Clinical Orthopaedics and Related Research®

, Volume 468, Issue 10, pp 2774–2780 | Cite as

Office-based Core Needle Biopsy of Bone and Soft Tissue Malignancies: An Accurate Alternative to Open Biopsy with Infrequent Complications

  • Sheila C. AdamsEmail author
  • Benjamin K. Potter
  • David J. Pitcher
  • H. Thomas Temple
Clinical Research



Biopsy is a critical step in the diagnosis of musculoskeletal malignancy. As an alternative to open biopsy, percutaneous core needle biopsy techniques have been developed. As many studies combine office-based, image-guided, and operative biopsies, the accuracy of office-based core needle biopsy is not well documented.


We asked whether (1) office-based core needle biopsy for the diagnosis of malignant musculoskeletal neoplasms would have few complications and diagnostic and accuracy rates comparable to those cited in the literature for core needle biopsy, (2) diagnostic errors related to office-based core needle biopsy would result in surgical treatment errors, and (3) tissue core quantity and tumor type would affect accuracy.

Patients and Methods

We retrospectively reviewed 234 patients with 252 core needle biopsies of malignant bone and soft tissue neoplasms at one institution between 1999 and 2007. Biopsy accuracy and errors were determined on the basis of histologic evaluation of prior or subsequent biopsies and/or resected specimens, when available. We eliminated 19 patients who had needle biopsies: three had the core needle biopsy completed in the operating room and 16 had insufficient documentation or followup, leaving 233 for study.


Of the 233 core needle biopsies, 212 (91%) were diagnostic and accurate for malignancy. Fourteen (6%) biopsies were nondiagnostic. Major errors, defined as a benign diagnosis in a malignant tumor, occurred in seven cases (3%). Minor errors, defined as errors in histopathologic diagnosis or grade, occurred in 24 biopsies (10%). All nondiagnostic and major core needle biopsy errors were identified and addressed with either a diagnostic open biopsy or definitive wide local excision, resulting in no surgical treatment errors. Accuracy was not influenced by core number; however, myxoid lesions showed a correlation with biopsy error. There were no biopsy-related complications.


Office-based core needle biopsy for diagnosis of malignant musculoskeletal neoplasms has high diagnostic and accuracy rates without associated complications.

Level of Evidence

Level II, diagnostic study. See the Guidelines for Authors for a complete description of the level of evidence.


Core Needle Biopsy Wide Local Excision Open Biopsy Definitive Surgical Treatment Benign Diagnosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Zoraida Moore and Nancy Garcia for assistance with this project.


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Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Sheila C. Adams
    • 1
    Email author
  • Benjamin K. Potter
    • 2
    • 3
    • 4
  • David J. Pitcher
    • 1
  • H. Thomas Temple
    • 1
  1. 1.Department of Orthopaedics and RehabilitationUniversity of Miami Miller School of Medicine, University of Miami HospitalMiamiUSA
  2. 2.Integrated Department of Orthopaedics and RehabilitationWalter Reed National Military Medical CenterWashingtonUSA
  3. 3.Integrated Department of Orthopaedics and RehabilitationWalter Reed National Military Medical CenterBethesdaUSA
  4. 4.Department of SurgeryUniformed Service University of Health SciencesBethesdaUSA

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