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The most reliable test to establish a definitive diagnosis of osteosarcoma is a bone biopsy, where a small sample of the affected tissue is removed for examination under a microscope. This procedure requires general anesthesia, and it carries a very small risk of fracturing the bone at the tumor site. More often, the next step after X-ray results that raise suspicion for osteosarcoma is a fine-needle aspirate, where a needle is inserted into the bone lesion to collect a sample of cells. The cells are then examined under the microscope to confirm a cancer diagnosis. The advantages of this procedure are that it is rapid, only minimally invasive, and relatively inexpensive. The disadvantages are that a specific type of cancer cannot always be established and, in some instances, a definitive diagnosis of cancer cannot be confirmed. Because removal of the leg is sometimes necessary to control the pain, a biopsy to confirm the diagnosis is sometimes done at the same time as the amputation surgery.

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