Biopsy vs. Aspirate

[amkjud]

Any comments on doing a biopsy vs. aspirate? Is a biopsy always needed as opposed to just an aspirate?
Also from one hip or both hips?

[Neil Cuadra]

They usually do the biopsy and aspiration at the same time. One procedure, one hip, and two types of material extracted, producing two categories of results.

The biopsy lets them study the number and quality of your blood forming cells. The aspiration lets them look for abnormal cells and chromosome damage. Usually both are important for diagnosis and for assessing changes in your disease condition, giving you information used to choose an appropriate treatment.

However, I suppose they might do only one if the other won't affect your treatment. To be sure, ask the doctor if the results will affect decision-making.

[amkjud]

Originally Posted by Neil Cuadra

They usually do the biopsy and aspiration at the same time. One procedure, one hip, and two types of material extracted, producing two categories of results.

The biopsy lets them study the number and quality of your blood forming cells. The aspiration lets them look for abnormal cells and chromosome damage. Usually both are important for diagnosis and for assessing changes in your disease condition, giving you information used to choose an appropriate treatment.

However, I suppose they might do only one if the other won't affect your treatment. To be sure, ask the doctor if the results will affect decision-making.

Is there a difference between aspirate and biospy with regard to pain level either during or after procedure?

[Neil Cuadra]

Originally Posted by amkjud

Is there a difference between aspirate and biospy with regard to pain level either during or after procedure?

My wife, who has had BMB's with light sedation, with no sedation, and with full sedation, told me that having them puncture your hip bone is reason enough for patients to be given painkillers, and that's the reason for discomfort afterwards. During the procedure she thinks the aspiration was more painful than the biopsy, or at least that she was more aware of it. My wife noticed that if she had stronger sedation during the procedure then there was less lingering pain for the rest of the day. We don't know the reason for that but we guess that it was because sufficient sedation kept her from squirming, producing less trauma at the incision site.

One thing I've learned from these forums is that people's experiences are wide-ranging, from mild discomfort to pain that makes them dread having another procedure without heavier pain relief. My wife's last bone marrow biopsy was done with IV propofol and she had no pain at all, during or afterwards, but some patients sail through biopsies with only oral painkillers and sometimes a dose of anti-anxiety medicine.

This article has a good description of the overall procedure.

[Greg H]

Hey amkjud!

I'm not sure there is much difference in the pain level. As Neil says, both are usually done in the same procedure. It's almost always done in the pelvic bone near the top of the hip. How painful folks find it seems to vary greatly from person to person. Some (like me) find it hardly a bother; others need to be anesthetized.

Here's my experience, sensation-wise:

1. The doctor pushes pretty firmly on the hip, feeling the pelvic bone below to find a good spot.

2. The cleaner they rub all over your hip before sticking you is often cold.

3. Next, you get an injection of lidocaine at the incision site. This burns briefly, like a bee sting.

4. If the lidocaine worked, you don't feel the scalpel making a hole for the biopsy needle.

5. The biopsy needle is inserted and ground into bone of the pelvis like a corkscrew. If you feel anything other than pressure, you need more lidocaine injected into the spot. Ask for it.

6. Once the doctor gets through the outer layer of bone, a finer needle is inserted through the biopsy needle to collect the aspirate with a syringe. Pulling out the aspirate produces a sharp burning sensation that lasts a few seconds. The doctor or nurse will often ask you to take a deep breath just before they pull the aspirate. This does help. The pain is intense, but brief.

7. After the aspirate is collected, they drill deeper with the biopsy needle to get the sample of marrow. In my experience, you should again only feel pressure -- though, if you have hard bones like me, the pressure can be considerable. Often, in this part of the process, I will feel a sharp twinge, tell the doctor, and they will hit me with more lidocaine.

8. After all is done, when the lidocaine wears off in a few hours, your hip will be sore. For me, that might last a day. The incision site may be tender for a couple of days.

Do not -- like I did -- make the mistake of undertaking vigorous exercise -- like walking a mile or two -- while still numb with the lidocaine. You will regret it when the lidocaine wears off.

That's about it, in my experience. Everyone seems to have a different experience of pain in this procedure -- sort of like going to the dentist. It's a terror for some; a walk in the park for others.

Take care!

Greg

[brad4d8]

Originally Posted by Greg H

How painful folks find it seems to vary greatly from person to person. Some (like me) find it hardly a bother; others need to be anesthetized.Greg

I agree. I had both done about a year and a half ago and felt minimal pain, even though they had trouble with one of the procedures and took longer than usual. Some residual pain, but nothing any worse than after my Vidaza shots.
Brad

[Dick S]

Greg H pretty much described it, but..................
Inserting the needle and going into the bone is merely pressure and very little to no pain. In my case the aspirate part (fluid) hurt somewhat, but not untolerable. You only feel pain during the extraction of the fluid period. They stop and he and the tech check the samples and make sure they got what they wanted. Then the Doc instructed me to take repeated deep breaths "like a woman having a baby" in prep for the bone marrow core extraction. I don't care what anybody says, that hurts, and last about 15 to 20 seconds. By the end of that time I was pretty much begging for it to end. After that, it's all over and you feel nothing with removal and closing. Over all it's a necessary inconvenience that you just have to learn to live with.

