Percutaneous Bone Biopsy

Background and indications

CT or fluoroscopy-guided percutaneous bone biopsy enables histological diagnosis of suspicious bone lesions: primary bone tumors (osteosarcoma, chondrosarcoma, giant cell tumor), bone metastases, infectious lesions (osteomyelitis), and indeterminate lesions on imaging.

Image guidance ensures targeted sampling of the most representative component of the lesion, avoiding necrotic areas.

Pre-procedure assessment

Assessment includes radiographs, CT and/or MRI of the lesion, coagulation panel, and multidisciplinary discussion (sarcoma tumor board if primary tumor suspected). Biopsy tract is planned with the orthopedic surgeon to be excisable en bloc if needed.

Procedure

Under local anesthesia and sedation, a bone trocar (11-14G) is inserted under CT or fluoroscopic guidance to the lesion. For lytic lesions, a standard biopsy needle may suffice. For sclerotic lesions, a hand trocar or motorized coaxial system may be needed. 2 to 4 bone cores are obtained. The procedure takes 20 to 45 minutes.

Results and scientific evidence

Image-guided percutaneous bone biopsy offers 80-95% diagnostic yield, variable by location and lesion nature (lytic vs sclerotic). It avoids open surgical biopsy in most cases and provides sufficient material for immunohistochemical and molecular analyses.

Risks and complications

Local pain (15-25%), pathological fracture (< 1%, mainly weight-bearing bone with extensive lytic lesion), hematoma (< 3%), infection (< 0.5%). Tumor seeding risk is minimal with a planned excisable tract.

Recovery

Relative rest for 24-48 hours. For biopsy of a weakened weight-bearing bone, temporary non-weight-bearing may be recommended. Results within 5-10 days.

Practical information

The procedure is performed as an outpatient or short inpatient stay depending on the case. It is performed by an interventional radiologist, in coordination with the orthopedist and oncologist.