Generality
Bone biopsy consists of taking and analyzing in the laboratory a sample of bone tissue from an individual with a bone disease or problem.
The first is an outpatient procedure, performed under local anesthesia; the second, on the other hand, is a real surgery, which requires general anesthesia.
What is a bone biopsy?
Bone biopsy is a diagnostic procedure that consists in taking and analyzing a sample of bone tissue in the laboratory.
If the bone problem that motivates the biopsy is generalized, the sampling can take place anywhere on the body, with preference for the most accessible sites.
If, on the other hand, the bone problem is limited, the collection of the sample to be analyzed takes place in the area of the body where the anomaly was found.
What do you mean by "more accessible venues"?
Collecting a sample of bone cells is easiest (and even preferable) in an area of the body where the bone is just below the skin surface - hence where the surrounding tissue is thin - and where it is distant from organs. internal or large blood vessels.
TYPES OF BONE BIOSPIA
There are two different methods of collection: by needle or after a "skin incision.
The needle biopsy is more properly called bone needle biopsy and consists of an outpatient procedure, during which local anesthesia is sufficient.
Post-incision skin biopsy is better known as "open" bone biopsy and consists of a real surgery, complete with general anesthesia.
As can already be understood from these brief descriptions, "bone needle biopsy is a decidedly less invasive procedure than" open "bone biopsy.
When you do
Doctors consider it appropriate to perform a bone biopsy when:
- Generalized bone disease, such as Paget's disease, is suspected based on physical examination and imaging tests (X-rays, CT, bone scan, or MRI).
- They need to establish whether a certain abnormal mass, present in a specific point of a bone, is a simple bone cyst (therefore a benign tumor) or a malignant tumor.
A classic malignant bone tumor, which requires a biopsy, is the so-called Ewing's sarcoma. - They suspect "osteomyelitis, that is, a" bacterial infection of the bones and bone marrow.
- They need to clarify the exact cause of lasting bone pain, which no other less invasive diagnostic test has been able to explain.
"OPEN HEAVEN" BONE BIOPSY ALLOWS SURGICAL OPERATION
The preparation and the "surgical incision performed on the occasion of an" open "bone biopsy are the same as those foreseen when a disease or a" bone anomaly is surgically operated on. "
Figure: Ewing's sarcoma.
Therefore, it is possible that doctors opt for an "open" bone biopsy (and not a less invasive bone needle biopsy), to continue, if necessary, with surgery.
COLLECTION OF THE BONE MARROW
It may happen that the doctor deems it appropriate to take, together with the bone tissue sample, some bone marrow cells, and then analyze them.
Typically, this occurs when there is a suspicion of leukemia, lymphoma or multiple myeloma.
Preparation
It is normal practice that, a few days before the bone biopsy, the doctor meets the patient, to inform him of the details of the procedure and to ask him some questions about:
- The clinical history. When we talk about clinical history, we refer to all the pathologies that the patient suffers or has suffered in the past. It is essential to communicate the presence of heart problems and coagulation diseases (such as haemophilia)
- The drugs taken at that time. It is very important to tell the doctor about the intake of antiplatelet agents (aspirin or clopidogrel) and / or anticoagulants (warfarin), as these preparations, "diluting the blood", favor bleeding.
Both types of bone biopsy that can be practiced include a "skin incision (N.B: in the" open "mode, the incision is not negligible) and a minimum blood loss from this. If the patient does not stop antiplatelet or anticoagulant treatments, this blood loss can be very dangerous. - Any allergies to drugs, especially anesthetics and sedatives. Medicines for anesthesia (whether local or general) and sedatives can trigger severe, if not fatal, allergic reactions in some individuals. Therefore, the patient is required to tell the doctor if he or she knows he is allergic to any medications for the anesthesia.
Female patients who have even the slightest suspicion of being pregnant are reminded to communicate this suspicion before or at the end of this questionnaire. At that point, the doctor will decide how to proceed.
WHEN IS GENERAL ANESTHESIA INTENDED?
If general anesthesia is planned, the doctor-patient pre-operative meeting is important for two other reasons:
- Because the patient will undergo a check of vital signs, by means of a blood test, an electrocardiogram and a blood pressure measurement. Based on the results of these tests, it is possible to understand if there are particular contraindications to general anesthesia.
- Because the patient will be informed to present himself, on the day of the procedure, with a complete fast for at least 8 hours. Generally, if the surgery is held in the morning, doctors recommend having the last meal by midnight the previous day. The only drink allowed, until a few hours before the operation, is water.
