Percutaneous Bone and Soft Tissue Biopsies: An Illustrative Approach

Even in pandemic times cancer remains one of the leading causes of death worldwide. Spine and peripheral skeleton constitute a common location for metastatic disease whilst numerous sarcomatous and other primary cancers may be depicted in the musculoskeletal system. Tissue sampling is necessary for histopathological identification as well as for molecular profiling in order to personalize cancer prevention, diagnosis and treatment; in addition cultures of bone and soft tissue sampling contribute to identifying pathogens in order to provide the most appropriate systemic therapy. Performing an open surgical biopsy increases morbidity and mortality while at the same time runs the risk of destabilizing a pathologic segment. Imaging guidance ensures high safety and efficacy rates and contributes to the minimally invasive character of percutaneous biopsy by providing immediate confirmation of correct needle location in the area of interest. Selecting the imaging guidance method which will visualize the target lesion and the needle trajectory as well as the largest possible needle biopsy that can maximize the diagnostic yield is of outmost importance for high safety and efficacy rates. The purpose of the present review is to provide a comprehensive, current overview of percutaneous, imaging guided biopsy in the spine and peripheral skeleton, to become familiar with the most common indications, to learn about different technical considerations during performance and to provide the current evidence. Controversies concerning products will be addressed.