Related Experiment Video
Updated: Feb 21, 2026
Optimization of Breast Biopsy and Mastectomy Sample Collection Procedures for Biobanking, Personalized Medicine, and Research Applications
Published on: September 2, 2025
Safety of omitting routine bleeding tests prior to image-guided musculoskeletal core needle biopsy
Yuri Shif1, Justin W Kung1, Colm J McMahon1
1Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.
Purpose:
To evaluate the safety of withholding preprocedure international normalized ratio (INR) and platelet testing in patients undergoing musculoskeletal (MSK) core needle biopsy (CNB).
Material And Methods:
Initially, a retrospective review of 1,162 consecutive patients undergoing MSK CNB with preprocedural INR and platelet testing was performed. Clinical (age, gender, bleeding disorder, liver disease, anticoagulation use, INR > 2, platelet count <50,000/ul) and biopsy factors (imaging modality, lesion type, biopsy needle gauge, number biopsy samples) were tested for association with bleeding complications. During the second phase, an additional 188 biopsies performed without preprocedural coagulation testing were studied. Categorical variables were compared using Chi-squared or Fisher's exact tests, continuous variables with a student t-test. Multivariate analysis was performed using logistic regression.
Results:
In the first phase, there was a complication rate of 2.6%, 30/1162. Of the 11 clinical and biopsy factors, soft tissue lesions (p = 0.029) and lesions biopsied under ultrasound (p = 0.048) had a higher rate of bleeding than bone lesions or lesions biopsied under CT, respectively. Only three patients had an INR >2, 0.3% (3/1162) and only four patients had platelet count <50,000/ul, 0.3% (4/1162). No patient with a bleeding complication had an abnormal preprocedure bleeding test. In the second phase, there was a bleeding complication rate of 1.1% (2/188).
Conclusion:
Bleeding complications from MSK biopsy are low, even when preprocedure coagulation testing is omitted.
Insights
Withholding preprocedure coagulation testing for musculoskeletal core needle biopsies (CNB) is safe, as bleeding complications are rare. This approach can streamline the biopsy process without increasing patient risk.
Area of Science:
- Radiology
- Interventional Radiology
- Musculoskeletal Imaging
Background:
- Preprocedural coagulation testing (INR and platelet count) is standard before invasive procedures.
- Musculoskeletal (MSK) core needle biopsy (CNB) carries a risk of bleeding complications.
- The necessity of routine coagulation testing for MSK CNB is debated.
Purpose of the Study:
- To evaluate the safety and efficacy of omitting preprocedure international normalized ratio (INR) and platelet testing for patients undergoing MSK CNB.
- To determine if withholding coagulation tests impacts bleeding complication rates in MSK CNB procedures.
Main Methods:
- Retrospective review of 1,162 patients undergoing MSK CNB with preprocedural coagulation testing.
- Analysis of clinical and biopsy factors associated with bleeding complications.
- Prospective evaluation of 188 MSK CNB procedures performed without preprocedural coagulation testing.
- Statistical analysis using Chi-squared, Fisher's exact, t-tests, and logistic regression.
Main Results:
- The overall complication rate in the first phase was 2.6% (30/1162).
- Soft tissue lesions and ultrasound-guided biopsies were associated with higher bleeding rates.
- Abnormal coagulation tests were rare (INR >2 in 0.3%, platelets <50,000/µL in 0.3%).
- No bleeding complications were linked to abnormal preprocedure tests.
- The complication rate in the second phase (without testing) was 1.1% (2/188).
Conclusions:
- Bleeding complications following MSK CNB are infrequent.
- Withholding preprocedure coagulation testing appears safe for MSK CNB.
- Routine coagulation testing may not be necessary for all MSK CNB procedures, potentially improving efficiency.
Related Concept Videos
01:14Imaging Studies I: CT and MRI
Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...
01:17Ultrasonography
During an ultrasonography procedure, a handheld device called...
01:30Radiological Investigation I: X-ray and CT
01:29Blood and Nerve Supply to the Bones
Nutrient Artery
The nutrient artery is the main blood vessel that enters the diaphysis via the nutrient foramen. While most long bones have only one nutrient foramen, large bones, such as the femur, may have two. This...