Diagnostic accuracy and safety of core needle biopsy for musculoskeletal lesions: A retrospective cohort study from a tertiary referral center

Level of EvidenceLevel III - Retrospective Cohort Study.BackgroundMusculoskeletal lesions commonly present as pain, masses, or incidental imaging findings. Accurate diagnosis is critical for treatment planning. Although open biopsy was historically considered the gold standard, core needle biopsy (CNB) has emerged as a minimally invasive and reliable diagnostic method with a favorable safety profile. The primary objective was to determine the diagnostic accuracy of image-guided core needle biopsy (CNB) for musculoskeletal lesions.MethodsWe conducted a retrospective analysis of 426 patients who underwent image-guided CNB for musculoskeletal lesions at a single tertiary referral center between January 2014 and December 2020. Patient demographics, biopsy characteristics, and diagnostic outcomes were analyzed. Diagnostic performance was evaluated using sensitivity, specificity, predictive values, and area under the ROC curve (AUC).ResultsMost patients were adults (82.4%) and male (56.6%). The lower limb was the most common biopsy region (43.2%), with the trunk (26.3%), upper limb (15.5%), and pelvis (14.3%) following in order of frequency. CNB demonstrated a sensitivity of 98.8%, specificity of 72.3%, negative predictive value of 99.0%, and overall accuracy of 82.3% (AUC = 0.855).ConclusionImage-guided CNB provides high diagnostic sensitivity and excellent negative predictive value for musculoskeletal lesions, with a very low complication rate. While it is effective as a first-line diagnostic tool, limitations remain in specificity and tumor subtype confirmation, particularly in heterogeneous or necrotic lesions. Standardized protocols and multidisciplinary interpretation are essential to optimize accuracy.