Diagnostic performance of computed tomography-guided percutaneous bone biopsy in musculoskeletal oncology: A single-center cohort study

doi:10.4329/wjr.125901

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World Journal of Radiology

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1949-8470

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Radiol. Oct 28, 2026; 18(10): 125901
Published online Oct 28, 2026. doi: 10.4329/wjr.125901

Diagnostic performance of computed tomography-guided percutaneous bone biopsy in musculoskeletal oncology: A single-center cohort study

Andreea Minodora Stuparu Adam, Alnuaimi Osama, Alexandru Stere, Daniel Cochior, Mark Eduard Pogărăşteanu, Cosmin Alec Moldovan, Ioan-Sorin Tudorache, Razvan Adam, Adina-Diana Moldovan

Andreea Minodora Stuparu Adam, Razvan Adam, Faculty of General Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu-Mures 540142, Mureș, Romania

Alnuaimi Osama, Department of Radiology Imaging, Affidea Clinic, Bucharest 013713, București, Romania

Alexandru Stere, Faculty of Materials Science and Engineering, National University of Science and Technology Politehnica Bucharest, Bucharest 060042, București, Romania

Daniel Cochior, Cosmin Alec Moldovan, Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University, Bucharest 031593, București, Romania

Daniel Cochior, Department of General Surgery, Monza Hospital, Bucharest 021967, București, Romania

Mark Eduard Pogărăşteanu, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, București, Romania

Mark Eduard Pogărăşteanu, Department of Orthopaedics and Trauma Surgery, Dr. Carol Davila Central Military Emergency University Hospital, Bucharest 010242, București, Romania

Cosmin Alec Moldovan, Department of General Surgery, Witting Clinical Hospital, Bucharest 010243, București, Romania

Ioan-Sorin Tudorache, Razvan Adam, Adina-Diana Moldovan, Department of Preclinical Sciences, Faculty of Medicine, Titu Maiorescu University, Bucharest 031593, București, Romania

Razvan Adam, Department of Orthopedics, Elias Clinical University Emergency Hospital, Bucharest 011461, București, Romania

Adina-Diana Moldovan, Doctoral School in Medicine, Titu Maiorescu University, Bucharest 031593, București, Romania

Author contributions: Stuparu Adam AM and Adam R contributed to conceptualization; Stuparu Adam AM and Moldovan CA contributed to methodology; Stere A, Osama A, Pogărăşteanu ME, and Cochior D contributed to validation; Cochior D and Moldovan AD contributed to formal analysis; Adam R, Tudorache IS, and Pogărăşteanu ME contributed to investigation; Osama A, Moldovan CA, and Moldovan AD contributed to data curation; Stuparu Adam AM, Adam R, and Stere A contributed to writing-original draft preparation; Cochior D and Moldovan CA contributed to writing-review and editing; Adam R contributed to supervision, project administration.

AI contribution statement: Portions of this manuscript were edited using AI tools (GPT-5.6 Sol model) solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.

Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki and was reviewed and approved by the Ethics Committee of Titu Maiorescu University of Bucharest (protocol No. 7/23.03.2026).

Informed consent statement: Written consent for the clinical intervention was obtained as part of routine care.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The underlying clinical data are available from the corresponding author at cosmin.moldovan@prof.utm.ro on reasonable request, subject to applicable institutional approval and patient-confidentiality requirements.

Corresponding author: Cosmin Alec Moldovan, MD, PhD, Associate Professor, Chief Physician, Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University, Gheorghe Petrascu 67A Street, 3^rd District, Bucharest 031593, București, Romania. cosmin.moldovan@prof.utm.ro

Received: July 20, 2026
Revised: September 3, 2026
Accepted: October 14, 2026
Published online: October 28, 2026
Processing time: 100 Days and 20.1 Hours

Abstract

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.

Keywords: Biopsy, Needle; Tomography, X-ray computed; Bone neoplasms; Diagnostic yield; Retrospective studies; Complications

Core Tip: In 64 consecutive image-guided bone biopsies performed over 36 months, diagnostic yield was 60/64 (93.75%). Recorded concordance was 60/60 among diagnostic, evaluable procedures; counting four non-diagnostic procedures as failures gave 60/64 for the full cohort. Six biopsies corrected the pre-procedural clinical diagnosis. Two minor class B complications were managed conservatively. These are descriptive local results, not evidence of unbiased 100% diagnostic accuracy: verification was incomplete and used a potentially non-independent composite standard. No predictors were tested and no pooled literature comparison was performed.