Bone biopsy using image guidance

What is a bone biopsy?

A bone biopsy is a procedure to take small pieces from one of your child's bones with a special needle. The small pieces of bone are then looked at in the laboratory under a microscope.

A bone biopsy is done using image guidance by an interventional radiologist.

Reasons for a bone biopsy

A bone biopsy can help doctors find out what might be wrong with your child’s bones. It can help in the diagnosis of an infection. It can also help doctors learn about how your child’s disease is changing.

How a bone biopsy is done

The interventional radiologist uses X-rays, ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) to find the part of the bone that needs to be looked at more closely. Using image guidance, the radiologist inserts a special needle to get small pieces of the bone. These pieces are the width of a thick needle (1 to 3 mm) and usually about 2 to 3 cm (about 1 inch) long.

Usually two or three samples are taken. The samples are then sent to a lab, where they are looked at closely and tests are done.

A bone biopsy usually takes one to two hours.

Bone biopsy

During a bone biopsy, the doctor takes out small pieces of bone using a special needle. The bone samples are examined in the laboratory under a microscope.

Risks of a bone biopsy

Bone biopsies are usually a low-risk procedure. The risk may increase depending on your child’s condition, age and health, and the location of the lesion.

The potential risks of a bone biopsy include:

  • bleeding
  • infection
  • fracture of a bone
  • damage to an adjacent nerve, muscle or blood vessel
  • needle injury to a nearby organ

Visiting the interventional radiologist before the procedure

Your child will have a clinic visit with the interventional radiologist before the procedure. During the visit you should expect:

  • A health assessment to make sure your child is healthy and that it is safe to have general anaesthesia and to go ahead with the procedure.
  • An overview of the procedure, and a review of the consent form with an interventional radiologist.
  • Blood work, if needed.

Giving consent before the procedure

Before the procedure, the interventional radiologist will go over how and why the procedure is done, as well as the potential benefits and risks. They will also discuss what will be done to reduce these risks, and will help you weigh any benefits against the risks. It is important that you understand all of these potential risks and benefits of the bone biopsy and that all of your questions are answered. If you agree to the procedure, you can give consent for treatment by signing the consent form. A parent or legal guardian must sign the consent form for young children. The procedure will not be done unless you give your consent.

How to prepare your child for the procedure

Before any treatment, it is important to talk to your child about what will happen. When talking to your child, use words they can understand. Let your child know that medicines will be given to make them feel comfortable during the procedure.

Children feel less anxious and scared when they know what to expect. Children also feel less worried when they see their parents are calm and supportive.

If your child becomes ill within two days before the procedure

It is important that your child is healthy on the day of the procedure. If your child starts to feel unwell or has a fever within two days before the biopsy, let you doctor know. Your child’s procedure may need to be rebooked.

Food, drink, and medicines before the procedure

  • Your child’s stomach must be empty before sedation or general anaesthetic.
  • If your child has special needs during fasting, talk to your doctor to make a plan.
  • Your child can take their regular morning medicine with a sip of water two hours before the procedure.
  • Medicines such as acetylsalicylic acid (ASA), naproxen or ibuprofen, warfarin, or enoxaparin may increase the risk of bleeding. Do not give these to your child before the procedure unless they have been cleared first by their doctor and the interventional radiologist.

Your child will have medicine for pain

Children are given medicine for treatments that may be frightening, uncomfortable or painful. This includes local anaesthesia, sedation or general anaesthesia. For a bone biopsy, most children are given a general anaesthetic.

On the day of the bone biopsy

Arrive at the hospital two hours before the planned time of your child’s procedure. Once you are checked in, your child will be dressed in a hospital gown, weighed and assessed by a nurse. You will also be able to speak to the interventional radiologist who will be doing the bone biopsy and the anaesthetist who will be giving your child medication to make them comfortable for the procedure.

During the bone biopsy, you will be asked to wait in the surgical waiting room.

After the bone biopsy

Once the bone biopsy is complete, your child will be moved to the recovery area. The interventional radiologist will come and talk to you about the details of the procedure. As soon as your child starts to wake up, a nurse will come and get you.

Results

Your referring doctor will receive the results of your child’s bone biopsy. You will need to make an appointment with them to discuss the results.

Going home

How much time your child stays in the hospital depends on the type of bone biopsy and how your child feels after the procedure. Some children have a bone biopsy and go home the same day. If your child’s doctor has arranged this, your child will be ready to go home about four to six hours after the bone biopsy. Occasionally some children will stay overnight after a bone biopsy for observation.

Caring for your child at home

Some children may feel pain or discomfort after the bone biopsy for the first day or two. If this happens, give your child acetaminophen as directed by your child's doctor.

For more details on how to care for your child after a bone biopsy, see Bone biopsy: Caring for your child at home after the procedure.

Key points

  • A bone biopsy is a procedure using imaging and a needle to remove small pieces of bone so that tests can be done on them.
  • During the procedure, your child will be given a general anaesthetic.
  • Your child will likely be able to go home from the hospital about four to six hours after the procedure.

Candice Sockett, RN(EC), MN:APN

Michelle Cote, BScN, RN

Joao Amaral, MD

2/9/2016

At SickKids

At SickKids, the interventional radiologists work in the Department of Diagnostic Imaging – Division of Image Guided Therapy (IGT). You can call the IGT clinic at (416) 813-6054 and speak to the clinic nurse during working hours (8:00 to 15:00) or leave a message with the IGT clinic nurse.

For more information on fasting see Eating and drinking before surgery.

For more information on preparing your child for their procedure see Coming for surgery.





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