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Pediatric Hematology/Oncology Clinical Trials

Pediatric Hematology/Oncology Clinical Trials

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Bone Biopsy

(Biopsy-Bone, Bone Lesion Biopsy)

Procedure overview

What is a bone biopsy?

A biopsy is a procedure performed to remove tissue or cells from the body for examination under a microscope. A bone biopsy is a procedure in which bone samples are removed (with a special biopsy needle or during surgery) to determine if cancer or other abnormal cells are present. A bone biopsy involves the outer layers of bone, unlike a bone marrow biopsy, which involves the innermost part of the bone.

There are 2 types of biopsy:

  • Needle biopsy. After a local anesthetic is given, the doctor makes a small incision in the skin and inserts the special biopsy needle into the bone to obtain a sample.

  • Open biopsy. After a general anesthetic is given, the doctor makes a larger incision in the skin and surgically removes a piece of bone. Depending on the lab findings, further surgery may be performed.

Other related procedures that may be used to help diagnose bone problems include computed tomography (CT scan), X-ray, magnetic resonance imaging (MRI) of the bones, and bone scan. Please see these procedures for additional information.

Anatomy of bone
Click Image to Enlarge

What is bone?

Bone is living tissue that makes up the body's skeleton. There are 3 types of bone tissue:

  • Compact tissue. The harder, outer tissue of bones.

  • Cancellous tissue. The sponge-like tissue inside bones.

  • Subchondral tissue. The smooth tissue at the ends of bones, which is covered with another type of tissue called cartilage. Cartilage is the specialized, gristly connective tissue that is present in adults, and is the tissue from which most bones develop in children.

Bone provides shape and support for the body, as well as protection for some organs. Bone also serves as a storage site for minerals and supplies the marrow from which blood cells are developed and then stored.

Reasons for the procedure

Bone biopsies may be performed to:

  • Evaluate bone pain or tenderness

  • Investigate an abnormality seen on X-ray

  • Determine if a bone tumor is malignant (cancerous) or benign

  • Determine the cause of an unexplained infection or inflammation

There may be other reasons for your doctor to recommend a bone biopsy.

Risks of the procedure

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

  • Bruising and discomfort at the biopsy site

  • Bone fracture

  • Prolonged bleeding from the biopsy site

  • Infection near the biopsy site or in the bone

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Before the procedure

  • Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

  • You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.

  • In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.

  • Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).

  • Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.

  • Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.

  • If you are pregnant or suspect that you are pregnant, you should notify your doctor.

  • You may be asked to fast for 8 hours before the procedure, generally after midnight. This is most likely if you are to have general anesthesia for the procedure.

  • You may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.

  • Based on your medical condition, your doctor may request other specific preparation.

During the procedure

A bone biopsy may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.

In addition, some biopsies may be done using a local anesthetic to numb the area, while others may be done under general or spinal anesthesia. If spinal anesthesia is used, you will have no feeling from your waist down. Your doctor will discuss this with you in advance.

Generally, a bone biopsy follows this process:

  1. You will be asked to remove clothing and will be given a gown to wear.

  2. An intravenous (IV) line may be started in your arm or hand.

  3. You will be positioned so that the doctor can easily reach the bone that is to be sampled. A belt or strap may be used to hold you in the correct position.

  4. The skin over the biopsy site will be cleansed with an antiseptic solution.

  5. If a local anesthetic is used, you will feel a needle stick when the anesthetic is injected. This may cause a brief stinging sensation. If general anesthesia is used, you will be put to sleep using intravenous medication.

  6. If a local anesthetic is used to numb the area, you will need to lie still during the procedure.

  7. A small incision will be made over the biopsy site and the biopsy needle will be inserted into the bone.

  8. If awake, you may feel discomfort or pressure when the doctor obtains the bone sample.

  9. The biopsy needle will be withdrawn and firm pressure will be applied to the biopsy site for a few minutes, until the bleeding has stopped.

  10. The doctor will close the opening in the skin with stitches or skin adhesive strips, if necessary.

  11. A sterile bandage or dressing will be applied.

  12. The bone sample will be sent to the lab for examination.

After the procedure

Your recovery process will vary depending on the type of anesthesia that is given. You will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home.

Once you are home, it is important to keep the biopsy area clean and dry. Your doctor will give you specific bathing instructions. If stitches are used, they will be removed during a follow-up office visit. If adhesive strips are used, they should be kept dry and generally will fall off within a few days.

The biopsy site may be tender or sore for several days after the bone biopsy. Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Notify your doctor to report any of the following:

  • Fever

  • Redness, swelling, bleeding, or other drainage from the biopsy site

  • Increased pain around the biopsy site

You may resume your usual diet and activities unless your doctor advises you differently. Your doctor may ask you to avoid strenuous physical activity for a few days.

