure bandage is applied to the biopsy site, and you may be asked to lie on the site to apply additional pressure.
  • If the biopsy was performed on the spine, you may have to spend 24 hours in the hospital. Otherwise you may leave in about an hour, assuming there is no bleeding (a rare complication) and that your pulse, blood pressure, breathing, and temperature are found to be normal.
  • You should have someone drive you home, as you may experience some discomfort at the biopsy site.
  • You must keep the biopsy site covered and dry (showers are okay, baths are not) for 48 hours.
  • If you experience pain or discomfort, take acetaminophen (Tylenol, etc) or acetaminophen with codeine.
  • Let your doctor know immediately if you experience bleeding through the bandage or signs of infection such as fever, pain on movement, or redness near the biopsy site.
Factors affecting results

The site at which the biopsy is performed: If the site is not carefully chosen, cancer cells or other cells affected by disease may be missed; if bone density is measured, the density may vary depending on the part of the bone examined.

Interpretation

The shape and appearance of bone cells are analyzed under a microscope in order to distinguish benign tumors from cancer. The presence of cells that play a role in inflammation may signal an inflammatory disorder, such as osteomyelitis. The sample may be stained with special dyes to detect other abnormalities, and certain chemicals in the tissue may be labeled so that they can be detected and measured. For example, low levels of certain minerals may lead to a diagnosis of osteomalacia, a disorder characterized by bone softening in adults.

Advantages

It may establish definitive diagnosis without surgery.

Disadvantages

It's invasive.

The next step

A positive test indicates that treatment may begin.

DID YOU KNOW?

Calcium in the body is in a constant state of flux, being absorbed and stored in the bones, then resorbed into the bloodstream. Because tetracycline attaches to the calcium in your blood it can be used to "label" bone. By comparing the tetracycline in the bone from the initial dose to the dose given at the time of the biopsy, a pathologist can evaluate the rate at which calcium is absorbed by the bones.

PATIENT TIP

The only pain you should feel as the bone sample is taken is in the periosteum that lines the bone, not the bone itself. Let your doctor know if you experience radiating pain during the procedure. In this case, the biopsy needle may be positioned differently.

 
 

 

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Medical Encyclopedia. © 2006 through a partnership of Answers Corporation. All rights reserved.  Read more
Medical Test. The Patient's Guide to Medical Tests by Faculty Members at The Yale University of Medicine and G.S. Sharpe Communications, Inc. Copyright © 1997 by Yale University of Medicine and G.S. Sharpe Communications, Inc. Published by Houghton Mifflin Company. All rights reserved.  Read more