An Analysis of CT‐Guided Percutaneous Core Needle Biopsy of Tibial Lesions: How Successful Are We?

BACKGROUND AND OBJECTIVES: Core needle biopsy (CNB) is commonly used to diagnose bone tumors, but characteristics of tibial lesions may affect its diagnostic performance. We evaluated the diagnostic performance of CT-guided CNB for tibial lesions, factors associated with diagnostic success, and outcomes of nondiagnostic biopsies. METHODS: We retrospectively reviewed 272 patients with tibial lesions treated at a quaternary sarcoma referral center from 2016 to 2022, of whom 43 underwent CT-guided CNB. Patient, lesion, and pathologic characteristics were evaluated for associations with diagnostic outcomes. RESULTS: Of 43 biopsies, 58.1% were diagnostic, 79.1% accurate, and 55.8% successful. Accuracy was significantly higher for non-diaphyseal than diaphyseal lesions (27/31 vs. 7/12; p = 0.038). Lesions < 5 cm were less likely to achieve diagnostic success than lesions ≥ 5 cm (OR 0.231, 95% CI 0.064-0.836; p = 0.022). Of 18 nondiagnostic CNBs, 12 underwent subsequent incisional biopsy, identifying five malignancies. CONCLUSION: CT-guided CNB of tibial lesions has modest diagnostic yield, with lower accuracy in diaphyseal lesions and reduced diagnostic success in lesions < 5 cm. These findings may inform biopsy planning and identify patients more likely to require incisional biopsy for definitive diagnosis.