Ultrasound Guided Musculoskeletal (MSK) Biopsy Preparation

Risks can include: 

• Bleeding/ Bruising 
• Nerve, tendon, ligament, cartilage damage and/or injury to structures adjacent to the target 
• Infection 
• Inconclusive Pathology result / Inadequate sample 

IMPORTANT: You will receive a phone call from our Biopsy Coordinator Nurse after your exam has been scheduled, to discuss the preparation instructions below and answer any remaining questions that you may have.  

Wear loose, comfortable clothing. If appropriate, we may ask you to change into a gown for the procedure. Do not wear any valuable jewelry, nor lotions or perfumes on the target area.  

We ask that you have a responsible friend or family member to drive you home. Please do not rely on bicycle, scooter, or walking; taking public transportation or rideshare is ok.  

We may ask you to cease blood thinners prior to the procedure, to reduce the risk of bleeding and bruising. You will discuss this with our Biopsy Co-Ordinator Nurse before you come in for the Procedure.  
If you are taking a major blood thinner (Plavix, Xarelto, Eliquis, Coumadin, Lovenox, etc.), please ask your doctor if it is okay for you to hold this medication for the biopsy; timelines and details will be discussed with you by the Biopsy Coordinator Nurse.  
Some over the counter medications can cause mild blood thinning effects. We ask that you hold Aspirin, Aleve (naproxen), and Celebrex (celecoxib) 5 days prior to biopsy, and ibuprofen (Advil) 2 days prior.  
Tylenol (acetaminophen) and other pain medications are not required to be held. 

If you have already been prescribed pain medication for pain in the target area, please take the medication prior to the procedure. There is no need to take additional pain medication prior to the procedure if you have not been prescribed pain medication or do not routinely take medication for pain in the target area. 

We need specific lab results on file for the procedure – these look at your blood clotting ability. If you haven’t already had these tests done in the last 4 weeks, the Biopsy Co-Ordinator Nurse will help arrange a blood draw when they call to speak with you about your preparation.  

You do NOT need to fast for this procedure. 

• You need to have checked in for your biopsy 15 minutes before your appointment time. Please plan on arriving at the hospital campus an additional 15 minutes earlier, to park your car and walk into the Department. Expect to be in the department for 1-2 hours.
• If necessary, you will be asked to change into a gown. This will only be done if necessary to gain access to the area.
• The technician (sonographer) will position you on the table and perform an ultrasound to locate the exact area to be targeted during the biopsy. 
• You will have a chance to speak with the doctor performing the procedure and sign a consent form – this is a good time to ask any additional questions you may have. 
• The area around the injection site will be cleaned, and the Doctor will inject a local anesthetic to numb the area where the needle will be inserted.
• Once the area is numb, the Doctor will insert the biopsy needle. It is normal to feel pressure from the needle, but if you are experiencing sharp pain, please tell the doctor so they can give you more numbing medicine.
• Once the tip of the needle is in the desired target, tissues samples will be removed through that needle and will be sent to the lab for processing. Multiple samples are required to obtain enough tissue for results – often, this does not require an additional biopsy needle poke, but instead, a slight adjustment of the needle already in place. If there are multiple targets for biopsy, there may be additional pokes – this is determined by the doctor performing the procedure, the request from your referring doctor, and your medical history. Do not be alarmed if the doctor is taking multiple samples – the samples are small to the human eye, so additional sampling is sometimes taken as a pro-active measure to prevent the need for a repeat biopsy.
• Once complete, the area will be cleaned, and a dressing will be applied. You will then change back into your clothing and are free to leave if you are feeling well.
• Samples taken will be sent to Pathology, and time for results may vary but generally take 7-10 business days. For specialty testing (like genetic tests of the tissue), these are sent out to specialty labs and can take up to 3 weeks. 

In most cases, the biopsy site is covered with a clear bandage and gauze. There are no stitches. Please do not get this area wet (i.e. no showering) for 24 hours after the procedure. After that time, you may shower normally. Please replace the bandage if it gets wet. If you remove the bandage or if the bandage falls off, please do not aggressively scrub the biopsy site. After your skin is dry, it is advised to keep the area covered with a band-aid for at least 2-3 days. Please do not submerge in water (bathtub, swimming) for 48 hours.  

We advise you do not perform strenuous exercise or heavy lifting for 2-3 days. Give your body a chance to heal from the needle poke, and re-introduce activity slowly and progressively, as tolerated. 

It is preferred to wait 24 hours before resuming major blood thinning medications or over-the-counter medications mentioned above for preparatory holds. Tylenol or prescribed narcotic medications are safe to take immediately after the procedure, if advised OK by your doctor. Ice packs or heat may be helpful if you have pain and soreness at the site.  

Radiology receives referrals from many different doctors, and each has their own workflow on following up with you on your results. If you have concerns about this, please contact your doctor that referred you for biopsy on how to best follow up. 

Call your provider if you experience: 

• Excessive bleeding 
• Persistent pain 
• Swelling and/or redness at the biopsy site 
• Fever (100.4oF or greater) in the 10 days following the procedure. 

Please note: If there is persisting pain, increased redness, or swelling at the site, this could be a sign of infection. Other signs of infection include fever greater than 100.4 F (taken by mouth) or drainage from the injection site.   

Can I eat before the procedure? Yes, you can eat and drink as usual. 

Should I take my regular medications? Please discuss medications with the Biopsy Coordinator Nurse during your pre-procedural phone call. Most medications can be continued. Medications that thin the blood may need to be held and will be reviewed with you by the Nurse during the preparation phone call. 

Will it hurt? Local anesthetic is liberally used to numb the area before biopsy, but you may experience some discomfort. If at any point during the procedure this becomes painful, you may ask the specialist for more anesthetic. The specialist will also do everything possible to make the procedure as comfortable as possible for you. 

What do I need to bring? Your ID and insurance information; be sure to leave all other valuables like jewelry at home.  

Will I get results right away? No. This type of biopsy involves sending your sample to the Laboratory for comprehensive testing. Once the Laboratory issues your result, it will be sent to your Referring Provider. You will discuss all results with your Referring Provider.  Results generally take 7-10 days. 

I am extremely anxious and/or have a needle phobia – what can I do? In some cases, the doctor that referred you to Radiology for this biopsy may be able to prescribe a one-time dose of an anti-anxiety medication. You will need to contact them to ask. If this is prescribed, you will bring the medicine with you to the appointment and take it AFTER SIGNING CONSENT WITH THE DOCTOR PERFORMING YOUR BIOPSY. If you take this medication before signing consent, the procedure will be cancelled.