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

Online resources

The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your doctor. Please consult your health care provider with any questions or concerns you may have regarding your condition.

This page contains links to other websites with information about this procedure and related health conditions. We hope you find these sites helpful, but please remember we do not control or endorse the information presented on these websites, nor do these sites endorse the information contained here.

American Academy of Orthopaedic Surgeons

American Cancer Society

National Cancer Institute (NCI)

National Institute of Child Health and Human Development

National Institutes of Health (NIH)

National Library of Medicine

Chris Evert Children's Hospital Clinical Trials Program focuses on having available clinical trials to improve cancer care by finding better ways to treat cancer and help pediatric cancer patients.

The decision to enroll in a clinical trial is voluntary and one that should be made with the close consultation of a physician.

Research Physicians

Dr. Rodriguez-Cortes

Hector Rodriguez-Cortes, MD
Principal Investigator

Dr. Roskos

Rudolph Roskos, MD
Investigator

Dr. Cambara

Alejandro Cambara, MD
Investigator

Research Office Staff

Claudia Diaz Pow Sang, BSN, RN, CCRP, Clinical Research Coordinator
Arlene McMillan, BSN, RN, OCN, MS, Clinical Research Nurse/Regulatory

Contact Information

For further information, please contact the Pediatric Hematology/Oncology Research Department:

  • Principal Investigator 954-355-4527
  • Pediatric Hematology Oncology Research Office at 954-355-5488 or 954-712-6406
  • or visit: www.clinicaltrials.gov

Clinical Trials List

Updated: June 2014

Leukemia
AALL0232: High Risk B-precursor Acute Lymphoblastic Leukemia (ALL)
Status: Closed to enrollment / Open for transfer only
AALL0331: Standard Risk B-precursor Acute Lymphoblastic Leukemia
Status: Closed to enrollment / Open for transfer only
AALL03B1: Classification of Acute Lymphoblastic Leukemia
Status: Closed to enrollment / Open for transfer only
AALL0433: Intensive Treatment for Intermediate-Risk Relapse of Childhood B-Precursor Acute Lymphoblastic Leukemia (ALL): A Randomized Trial of Vincristine Strategies
Status: Closed to enrollment
AALL0434: Intensified Methotrexate, Nelarabine (Compound 506U78;IND #52611) and Augmented BFM Therapy for Children and Young Adults with Newly Diagnosed T-cell Acute Lymphoblastic Leukemia (ALL)
Status: Open to enrollment
AALL05B1: A Children's Oncology Group Protocol for Collecting and Banking Relapsed Acute Lymphoblastic Leukemia Research Specimens
Status: Open to enrollment
AALL07P1: A Phase II Pilot Trial of Bortezomib (PS-341, Velcade, IND# 58,443) in Combination with Intensive Re-Induction Therapy for Children with Relapsed Acute Lymphoblastic Leukemia (ALL) and Lymphoblastic Lymphoma (LL)
Status: Open to enrollment
AALL08B1: The Classification of Acute Lymphoblastic Leukemia
Status: Open to enrollment
AALL0932: Treatment of Patients with Newly Diagnosed Standard Risk B-Precursor Acute Lymphoblastic Leukemia (ALL)
Status: Open to enrollment
AALL1131: A Phase III Randomized Trial for Newly Diagnosed High Risk B-Lymphoblastic Leukemia (B-ALL) Testing Clofarabine (IND# 73789, NSC# 606869) in the Very High Risk Stratum
Status: Open to enrollment
AAML0431: The Treatment of Down Syndrome Children with Acute Myeloid Leukemia (AML) and Myelodysplastic Syndrome (MDS) Under the Age of 4 Years
Status: Closed to enrollment / Open for transfer only
AAML0531: A Phase III Randomized Trial of Gemtuzumab Ozogamicin (Mylotarg®) Combined with Conventional Chemotherapy for De Novo Acute Myeloid Leukemia (AML) in Children, Adolescents, and Young Adults
Status: Closed to enrollment / Open for transfer only
AAML1031: A Phase III Randomized Trial for Patients with de novo AML using Bortezomib (IND# 58443, NSC# 681239) and Sorafenib (BAY 43-9006, IND#69896, NSC# 724772) for Patients with High Allelic Ratio FLT3/ITD
Status: Open to enrollment
9904: ALinC 17 Treatment for Patients with Low Risk Acute Lymphoblastic Leukemia - A Phase III Study
Status: Closed to enrollment / Open for transfer only

