title: Strategies for obtaining bone biopsy specimens from breast cancer patients - Past experience and future directions.
abstract: BACKGROUND
  Cancer and its treatment can have multiple effects on the bone. Despite the widespread use of in vivo and in vitro models, it is still necessary to understand these effects in humans. Obtaining human bone biopsies is technically challenging and in this article we review the experiences from the Ottawa Bone Oncology Program.
  
  
  METHODS
  A series of bone biopsy studies in breast cancer patients with and without bone metastasis have been performed. We reviewed the results of these studies and present them in a descriptive manner. We discuss lessons learned from each project and how they have affected future directions for research.
  
  
  RESULTS
  Since 2009, 5 studies have been performed accruing 97 breast cancer patients. Study endpoints have ranged from comparing the yield of malignant cells from CT-guided versus standard iliac crest biopsies, to studies assessing the feasibility of micro-CT analysis on Jedhadi trephines to evaluate bisphosphonate effects on bone micro-architecture. More recently, we have assessed the feasibility of performing repeat bone biopsies in the same patient as well as evaluating the practicality of obtaining bone tissue at the time of orthopaedic surgery.
  
  
  CONCLUSIONS
  Human bone tissue is an important biological resource. Our experience suggests that obtaining bone biopsies is feasible and can yield adequate amount of tumour cells for many studies. However, these remain technically challenging specimens to obtain and given the rapid advances in cancer therapeutics and the use of potent adjuvant bone-targeted agents, more centres need to be involved in these types of studies.
authors.affiliation: Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Mohammed F K
authors.initials: MF
authors.lastname: Ibrahim
authors.affiliation: Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Hilton
authors.affiliation: Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: Addison
authors.affiliation: Division of Anatomical Pathology, Eastern Ontario Regional Laboratory Association, Ottawa, Ontario, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Robertson
authors.affiliation: Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Joel
authors.initials: J
authors.lastname: Werier
authors.affiliation: Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Sasha
authors.initials: S
authors.lastname: Mazzarello
authors.affiliation: Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Vandermeer
authors.affiliation: Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Carmel
authors.initials: C
authors.lastname: Jacobs
authors.affiliation: Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Clemons
keywords: Biopsy; Bone metastases; Metastatic breast cancer