Bone Biopsy in Pediatric Medicine

Pediatric Procedures Introduction Clinical Indications Types and Approaches Procedure Details Complications & Management

Key Points

• Essential diagnostic tool for bone pathologies
• Multiple techniques: Fine-needle, Core, and Open biopsy
• Requires precise anatomical planning
• Critical for diagnosis of bone tumors and infections
• Often performed under image guidance

Overview

Bone biopsy is a specialized diagnostic procedure involving the extraction of bone tissue for histological, microbiological, and molecular analysis. In pediatric practice, it serves as a crucial tool for diagnosing various bone pathologies, particularly when less invasive methods are inconclusive or insufficient for definitive diagnosis.

Clinical Indications

Primary Indications

• Bone Tumors
  • Primary bone tumors (benign and malignant)
    • Osteosarcoma
    • Ewing sarcoma
    • Langerhans cell histiocytosis
  • Metastatic lesions
  • Suspicious bone lesions on imaging
• Infections
  • Chronic osteomyelitis
  • Atypical infections
  • Culture-negative infections
  • Tuberculosis of bone
• Metabolic Bone Disorders
  • Unexplained osteoporosis
  • Metabolic bone diseases
  • Skeletal dysplasias

Pre-procedure Evaluation

• Imaging Studies
  • Plain radiographs
  • CT scan
  • MRI
  • Nuclear medicine studies when indicated
• Laboratory Tests
  • Complete blood count
  • Coagulation profile
  • Bone profile
  • Inflammatory markers

Types and Approaches

Fine-Needle Aspiration Biopsy (FNAB)

• Characteristics
  • Least invasive technique
  • Uses thin needle (20-22 gauge)
  • Provides cytological samples
• Advantages
  • Minimal trauma
  • Quick procedure
  • Lower complication risk
• Limitations
  • Limited sample size
  • May not provide architecture
  • Higher false-negative rate

Core Needle Biopsy

• Characteristics
  • Uses larger needle (8-14 gauge)
  • Provides tissue core
  • Usually image-guided
• Advantages
  • Better tissue sample
  • Preserves architecture
  • High diagnostic yield
• Best Applications
  • Deep-seated lesions
  • Mixed lytic-sclerotic lesions
  • Metabolic bone disorders

Open Biopsy

• Characteristics
  • Surgical procedure
  • Provides large sample
  • Direct visualization
• Indications
  • Failed needle biopsy
  • Need for large tissue sample
  • Complex anatomical locations

Procedure Details

General Preparation

1. Pre-procedure Planning
   • Review of imaging studies
   • Selection of approach
   • Marking of entry point
   • Anesthesia planning
2. Equipment Preparation
   • Appropriate biopsy needles
   • Image guidance equipment
   • Specimen containers
   • Culture media if infection suspected

Technique Specifics

1. Core Needle Biopsy Technique
   • Patient positioning
   • Sterile preparation
   • Local anesthesia infiltration
   • Small skin incision
   • Guided needle advancement
   • Multiple cores if needed
   • Specimen handling
2. Specimen Processing
   • Fresh specimen for culture
   • Formalin fixation for histology
   • Special studies if needed
   • Proper labeling and transport

Complications & Management

Potential Complications

• Immediate Complications
  • Bleeding
  • Pain
  • Neurovascular injury
  • Fracture (rare)
• Delayed Complications
  • Infection
  • Hematoma formation
  • Pathological fracture
  • Tumor seeding (extremely rare)

Post-Procedure Care

• Immediate Care
  • Compression dressing
  • Pain management
  • Activity modification
  • Vital sign monitoring
• Follow-up Care
  • Wound inspection
  • Result review
  • Treatment planning
  • Activity guidelines

Further Reading

• Modern Approaches to Bone Biopsy
• Orthobullets: Bone Biopsy Technique
• Radiopaedia: Bone Biopsy
• Medscape: Bone Biopsy Procedures
• Children's Oncology Group Guidelines