Bone Biopsy -- Important? Advice please!

fight4two

I'm newly diagnosed with spinal mets -- revealed from an elevated ca 27.29 and a subsequent PET scan. I have been transferred to a new oncologist who is saying I need a bone biopsy. What is the purpose of the bone biopsy? She said it is to check the hormone receptor status as it may have changed from my original tumor 4 years ago. But then I heard conflicting information that bones aren't good for showing receptor status. I'm just confused about the purpose of the bone biopsy and if its an important step to go through in this journey or not. Does it confirm you have cancer in your bones? I thought that was already confirmed with the PET.

Anyhow -- for those who have gone this route -- please advise!! Plus, if you did the bone biopsy, can you tell me what to expect? I'm a little nervous because they are requesting me to fast and come in an hour an a half before to monitor me and they said they have to check my vitals when I'm recovering after -- and it's been referenced as a surgery? I'm just feeling very in the dark about this procedure and scared about what I've actually signed up for. I wouldn't want to do this procedure if its not necessary or extremely informative. It's still early days for me and I'm kind of in a state of panic and confusion -- not feeling very well informed.

kayrnic

I had a bone biopsy to my L2 vertebrae because it's the only place they could get to. It was to make sure the receptor status was the same and that the treatment they were planning to give me would be appropriate.

The procedure was pretty easy. They prep you by starting an IV. They use a ct machine to guide the biopsy. You are drugged up and nice and happy, although, I was awake. I remember very little about it. They kept me for about 2 hours to make sure there weren't any complications and sent me home. I was a little sore for a couple of days but that's it.

Overall, it was very easy and there are other tests that have been way worse than that. I would say to do it because the more you know about your cancer, the better treatment decisions can be made.

Good luck!

Casun19

I can't speak to what it's like on the spine but I had 2 bone biopsies on my pelvis and you are right it is to confirm cancer and the receptor status. The first biopsy I had confirmed mets but didn't collect enough cells to determine the hormone status which is why I had a second biopsy. i think this is why people mention that the bone is a tricky sample.

They don't want you to eat because the Usually put you in a mild sedation state which makes you very relaxed and comfortable but awake.

The test is very informative but if you are feeling uncomfortable ask your doctor about it more. Might settle your nerves. Good luck!

Freya244117

I had a biopsy on L5. It was a painless procedure, I just felt a bit of pressure. I was chatting to the surgeon as it was being done. I didnt find it anything to be concerned about, and knowing if the hormone receptor status had changed was important in regards to treatment. Best wishes.

hodges

Hello! All of the procedures we go through, could foster anxiety, right? I have had bone biopsies, not fun, but necessary. I just try to remember that it is necessary so the providers can make the best treatment available. Prayers and Hugs to you

Nan812

Hi, I had a bone biopsy on my T8. I think I'm a wimp...or maybe a high tolerance to pain meds...it hurt. I wish i would have gotten into the most comfortable position possible from the beginning (had to have my arm over my head, laying on it, on my side) Once they start, you can not readjust (because of the ct guidance) so my arthritic shoulder was on fire for most of the procedure. Thank goodness it didn't take to long, but it is very important in deciding which treatment will work best for you. I wish you a speedy and pain free procedure.

zarovka

It is true that bone biopsies can be unreliable for determining hormonal status. There something about pulling cells out through the calcium that interferes with the tests that determine hormonal status. It's worth googling and asking your doctor about. You can determine hormonal status from circulating tumor cells in the blood and there are some that would argue that is more accurate in the case of bone mets. It's a complicated topic. You can either go for a deep dive into the literature and make your own decision, or ask an onc or two and make your decision that way. But it is a question.

>Z<

GG27

I had a CT guided bone biopsy in my sternum with only local anesthetic and had no pain afterward, we left on vacation immediately from coming out of the hospital. The nice thing was, no fasting because it was local. It confirmed that the hormonal status was the same which helped with treatment options.

pajim

fight4two, I'm one who has NOT had a bone biopsy. I had ER+ breast cancer four years before mets were diagnosed. My onc just said "classic presentation" and prescribed letrozole.

Now it could be that there wasn't enough lesion TO biopsy. I had back surgery and they had taken out as much as they could, but they didn't test it for receptor status.

As letrozole and faslodex did the job I assume my onc was right.

