How should musculoskeletal biopsies be performed?

Biopsy refers to tissue sampling for histological examination, diagnosis, classification, and grading of a tumor. The goal of biopsy is to obtain a diagnostic tissue sample without complications, tumor spread, and compromise of future treatments.1,2 As a rule, all lesions should be biopsied as if they were malignant,2,3 and all soft tissue masses 3 cm or larger in diameter or growing lesions should be biopsied.2,4 Biopsy for musculoskeletal tumors can be closed (percutaneous) or open (incisional or excisional). Closed biopsy can be performed with a fine needle (fine-needle aspiration biopsy) or a core needle, and can be imaging guided or not. This editorial discusses the techniques, principles, and errors of biopsies for musculoskeletal tumors from radiologists’ and orthopedic surgeons’ perspectives.