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Brain & Spine
ACNS02B3: A Children's Oncology Group Protocol for Collecting and Banking Pediatric Brain Tumor Research Specimens
Status: Open to enrollment
ACNS0331: A Study Evaluating Limited Target Volume Boost Irradiation and Reduced Dose Craniospinal Radiotherapy 18.00 Gy and Chemotherapy In Children with Newly Diagnosed Standard Risk Medulloblastoma: A Phase III Double Randomized Trial
Status: Open to enrollment
ACNS0334: A Phase III Randomized Trial for the Treatment of Newly Diagnosed Supratentorial PNET and High Risk Medulloblastoma in Children < 36 Months Old with Intensive Induction Chemotherapy with Methotrexate Followed by Consolidation with Stem Cell Rescue vs. the Same Therapy Without Methotrexate
Status: Open to enrollment
ACNS0831: Phase III Randomized Trial of Post-Radiation chemotherapy in Patients with NewlyDiagnosed Ependymoma Ages 1 to 21 Years
Status: Open to enrollment

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Ewing Sarcoma
AEWS07B1: A Children's Oncology Group Protocol for Collecting and Banking Ewing Sarcoma Specimens
Status: Open to enrollment
AEWS07P1: A Pilot Study of Chemotherapy Intensification by adding Vincristine, Topotecan and Cyclophosphamide to Standard Chemotherapy Agents with an Interval Compression Schedule in Newly Diagnosed Patients with Localized Ewing Sarcoma Family of Tumors
Status: Closed to enrollment / Open for transfer only
AEWS1031: A Phase III Randomized Trial of Adding Vincristine-Topotecan-Cyclophosphamide to Standard Chemotherapy in Initial Treatment of Non-metastatic Ewing Sarcoma
Status: Open to enrollment

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Germ Cell
AGCT0132: A Phase III Study of Reduced Therapy in the Treatment of Children with Low and Intermediate Risk Extracranial Germ Cell Tumors Closed to enrollment
Status: Open for transfer only

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Liver
AHEP0731: Treatment of Children with All Stages of Hepatoblastoma
Status: Open to enrollment

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Lymphoma
AHOD0031: A Phase III Study of Dose-Intensive, Response-Based Chemotherapy and Radiation Therapy for Children and Adolescents with Newly Diagnosed Intermediate Risk Hodgkin Disease
Status: Closed to enrollment / Open for transfer only
AHOD04B1: Hodgkin Disease Banking Study
Status: Open to enrollment

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Neuroblastoma
ANBL0032: Phase III Randomized Study of Chimeric Antibody 14.18 (Ch14.18) in High Risk Neuroblastoma Following Myeloablative Therapy and Autologous Stem Cell Rescue
Status: Open to enrollment
ANBL00B1: Neuroblastoma Biology Studies
Status: Open to enrollment
ANBL00P3: A Phase III randomized trial of Intravenous Gammaglobulin Therapy for Patients with Neuroblastoma Associated Opsoclonus-Myoclonus-Ataxia Syndrome Treated with Chemotherapy and Prednisone
Status: Closed to enrollment

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Osteosarcoma/Bone
AOST06B1: A Children's Oncology Group Protocol for Collecting and Banking Osteosarcoma Specimens
Status: Open to enrollment

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Renal/Kidney
AREN03B2: Renal Tumors Classification, Biology, and Banking Study
Status: Open to enrollment
AREN0532: Treatment for Very Low and Standard Risk Favorable Histology Wilms Tumor
Status: Closed to enrollment
AREN0534: Treatment for Patients with Bilateral, Multicentric, or Bilaterally-Predisposed Unilateral Wilms Tumor
Status: Open to enrollment

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Rhabdomyosarcoma (Soft Tissue Sarcoma)
ARST0331: Vincristine, Dactinomycin, and Lower Doses of Cyclophosphamide With or Without Radiation Therapy for Patients with Newly Diagnosed Low-Risk Embryonal/Botryoid/Spindle Cell Rhabdomyosarcoma
Status: Closed to enrollment / Open for transfer only
ARST0332: Risk-Based Treatment for Non-Rhabdomyosarcoma Soft Tissue Sarcomas in Patients Under 30 Years of Age
Status: Closed to enrollment / Open for transfer only
9902: A COG Soft Tissue Sarcoma Diagnosis, Biology and Banking Protocol
Status: Open to enrollment

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Other
ABTR01B1: A Children's Oncology Group Protocol for Collecting and Banking Pediatric Research Specimens Including Rare Pediatric Tumors
Status: Open to enrollment
ACCL0933: A Randomized Open-Label Trial of Caspofungin versus Fluconazole to Prevent Invasive Fungal Infections in Children Undergoing Chemotherapy for Acute Myeloid Leukemia (AML)
Status: Open to enrollment
ACCRN07: Protocol for the Enrollment on the Official COG Registry, The Childhood Cancer Research Network (CCRN)
Status: Open to enrollment
ALTE05N1: Umbrella Long-term Follow-up Protocol
Status: Open to enrollment

Please call the Principal Investigator or Study coordinator with any questions or potential subjects.

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