An Analysis of CT‐Guided Percutaneous Core Needle Biopsy of Tibial Lesions: How Successful Are We?

Background and Objectives Core needle biopsy (CNB) is commonly used to diagnose bone tumors, but characteristics of tibial lesions may affect its diagnostic performance. We evaluated the diagnostic performance of CT‐guided CNB for tibial lesions, factors associated with diagnostic success, and outcomes of nondiagnostic biopsies. Methods We retrospectively reviewed 272 patients with tibial lesions treated at a quaternary sarcoma referral center from 2016 to 2022, of whom 43 underwent CT‐guided CNB. Patient, lesion, and pathologic characteristics were evaluated for associations with diagnostic outcomes. Results Of 43 biopsies, 58.1% were diagnostic, 79.1% accurate, and 55.8% successful. Accuracy was significantly higher for non‐diaphyseal than diaphyseal lesions (27/31 vs. 7/12; p = 0.038). Lesions < 5 cm were less likely to achieve diagnostic success than lesions ≥ 5 cm (OR 0.231, 95% CI 0.064–0.836; p = 0.022). Of 18 nondiagnostic CNBs, 12 underwent subsequent incisional biopsy, identifying five malignancies. Conclusion CT‐guided CNB of tibial lesions has modest diagnostic yield, with lower accuracy in diaphyseal lesions and reduced diagnostic success in lesions < 5 cm. These findings may inform biopsy planning and identify patients more likely to require incisional biopsy for definitive diagnosis.