NancyHB

Thank you for sharing this information. I was dx with bone mets a few days ago on two ribs. My MO wanted to proceed directly to radiation but the RO has asked for a bone biopsy, I assume to determine receptor status. I was ER+ my first time around 5 years ago, but my local recurrence was TN last year. Since my bone scan was clear last year I suspect my MO assumes these mets are TN, but I guess we'll be sure. I meet with the thoracic surgeon next Tuesday. Never thought I'd be praying to be able to take Tamoxifen!

ScienceGirl

I had a bone biopsy on my hip when first diagnosed stage IV. Only purpose was for receptor status. They were pretty sure from scans that it was metastatic breast cancer. I requested general anesthesia and was quite sore for almost a week. In hindsight, I could have skipped the biopsy, waited a few months that would have shown that arimidex was working very well so I was ER+ same as my initial diagnosis. Biopsy said I was PR- which was different from my initial diagnosis, but doctors have dismissed this saying that it's hard to measure. Overall I'm not sure the biopsy was necessary.

I think we should exercise our right to say "NO Thank You" sometimes to our medical providers, remember it's your personal choice.

Nan812

when the tumor on my adrenal gland popped up last year, they wanted to biopsy it....they said once they radiated it they wouldnt be able to tell its H status...we decided it really didnt matter this time (we weren't doing chemo for it ) so I got out of that one i wouldnt have gotten out of it if I hadn't questioned the necessity of it tho.

teacher911

I've had 2 bone biopsies about 4 years apart. The first was in my rib and it was fine and the second this past fall was in my sacrum. Both were done by expert ct/radiologists and I was awake for both procedures. Neither of them hurt but the sacrum because of it's position was more tender. I think information was important for my onc and myself. I wish you well.

Fitztwins

Yes, it is important. To see if anything has changed in the pathology of your tumor. As many have stated its not that big of a deal. Plus if you want to do any clinical trials , they will need this information.

Good luck! onward and upward.

Janis

(I am 8 years into this mets journey)

fight4two

Thanks everyone for your input and personal experiences. I have decided to proceed with the biopsy and will be going in for it tomorrow. Please think good thoughts for me!

Freya244117

Good thoughts coming your way.

NancyHB

I met with the thoracic surgeon last week, and ran right back to my MO, completely confused. Surgeon wants to do a rib resection under general anesthesia, outpatient, but send me home with a chest tube for "a day or two" to ensure my lung doesn't collapse. He says it's the only way to do a rib biopsy. I don't believe it and am very uncomfortable with the suggestion. I see from this thread that most of you used radiologists for bone biopsies; it only makes sense that a surgeon would want to do it surgically. Am I making too big a fuss about this

Nan812

yikes!! Nancy that sounds terrible!! it just sounds like so much pain for you to go thru! I think I would want a second opinion on that one.

stagefree

each of us have our unique cases. As much as we express our own sitıations, I suggest you trust your doc's decision. If you do not click with your MO/RO from day one, the treatment process will not be comfortable for you in any way. Hope things turn out easily managable.

Hugs

Ebr

zarovka

Nancy -

I have to strongly disagree with the lovely and wise and often very funny Ebr. I am not one who trusts my docs decisions if they make me uncomfortable. You are uncomfortable because there are a lot of red flags. The discomfort is your intuition speaking. Most of us here are alive because at one point or another, our intuition guided us at a critical juncture.

We debate whether to do even simple biopsies at all because of the risk involved in even the most basic procedure. I generally believe that simple biopsies are worth the risk, but bone biopsies are of questionable value depending on what you are trying to learn. And this one is very risky.

You need a second opinion to determine whether a bone biopsy is worth the risk. Ask about circulating tumor cell tests (CTCs). These are blood tests that find cancer cells in your blood. If you have any CTC's, they can use these cells to determine the hormonal status of your cancer. Unfortunately we don't all have CTC's and it is a new approach. Not all doctors will agree with me because the test is not as well understood as a straight up biopsy.

However it is worth asking, and asking, and asking until all your questions are answered and you feel comfortable with the choice YOU are making.

