Diagnostic performance of computed tomography-guided percutaneous bone biopsy in musculoskeletal oncology: A single-center cohort study
Andreea Minodora Stuparu Adam1, Alnuaimi Osama2, Alexandru Stere3
1Faculty of General Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu-Mures 540142, Mureș, Romania.
Background:
Computed tomography guided percutaneous bone biopsy provides tissue for the assessment of suspected primary and secondary bone lesions. Diagnostic yield, concordance with subsequent diagnostic assessment, and adverse events describe different aspects of performance. Their interpretation depends on case selection, outcome definitions, and the completeness and independence of diagnostic verification.
Aim:
To describe diagnostic yield, recorded diagnostic concordance, and complications in a retrospective single-center cohort of image-guided bone biopsies.
Methods:
We retrospectively reviewed 64 consecutive image-guided percutaneous bone biopsy procedures performed from January 2023 through December 2025. Diagnostic yield required clinically useful histopathology without repeat sampling. Recorded concordance used a composite of surgical histopathology, immunohistochemistry-supported assessment, or clinical and imaging follow-up. Non-diagnostic procedures remained in the full-cohort analysis. Complications were classified using the legacy Society of Interventional Radiology system. Proportions were summarized with exact binomial 95% confidence intervals (CI); no external hypothesis tests were performed.
Results:
Diagnostic yield was 60/64 (93.75%; 95%CI: 84.8%-98.3%). Recorded concordance among 60 diagnostic, evaluable procedures was 60/60 (100%; 95%CI: 94.0%-100%). The full-cohort concordant diagnostic-result rate was 60/64 (93.75%) when four non-diagnostic procedures were counted as failures. Six biopsies revised the pre-procedural clinical diagnosis. Pelvic lesions were the most frequent sites. Two minor class B biopsy-tract fistulas occurred (2/64, 3.1%; 95%CI: 0.4%-10.8%); no major complications were recorded (0/64; 95%CI: 0%-5.6%). The heterogeneous cohort, incomplete verification reporting, and potentially non-independent composite reference standard limit interpretation of the conditional concordance estimate.
Conclusion:
This cohort showed high diagnostic yield and two recorded minor complications. Conditional concordance does not establish unbiased diagnostic accuracy; independent verification and prospective confirmation are needed.