BTW Greg, I didn't know you could ask for more Lidocaine and it takes time for Lidocaine to work so I wonder what possible good it could do once the procedure starts.

[Greg H]

Hey Dick!

You know, one of the great disadvantages of being a patient talking bout this procedure is that you are lying flat on your belly, while they work on your butt. It makes it very hard for me to get a line on what's happening when.

In any case, I too have had BMBs in which the core extraction was painful. In this last case, the doc noticed my squirming and grunting and said she'd had to "go laterally" and "hadn't numbed that area." She did something that I assumed was more lidocaine, and I felt nothing from then on out. I've had similar experiences with other BMBs. I'm pretty stoic, but I also prefer not to endure unnecessary pain, so I keep the doc informed about what I'm feeling during the procedure.

I'm not smart about how long lidocaine takes to work. But I have a nurse who likes to use it prior to inserting my IV for transfusions, and it seems to numb things pretty darned quick.

I don't really need it, but it makes her feel better, which makes the IV needle find its mark more readily.

Take care!

Greg

[Chirley]

Hi Greg, I noticed you said you lie on your stomach. I've never heard of anyone doing that. I've had all of mine (bar one) lying on my side. The one exception was when I was lying on my back and had it done on my anterior iliac crest.

Regards

[mausmish]

Just had my 8th bmb last week and it was the worst so far but not unbearable. Ditto on what Greg said - I'm stoic but don't want more pain than necessary so speak up. Most of the time I feel little more than pressure and don't even flinch. I realized they were taking longer and hurting me more than usual this time and asked what was wrong. She asked if I'd ever had a dry tap (no, I haven't) because she was having trouble getting aspirate. My bones are very soft. She tried three different spots and then said she'd have to move to a new location. She gave me more lidocaine and went in laterally. The lidocaine worked very quickly. I was a little shaky afterwards but think it was because they slapped a big bandage on and sent me away immediately. Usually, they get me to roll over and lie quietly with pressure on my back for 10-15 minutes.

p.s. all my bmb's have been lying flat on my stomach - have had them at three different facilities.

[Greg H]

Hi Chirley & Karen!

Like Karen, I've had all my BMB's lying flat on my stomach. I hove noticed, however, that a lot of web illustrations of the procedure have folks on their sides.

[IMG]
bone_biopsy_pevis by hankins.greg, on Flickr[/IMG]

I haven't had a "dry tap," but during my BMB last May, at NIH, the resident managed to drill into spot where the marrow was too thin to get a good sample of the marrow. They called in a staff physician, who tried a second spot, but he also failed to come up with a usable sample.

I'm hopeful the BMB just done will prove more useful.

Take care!

Greg

[mausmish]

Results are in from last week's biopsy. All is good!

Greg, for my first bmb, I lay on my side while waiting based on the diagrams I'd seen but the doctor asked me to roll onto my stomach when he arrived. If I were doing the procedure, I think it would be easier having the patient lying flat and coming in from above instead of the side.

[amkjud]

Thanks for the responses. I asked about biopsy vs. aspirate with regard to pain because one doctor said my son only needs a biospy and no reason for additional pain of aspirate?

[Dick S]

Originally Posted by amkjud

Thanks for the responses. I asked about biopsy vs. aspirate with regard to pain because one doctor said my son only needs a biospy and no reason for additional pain of aspirate?

I'm confused and sounds like the doctor is not communicating very well. A Biopsy is an extraction and a test. The material they take during a biopsy sample is either an aspirate or bone marrow core or both. You can't do a biopsy without at least an aspiration.

[mausmish]

I'm of the opinion that as long as they're in there, go ahead and do both. More diagnostic info and better than having to go back in again later if they change their minds.

[Greg H]

I agree with Dick & Karen. The aspiration is, in fact, the most painful part of the procedure for me.

But, I believe it is from the aspirate that the pathologist takes the cells used to do the analysis of chromosomes. Given that your son had a chromosomal abnormality, which then disappeared, it seems like it would be good to know whether it has come back.

I'd go for the full biopsy.

Take care!

Greg

[Dick S]

Originally Posted by Greg H

But, I believe it is from the aspirate that the pathologist takes the cells used to do the analysis of chromosomes. Given that your son had a chromosomal abnormality, which then disappeared, it seems like it would be good to know whether it has come back.
Greg

The aspirate gives them the most info. As my doctor put it about taking the bone core, "The bone marrow core tells them which cells are living side by side to each other in the bone and what's going on in there". I'm sure that's simple layman's terms and they extract other valuable info from that too.