Background: Image guided core needle biopsy (CNB) is an important tool in the
management of musculoskeletal neoplasms. Although the diagnostic yield and accuracy of this
procedure are high, non-diagnostic results can occur. A non-diagnostic CNB result can cause
unnecessary patient and physician anxiety and can lead to repeat biopsy and delay in treatment.
Knowledge of the radiologic and histologic factors affecting diagnostic yield in CNB of
musculoskeletal lesions can assist the radiologist in selecting which lesion to biopsy and help to
manage physician and patient expectations of the biopsy results.
Discussion: Small, sclerotic, necrotic, and benign lesions have lower diagnostic yield than large,
lytic, non-necrotic and malignant lesions. Before the biopsy is performed, the relevant imaging
studies should be reviewed and the best lesion to target should be discussed with the orthopedic
oncologist and pathologist. Sampling the least necrotic and least sclerotic portion of the lesion, as
well as obtaining sufficient samples, and targeting the walls of cystic lesions can improve
Conclusion: Ultimately, despite optimizing CNB methods, non-diagnostic results can still occur but
do not need to be considered failures. At times, they can provide evidence that a lesion is benign
and helps averting additional interventions.