Image Guided Biopsy of Musculoskeletal Lesions with Low Diagnostic Yield

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 diagnostic yield. 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.