Dear Editor,

We read with great interest the case report entitled “Battery-powered bone drill: caution needed in densely blastic lesions”, as we typically utilize the same OnControl 10G biopsy device (Vidacare Corporation, Shavano Park, TX, USA) for blastic lesion biopsy.

Although we have not directly observed the teeth of the biopsy device bending as reported by the authors, we have encountered similar difficulty extracting specimens from blastic lesion biopsy several times at our institution. On at least three occasions over the past two years, the sample has become firmly wedged within the biopsy cannula and was only able to be removed with great effort. In a more recent case of an iliac crest biopsy in a 61-year-old female with diffuse blastic lesions suspicious for metastatic breast carcinoma, we were completely unable to remove the sample according to the manufacturer’s guidelines.

We agree with the author’s recommendations of avoiding taking samples larger than 5 mm, and have also received feedback from the device manufacturer recommending the same. However, in the unfortunate situation where a sample does become stuck, we offer the following simple alternative extraction method:

Rather than using brute force to push the sample out or risk operator injury by pushing from the opposite end, against manufacturer instructions, we have used a separate smaller gauge core needle biopsy device, for example, a Bonopty 12G biopsy set (Apriomed, Londonderry, NH, USA) to simply “biopsy the biopsy”. By inserting the smaller device inside the bore of the larger cannula, and hand drilling, smaller portions of the sample can be serially extracted with minimal effort. Using this technique, we were able to safely and successfully extract sample material to send for pathologic analysis, and were able to confirm metastatic breast carcinoma.

With this technique, even if one takes a larger core sample of a blastic lesion with a battery-powered device, there should be no worry about the sample becoming stuck. In the worst case, if the sample cannot be extracted with the standard manufacturer technique, just “biopsy the biopsy.”