Tests for Bone Cancer

Symptoms, a physical exam, and the results of imaging tests, and blood tests might suggest that a person has bone cancer. But in most cases, doctors must confirm this by testing a tissue or cell sample and checking it with a microscope (a procedure known as a biopsy).

Accurate diagnosis of a bone tumor often depends on combining information about what bone is affected and which part of the bone is involved, how it looks on x-rays, and what the cells look like under a microscope.

Other diseases, like bone infections, can cause symptoms and imaging results that might be confused with bone cancer.

Bone metastasis can also look like primary bone cancer. Bone tumors are more often caused by cancer that has spread to the bone from some other part of the body. This is a bone metastasis. A single bone metastasis can have the same signs and symptoms as a primary bone tumor, so many doctors require a biopsy to diagnose a patient’s first bone metastasis. After that, new bone metastases can usually be diagnosed based on x-rays and other imaging tests.

Imaging tests


Most bone cancers show up on x-rays of the bone. The bone at the site of the cancer may look “ragged” instead of solid. The cancer can also appear as a hole in the bone. Sometimes doctors can see a tumor around the defect in the bone that might extend into nearby tissues (such as muscle or fat). The radiologist (doctor who specializes in reading x-rays) can often tell if a tumor is malignant by the way it appears on the x-ray, but only a biopsy can tell for sure.

A chest x-ray is often done to see if bone cancer has spread to the lungs.

Computed tomography (CT) scans

CT scans are helpful in staging cancer. They help show if the bone cancer has spread to your lungs, liver, or other organs. The scans show the lymph nodes and distant organs where there might be cancer spread.

CT scans can also be used to guide a biopsy needle into a tumor. This is called a CT-guided needle biopsy. For this test, you stay on the CT scanning table while a radiologist moves a biopsy needle toward the tumor. CT scans are repeated until the tip of the needle is within the mass. (See Needle biopsy below.)

Magnetic resonance imaging (MRI) scans

MRI scans are often the best test for outlining a bone tumor. They are very helpful for looking at the brain and spinal cord.

Radionuclide bone scans

Bone scans can show if a cancer has spread to other bones. It can find smaller areas of metastasis than regular x-rays. Bone scans also can show how much damage the cancer has caused in the bone.

Areas of diseased bone will be seen on the bone scan as dense, gray to black areas, called “hot spots.” These areas suggest cancer is present, but arthritis, infection, or other bone diseases can also cause hot spots. Other imaging tests or a bone biopsy may be needed to know what's causing the change.

Positron emission tomography (PET or PET) scans

PET scans use glucose (a form of sugar) that's attached to a radioactive atom. A special camera can detect the radioactivity. Cancer cells absorb a lot of the radioactive sugar because of their high rate of metabolism. PET scans are useful in looking for cancer throughout your entire body. It can sometimes help tell if a tumor is cancer or not cancer (benign). It's often combined with CT scans to better pinpoint some kinds of cancer.


A biopsy takes a piece of tissue from a tumor so that it can be looked at with a microscope and tested in the lab. This is the only way to know that the tumor is cancer and not another bone disease.

If it is cancer, the biopsy can tell the doctor if it's a primary bone cancer or cancer that started somewhere else and spread to the bone (metastasis). Many types of tissue and cell samples are used to diagnose bone cancer. It's very important that your biopsy be done by a surgeon with experience in diagnosing and treating bone tumors.

The type of biopsy done is based on whether the tumor looks benign (not cancer) or malignant (cancer) and exactly what type of tumor it most likely is (based on x-rays, the patient’s age, and where the tumor is). Some kinds of bone tumors can be diagnosed from needle biopsy samples, but larger samples (from a surgical biopsy) are often needed to diagnose other types.

Whether the surgeon plans to remove the entire tumor during the biopsy will also impact the type of biopsy done. Sometimes the wrong kind of biopsy can make it hard for the surgeon to later remove all of the cancer without having to also remove all or part of the arm or leg containing the tumor. It also may cause the cancer to spread.

Needle biopsy

There are 2 types of needle biopsies: fine (aspiration) and core. For both types, a drug is first used to numb the area for the biopsy.

For fine needle aspiration (FNA), the doctor uses a very thin needle and a syringe to take out a small amount of fluid and some cells from the tumor. Sometimes, the doctor can aim the needle by feeling the tumor if it's near the surface of the body. If the tumor is too deep to feel, the doctor can guide the needle while looking a CT scan. This is called a CT guided needle biopsy and it is often done by an x-ray specialist known as an interventional radiologist.

In a core needle biopsy, the doctor uses a larger needle to remove a small cylinder of tissue (about 1/16 inch in diameter and 1/2 inch long). Many experts feel that a core needle biopsy is better than FNA to diagnose a primary bone cancer.

Surgical bone biopsy

In this procedure, a surgeon needs to cut through the skin to reach the tumor to remove a small piece of tissue. This is also called an incisional biopsy. If the entire tumor is removed (not just a small piece), it's called an excisional biopsy.

These biopsies are often done with the patient under general anesthesia (drugs are used to put you into a deep asleep). They can also be done using a nerve block, which numbs a large area. If this type of biopsy is needed, it's important that the surgeon who will later remove the cancer also be the one to do the biopsy.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: November 28, 2017 Last Revised: February 5, 2018

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