Bone biopsy

A bone biopsy is where a surgeon or radiologist takes a small sample of bone. They send this to the laboratory for a specialist doctor to look at under a microscope. They can find out whether an abnormal area of bone is cancer or not.

You have this test in the interventional radiology department or operating theatre with the help of an x-ray or scan. The x-ray or scan shows exactly where to place the biopsy needle. It is a minor procedure. You have it under local anaesthetic with or without sedation . Or you might have a general anaesthetic .

Why do I need a bone biopsy?

You have this test if your doctor thinks your symptoms could be caused by cancer. If it is cancer, the biopsy result will show what type of cancer it is and other features that help your doctor decide on the best treatment for you.

Some bone tumours are not cancerous (benign) and can't spread. Doctors may diagnose these types of tumours from the x-rays or scans and do not always need to take a biopsy.

Preparing for your bone biopsy

You meet your surgeon or radiologist before your biopsy. If you are having a general anaesthetic, you will meet the anaesthetist . They will talk through what is going to happen. They will also explain about any possible side effects. They then ask you to sign a consent form. This is a good time to ask any questions you may have. 

If you are taking medicines

Take your medicines as usual unless the doctor tells you otherwise. If you take medicines to thin your blood, you might need to stop these before your biopsy. Your doctor will let you know when to stop.

Tests before your biopsy

You usually have some blood tests before the biopsy. You might also have an ECG to check the health of your heart.

Your doctor or nurse will explain the tests you need.

Eating and drinking before a general anaesthetic

If you have a general anaesthetic this means you will be asleep for the procedure. To have a general anaesthetic you have to stop eating 6 hours beforehand. You can drink clear fluids only for up to 2 hours beforehand.

You’ll get written instructions about this before your appointment.

What happens

You put on a hospital gown before you go for the biopsy. Your nurse takes you into where you have the test. 

You have a small tube put into a vein in the back of your hand if you are having sedation or a general anaesthetic. This is called a cannula. You have the sedative or anaesthetic medicine through this tube. The doctor or surgeon won’t start the biopsy until the sedative or anaesthetic are working.

For a local anaesthetic the doctor injects the local anaesthetic directly into the biopsy area. This medicine might sting for several seconds and then the area will go numb. This is so you can’t feel any pain, but you may feel pressure during the biopsy.  

The doctor usually cleans your skin and puts sterile drape around the area they are going to biopsy. This is to try and prevent infection.

What happens next depends on the type of biopsy.

If you are having a needle biopsy:

Your doctor puts a long, thin needle into the abnormal area in your bone. They may be able to feel the abnormal area so that they know where to put the needle. Or they might use an x-ray or CT scan to help them guide the needle into place.

When they have the correct position your doctor gently draws out a small amount of bone tissue through the needle. They might take more than one sample. They then place a small dressing or plaster over the biopsy site. The doctor sends the sample to the laboratory for testing.

If you are having a surgical biopsy:

Your surgeon makes a small cut in your skin over the area they need to take the biopsy. They then remove a piece of bone and send it to the laboratory.

You might have a surgical biopsy if:

• your needle biopsy is negative, but your doctor still suspects that something is wrong
• a larger piece of bone is needed to get a diagnosis

After your bone biopsy

You go to the recovery room after the procedure. You might feel a bit drowsy at first if you had a general anaesthetic or sedation. You will have a dressing or plaster over your biopsy area. You should be able to eat and drink once you are fully awake.

You go from the recovery area to the ward. Your nurse will keep a close eye on you for at least the next few hours.

Going home

Everyone recovers differently. In some hospitals, you go home the same day. Or you might have to stay in hospital overnight. Your medical team will tell you when you’re ready to go home.

Make sure you rest at home for as long as your team advise you to. They will give you instructions about how to care for your biopsy site and the dressing.

You may need to use crutches if you have had a biopsy taken from a bone in your leg. This stops you from putting too much weight on your leg after the biopsy.

Take painkillers as prescribed by your doctor. Your nurse will tell you who to contact if you have any pain problems when you’re at home.

Possible risks after a bone biopsy

A bone biopsy is a very safe procedure. But as with any medical procedure, there are possible risks. Your doctor will make sure the benefits of having a biopsy outweigh the possible risks.

Some of the possible risks include:

Mild discomfort or pain

You might feel a bit sore at the biopsy site for a few days after the test. Your doctor or nurse will give you painkillers to help with this. Contact them if the pain gets worse.

Bruising

You might see some bruising in the area, this is normal. It will go after a week or two.

Bleeding

You might notice a small amount of blood on the dressing or plaster. Contact your doctor or nurse if you notice the biopsy site has any heavy bleeding. 

Infection

There is a risk of getting an infection during this test. Tell your doctor or nurse if you have symptoms of an infection. These include:

• a temperature over 37.5°C or below 36°C
• feeling cold or shivery
• aching muscles
• feeling generally unwell
• redness at the biopsy site
• ooze or pus at the biopsy site

You might need antibiotics to treat an infection.

A break in the bone

There is a risk of the biopsy causing a break in the bone (fracture). This is because the biopsy creates a weak point in the bone. To help prevent a fracture you might have crutches after a biopsy from a leg bone. This helps you not put any weight on the weakened bone.

There are also other possible risks from having an x-ray or CT scan.

Getting your results

Your scan will be looked at by a specialist doctor and you should get your results within 1 or 2 weeks. You won't get any results at the time of the scan. 

Waiting for test results can make you anxious. Ask your doctor or nurse how long it will take to get them. Contact them if you haven’t heard anything after a couple of weeks.

You might have the contact details for a specialist nurse. You can contact them for information and support if you need to. It may help to talk to a close friend or relative about how you feel. 

Contact the doctor that arranged the test if you haven't heard anything after a couple of weeks.