What You Should Know About Bone Marrow Biopsy for the Staging of Lymphoma


Answers to frequently asked questions about bone marrow aspiration and biopsy evaluation in lymphoma.

by Dr. C.H. Weaver M. D. updated 12/2018

Why is a bone marrow aspiration and/or biopsy performed?

A bone marrow biopsy is performed

  • If your blood show that the levels of platelets, white or red blood cells are too high or too low (anemia)
  • To evaluate and stage blood cell conditions, such as leukopenia, thrombocytopenia, or polycythemia.
  • To evaluate and diagnose cancers of the bone marrow or blood, such as leukemia or lymphoma.

In order to obtain a bone marrow sample, the physician must insert a needle through the skin, muscle and outer edge of bone. Although a bone marrow biopsy is typically associated with little pain and only takes about 10 to 20 minutes, many patients have fear, and anxiety before this procedure.

How is the bone marrow biopsy performed?

A bone marrow biopsy is typically performed by inserting a needle into the back of the hip bone. Although not always necessary, some doctors will give their patients intravenous medication for relaxation prior to the procedure.

The patient typically lies face down and when comfortable, the skin is cleaned and a local anesthetic is administered to numb the skin and periosteum covering the bone. A hollow, stainless steel needle is then inserted into the back part of the hip bone. First, a sample of the liquid marrow is drawn into the syringe (bone marrow aspiration). The patient might feel some minor discomfort such as a pulling or drawing feeling down the leg.

Next, the physician will take a biopsy from the bone marrow by pressing the needle forward and rotating in both directions in order to break away a small sample. Most physicians use the same needle for both aspiration and biopsy collection. After the aspiration and biopsy, the needle is removed, pressure is applied and a bandage is placed on the biopsy site. Most patients report that after the procedure, the pain immediately diminishes, but they are left with minor discomfort for a few hours. The doctor performing the biopsy may provide specific follow-up instructions, depending on sedation and individual circumstances.

How to prepare for a bone marrow biopsy.

Bone marrow exams are often performed on an outpatient basis. Special preparation usually isn't needed. Individuals should...

  • Tell your doctor about medications and supplements you take. Certain medications (aspirin) and supplements may increase the risk of bleeding after a bone marrow biopsy and aspiration.
  • Tell your doctor if you're nervous about your procedure. Patients should talk to their doctor before the procedure in order to understand how to manage or minimize any discomfort or anxiety associated with a bone marrow biopsy. If properly performed, a bone marrow biopsy should not cause patients significant pain and should provide useful information.

What are the risks of a bone marrow biopsy?

All medical procedures carry some form of risk, but complications from a bone marrow test are uncommon and occur in less than 1 percent of individuals. The main risk of this procedure is excessive bleeding. Infection and persistent pain may also occur.

Is a bone marrow biopsy painful?

Most people need only local anesthesia, as bone marrow aspiration, in particular, can cause brief, but sharp, pain. Individuals are fully awake during the procedure, but the aspiration and biopsy site will be numbed to reduce pain.

What does the bone marrow biopsy show?

The biopsy will determine whether there is evidence of cancer in the bone marrow which changes the stage and treatment of the cancer/lymphoma. The test also reveals how well you are producing white blood cells, red blood cells and platelets.

Why is a bone marrow biopsy performed in individuals with lymphoma?

Cancers that begin in cells of the lymph system are referred to as malignant lymphomas. The lymph system includes the spleen, thymus, tonsils, bone marrow, lymph nodes and circulating white blood cells called lymphocytes. Lymphocytes and the lymph system are part of the immune system that protects the body from disease and infection. Cancers of the lymph system are referred to as Hodgkin’s lymphoma or non-Hodgkin’s lymphoma.

Newly diagnosed lymphoma patients are required to undergo a number of tests and procedures to ensure accurate diagnosis and staging. Tests may include a lymph node biopsy, blood tests, a CT scan, PET scan and bone marrow biopsy. Some patients report that of these, the most difficult is the bone marrow biopsy.

Bone marrow, found in the center of most large bones, is a spongy material that produces red blood cells, white blood cells and platelets. A bone marrow biopsy is used to evaluate how well the bone marrow is functioning and to determine if lymphoma is present. This is important because the presence of lymphoma in the bone marrow may change a patient’s therapy.