Failure to abstain from food and liquids will result in cancellation of the procedure.
Bone needle biopsy
Performed by a radiologist or an orthopedic surgeon, bone needle biopsy usually takes place in the following way:
- After the patient has been placed in a comfortable outpatient bed, a nurse applies an "intravenous entrance" to his arm for the administration of the sedatives provided during the procedure.
- Then, the operating doctor intervenes, who cleanses the area of skin where he will insert the needle for sampling with a disinfectant, and applies the local anesthetic.
If the collection area has hair, it is shaved in time either by a member of the medical staff or by the patient himself, before going to the hospital.
- Immediately after the anesthetic has started to work, the doctor inserts the "biopsy needle." The latter is usually long and very thin.
If the injection of the needle proves difficult, a very small skin incision may be necessary, to facilitate the entry of the instrument aimed at sampling.
- As soon as he feels he has reached the bone of interest, the doctor uses the needle to aspirate a sample of bone tissue.
- After collection, the injection area is bandaged to stop any bleeding, and a topical antiseptic is applied to minimize the risk of infection.
After placing the patient on the bed, the bone needle biopsy lasts about 15 to 30 minutes.
AFTER THE PROCEDURE
At the end of the intervention, the patient is kept under observation for a short period of time. After that, if there is a family member or relative to take care of him, he can already return home.
The bandage must be kept in place for at least one day: its cleaning is very important, to avoid the appearance of infections.
FEELINGS DURING AND AFTER THE PROCEDURE
Despite local anesthesia, the patient may feel a slight prick, similar to a pinch, during needle insertion.
During the harvest, however, it may feel as if something is pressing on the bone (and indeed that is what is happening).
After the procedure and for about a week, the area of the sample is usually sore. For this reason, doctors may prescribe pain relievers.
RISKS
Bone needle biopsy is a very safe procedure.
However, in some rare cases, the insertion of the needle can lead to a bone fracture, damage to a nerve end or a blood vessel, injury to an organ located near the collection site and / or a skin infection (osteomyelitis ).
"Open" bone biopsy
The "execution of an" open "bone biopsy is the sole responsibility of a surgeon (usually an orthopedist) and takes place in an operating room.
In chronological order, the procedural steps are:
- Placement of the patient on a comfortable operating table.
- Anesthesia and sedation. The general anesthesia and sedation are dealt with by an anesthetist, who remains in the operating room for the entire duration of the operation. Anesthetics and sedatives are usually given intravenously.
- Disinfection of the sampling area. As in the case of bone needle biopsy, it is the operating surgeon who disinfects the skin area to be incised.
If hair removal is necessary, this is done before entering the operating room.
- Engraving and collection of the tissue sample. The size of the surgical incision depends on the needs of the operating surgeon and on the site of the sampling. The sampling is carried out with special surgical instruments.
- Closing the incision with sutures. After collecting the sample, the surgeon closes the incision with a few sutures, disinfects the entire operated area again and applies a protective bandage.
If they are not resorbable, the sutures are removed after 14 days at the latest.
After placing the patient in the operating table, the "open" bone biopsy can last from 30 to 60 minutes.
AFTER THE PROCEDURE
Generally, after surgery, the patient must stay in the hospital for at least an entire night. During this period of hospitalization, the operating surgeon and medical staff periodically monitor his vital signs and observe the impact of the operation on his state of health.
To return home, the presence of a relative or a friend is necessary, because general anesthesia alters reflexes and attention for even more than 24 hours.
The protective bandage should be kept for about 48 hours.
FEELINGS DURING AND AFTER THE PROCEDURE
During the procedure, the patient is asleep, so he feels nothing.
Upon awakening, he may feel tired and very confused, but these two sensations wear off with the passage of time.
Generally, for about a week, the operated area feels sore. Therefore, it is normal practice for the doctor to prescribe painkillers.
RISKS
The "open" bone biopsy is a fairly safe procedure; however, like any surgical operation, there is a risk of:
- Severe bleeding
- Infections
- Allergic reactions to the drugs administered. Those on anesthetic drugs can also be very serious and lead to death
Results
Available within a few days, the results of a bone biopsy are very reliable, whatever the cause that made it necessary.
When is bone biopsy contraindicated?
It is contraindicated for all people who also suffer from an immune system disease, as there is a greater risk of infection.
In which cases could the bone biopsy be useless?
When the doctor has not taken an appropriate bone sample. This is more likely to occur during a bone "needle biopsy."
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