Both benign and malignant tumors are common in the bone. Malignant tumors such as cancers may originate from bone tissue (primary cancers) or may originate from other organs and spread to the bone (metastases). If a suspicious mass is found in the bone by imaging methods, a biopsy is required to clarify the condition.
As in other organs, the ideal biopsy method in the bone is needle biopsy. The surgical method should be considered as a last resort because of the necessity of general anesthesia and operation as well as higher complication rate and need for hospital stay. The needle biopsy in the bone can be done in two ways:
Standard cutting needle (trucut or core) biopsy: In some cases, the mass in the bone breaks out the hard outer layer of the bone called the cortex. In such cases, it is not necessary to pass the rigid bone cortex and standard biopsy method used for soft tissues can be applied. Ultrasound or CT guidance can be used for this purpose.
Thick needle biopsy: In many cases, the suspicious mass is inside the bone and must be reached by piercing the hard outer layer of the bone (cortex). In these cases, first a larger needle is inserted into the bone, the cortex is passed and the suspicious mass is reached under CT guidance. Afterwards, a long piece of 2-3 mm thickness is taken from the bone with a separate cutting system which is sent through this needle.
Video information: "Tomography-guided bone biopsy"
Bone biopsy, like other needle biopsies, is done under local anesthesia and is extremely comfortable for the patient. In some cases, bone biopsy can be performed in combination with treatments that destroy the tumor, such as percutaneous ablation, or strengthen bone, such as vertebroplasty-cementoplasty. In this case, both a diagnosis and treatment are performed in a single procedure.
Interventional oncology in cancer management
Prof Saim Yilmaz, MD