>Z<

Midwest_Laura

Nancy: perhaps the rib resection has to do with the location of the cancer.  I have 5 mets on my spine and one on my rib.  However, my MO and RO have both recommended NOT to do a biopsy.  The reason behind the decision is the location of the spots found on the MRI and PET.  All of the spots are on the anterior side of my spine and the anterior side of the rib that is on my backside.  So, to perform a biopsy, they would either have to drill in through the front (and probably do the rib resection) or take a significant risk by coming in from the back and probably hitting a few nerves or the spinal cord along the way.  Consequently, we are using deductive reasoning to determine what those spots really are.  I'm on neoadjuvant chemo now.  I have pre-chemo scans as a baseline.  When my chemo is done at the end of this month, we will re-scan and compare the two.  If those spots have shrunk like the primary tumor - definitely cancer.  If the spots are the same - could be arthritis.  (I'm not holding out any hope on the arthritis front.)  We understand that simply knowing that those scan spots are cancer doesn't tell us anything about the pathology.  Once I start on Tamoxifen and wait a few months, we will continue the scans, comparisons, and deductive reasoning to make an educated guess on the pathology instead.

DivineMrsM

I don't mean to hijack the train of thought on this thread, but it is interesting to read that a number of you did not have bone biopsies. I didn't, either; my doctor said it was not necessary after a suspicious bone scan was followed up with a PET scan. The mets were hip, rib, shoulder blade area and scattered vertebrae, I had neoadjuvant chemo and everything shrunk. After lumpectomy and rads, I started Arimidex and have been stable since 2011.

The reason I mention this is because when I filed for disability payments last year, thru a service employee retirement, I was sent to their doctor. He decided since I did not have a bone biopsy, and since I have been stable so many years, I only had stage two cancer and the scans, (which he never looked at altho I brought the dvds to him) probably showed arthritis.

What a quack. I was denied payments (even tho Socil Security qualified me for disability and hence, Medicare), so I got a lawyer, filed an appeal and numerous months later was awarded benefits.

Needless to say, that quack doctor did a number on my head. I questioned if I really did have stage iv. I went thru freaking out a bit if I was misdiagnosed. So I am always a bit relieved to know I am not the only one who did not get a biopsy

zarovka

I think Dr's are quick to biopsy the breast and lymph nodes because it is easy and extremely important. Lung and liver mets can be easy too, depending on the location.

Bone biopsies are never fun. In addition, the procedure itself can screw up the sample and alter the hormonal status of the sample so ... between the risk and the questionable reliability, some Doctors will say: what is the point?

The bottom line is that Nancy raises a good question and hope gets another opinion and reports back.

>Z<

NancyHB

Thank you all so much for your input. It helped incredibly in the decisions I've made the last two weeks. I didn't feel comfortable with the idea of the rib resection; even my MO seemed a little uncomfortable but the tumor board recommended it so he trusted their expertise. I connected with my PA who agreed with my concerns and strongly suggested a second opinion. Trusting my gut instinct I'd already called UofM and scheduled a second opinion appointment in anticipation of moving my care there. I've put my surgery on hold pending the outcome of this Wednesday's appointment.

This is my third go-around at this point. I've been with my current MO through both my first and second dx, and while we've had our differences over the years, he's a strong advocate. I trust him implicitly, but also know he has a tumor board behind him that sometimes doesn't support his decisions. If UofM suggests a rib resection, then I'll know this is probably the only way to get the biopsy they want. And given my first dx was ER+ and this last was TN, I suspect it's more about determining receptor status than confirming mets. But - we shall see.

Thanks again for your suggestions. It's a wild new world out here I'm learning to navigate, and I appreciate the support.

NancyHB

finally had my appointment with UofM - what a wonderful experience! We met first with the NP who was shocked and surprised the rib resection had been suggested for two mets. "It's like taking a sledgehammer to a hangnail" she said. She explained with ribs it's really the only way to biopsy because of the high risk of puncturing the lung with a needle biopsy. We met with our new MO who's fabulous. She confirmed what we already thought - the tumor board wanted the biopsy to determine hormone receptor status. Good conversations.

With only two mets she's not frantic to start treatment, since anything now is palliative rather than curative and right now I feel physically really good. I'll have another bone scan in three weeks to look for progression, then we'll decide what to do. Dr. said no biopsy on bone until it pops up somewhere else more easily biopsied.

even without the biopsy the MO feels confident this is mets based on the progression seen over scans in the last year.

Thank you for your feedback; it really helped me feel confident listening to my gut and advocating for myself