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Bone lesion biopsy

Definition

A bone lesion biopsy is the removal of a piece of bone or bone marrow for examination.

Alternative Names

Bone biopsy; Biopsy - bone

How the test is performed

The health care provider applies a numbing medicine (local anesthetic) to the area, and makes a small (about 1/8 inch) cut in the skin. A special drill needle is usually used. The biopsy needle is pushed and twisted into the bone.

Once the sample is obtained, the needle is twisted out and the sample is sent for examination. Pressure is applied to the site. Once bleeding stops, the site is cleaned and covered with a bandage.

Bone biopsy may also be done under general anesthesia to remove a larger sample. This may allow for immediate surgery to remove the bone if the exam shows that it is cancerous.

How to prepare for the test

You may be told not to drink or eat anything for several hours before the biopsy.

How the test will feel

With a needle biopsy, you may feel moderate discomfort and pressure, even though a local anesthetic is used. You must remain still during the procedure.

After the biopsy, the area may be sore or tender for several days.

Why the test is performed

The most common reasons for bone lesion biopsy are to tell the difference between cancerous and noncancerous bone tumors and to identify other bone problem. It may be performed on people with bone pain and tenderness, particularly if x-ray, CT scan, or other testing reveals a problem.

Normal Values

Normal bone appears as two types: compact and cancellous.

• Compact bone is dense and contains layers of mineral deposits called lamellae.
• Cancellous bone looks porous, with widely spaced mineral deposits, and red and yellow marrow in the center of the bone.

What abnormal results mean

Benign bone tumors include:

• Bone cyst
• Fibroma
• Osteoblastoma
• Osteoid osteoma

Cancerous tumors include:

• Ewing's sarcoma
• Multiple myeloma
• Osteosarcoma

Abnormal results may also be due to:

• Infections such as:
  • Coccidiomycosis
  • Histoplasmosis
  • Mycobacteria infection
• Osteitis fibrosa
• Osteomalacia
• Osteomyelitis
• Rickets

What the risks are

• Bone fracture
• Bone infection (osteomyelitis)
• Damage to surrounding tissue
• Discomfort
• Excessive bleeding
• Infection near the biopsy area

Note: Some people with bone disorders also have blood clotting disorders, which can increase the risk for bleeding.

Special considerations

Signs of bone infection (one of the most serious risks) include fever, headache, pain with movement, redness and swelling of the tissues around the biopsy site, and drainage of pus from the biopsy site. If these occur, seek immediate medical attention.

References

Gebhardt MC, Springfield D, Neff JR. Sarcomas of bone. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds. Abeloff’s Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 96.

Lorenzo JA, Canalis E, Raisz LG. Metabolic bone disease. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 28.

Andros G, Lavery LA. Diabetic foot ulcers. In: Cronenwett JL, Johnston W, eds. Rutherford’s Vascular Surgery. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 112.

Review Date: Jul 28, 2010
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.