To confirm that you have cancer, your doctor usually needs to remove fluid or tissue from the bone tumor. This is called a biopsy.
A biopsy is the only sure way to tell if you have cancer and to know what kind of cancer it is. A biopsy can also help the doctor tell whether the tumor is a primary bone cancer, meaning it starts in the bone. Or, it can help the doctor tell if it is a secondary bone cancer, meaning it has spread to the bone from someplace else.
Your doctor can take a bone biopsy in two ways:
No matter what kind of biopsy you have, it is important that a surgeon experienced in diagnosing and treating bone tumors, called an orthopedic oncologist, does the procedure. Radiologists who specialize in bone and soft tissue diseases also do needle biopsies.
Once either biopsy is done, the doctor sends the tissue sample to the pathology lab. There, a doctor called a pathologist looks at the tissue under a microscope to check for cancer cells. It usually takes a few days for the results of your biopsy to come back. Waiting for biopsy results can be stressful. It is important to get the correct diagnosis, though. The diagnosis determines the best treatment plan for you.
A surgical biopsy is also called an open bone biopsy. You have this type of biopsy in a hospital. It is considered a minor operation because it involves the doctor making a small incision. The incision allows the doctor to take a sample of tissue from the bone tumor.
Tell your doctor if you are taking any medications that thin your blood, called anticoagulants or antiplatelets, before the biopsy. These medications include Coumadin (warfarin), Pradaxa (dabigatran), Xarelto (rivaroxaban), Plavix (clopidogrel), Effient (prasugrel), or aspirin. Usually, you have to stop taking these medications a few days before a surgical biopsy. Only stop taking blood-thinning medications if you have specific instructions from your cancer doctor as well as the doctor who originally prescribed the medication.
Before the biopsy, your doctor asks you to not eat or drink for several hours. You usually will not eat or drink starting from midnight the night before the procedure. Young children need anesthesia that makes them sleep during the surgery. Most adults also have surgical biopsies done after receiving general anesthesia. Some people, though, can be awake for the procedure. They only need medicine to numb the skin above the bone tumor.
During the biopsy, the doctor cuts through your skin to remove a small part of the tumor. Sometimes, the doctor removes the whole tumor, but this must be carefully planned and is not routinely recommended. Usually, during the operation, a pathologist examines a piece of the tissue to look for cancer cells. This is called a frozen section analysis.
For several days after the biopsy, the area may feel sore. The discomfort can usually be eased with medication.
Needle biopsies can be done in two ways:
Fine needle biopsy
Core needle biopsy
You can usually have a needle biopsy done in your surgeon's office. Or you may have it done in the radiology department of a hospital by radiologists who specialize in the procedure. Or, you may have a needle biopsy done by a doctor who specializes in cytology and pathology, called a cytopathologist. A needle biopsy is typically done with a local numbing medication injected over the biopsy site.
Before any needle biopsy, tell your doctor if you are taking any medications that thin your blood, called anticoagulants or antiplatelets, before the biopsy. These medications include Coumadin (warfarin), Pradaxa (dabigatran), Xarelto (rivaroxaban), Plavix (clopidogrel), Effient (prasugrel), or aspirin. Usually, you have to stop taking these medications a few days before a surgical biopsy. Only stop taking blood-thinning medications if you have specific instructions from your cancer doctor as well as the doctor who originally prescribed the medication.
Fine needle biopsy
With a fine needle biopsy, the doctor inserts a very tiny needle into the tumor and removes fluid and tissue. A fine needle biopsy is less invasive than a core needle biopsy. A fine needle biopsy only removes cells. It is only accurate for some types of tumors, and is not used very often for bone tumors.
A cytopathologist does this procedure. The procedure takes only 10 to 15 minutes.
Results are ready in 24 to 48 hours. The doctor looks at the samples right away to make sure enough cells were obtained. Sometimes the doctor can make a diagnosis at that time.
Core needle biopsy
With a core needle biopsy, the surgeon or radiologist uses a large needle to remove a small plug, or core, of tissue. The tissue removed is usually enough to diagnose any type of tumor.
First, the doctor numbs your skin and tissue over the tumor with an injection of medication.
If the tumor is near the surface of your body, the doctor can aim the needle by feeling the tumor.
If the tumor is too deep to feel by hand, the doctor may use a computed tomography (CT) scan to guide the needle to the tumor. The CT scan takes pictures of the inside of your body and allows the doctor to see on a computer screen where the needle is going. You will need to lie still on a table. A technician places the part of your body being examined within the scanner. The scanner is a machine that surrounds the table. The CT scan is painless, but you may find it uncomfortable to hold still in certain positions for several minutes at a time. Some people need more medicine to calm them down so they lie still.
When radiologists do the biopsy, some people get anesthesia through an intravenous (IV) drip. With a drip, the medicine goes through the tubing into a vein. This type of anesthesia is called conscious sedation. If you get this type of sedation, you will be told not to eat or drink for at least six to eight hours before the procedure.
During the biopsy, you may feel some pressure and discomfort. You must remain still. You'll have a small amount of bleeding where the doctor inserts the needle. The doctor will apply pressure to the small needle hole until the bleeding stops. Then the doctor will clean the area and cover it with a bandage.
For several days after the biopsy, the area may feel sore, so you should try to take it easy. For example, if the biopsy was done in your leg, avoid walking a lot or doing high-energy activities.