Predictors of re-biopsy in percutaneous musculoskeletal tumor biopsies: A single-center retrospective cohort study

Purpose: This study aimed to evaluate the diagnostic success of percutaneous biopsies performed for suspected mus culoskeletal tumors and to identify clinical, anatomical, and procedural factors associated with the need for repeat biopsy (re-biopsy). The secondary objective was to assess the impact of multidisciplinary team (MDT) evaluation on reducing unnecessary re-biopsy procedures. Methods: A total of 565 patients (331 bone, 234 soft tissue lesions) who underwent percutaneous biopsy for suspected musculoskeletal tumors between 2020 and 2024 were retrospectively analyzed. Diagnostic success was defined as a biopsy yielding a definitive histopathological diagnosis sufficient to guide treatment planning without additional tissue sampling. Predictive factors including lesion size, depth, location, and performing specialty were evaluated using univariate and multivariate logistic regression analyses. Results: The initial diagnostic yield was 65.5%. Multivariate analysis revealed that lesion width <2 cm (OR = 2.01; 95% CI, 1.19–3.39; p = 0.009) and biopsy performed by an interventional radiologist (compared to an orthopedic surgeon) (OR = 5.25; 95% CI, 2.83–9.74; p < 0.001) were independent predictors of re-biopsy recommendation. Among 72 patients recommended for re-biopsy, MDT evaluation averted the need for a second procedure in 38 cases (52.8%). Conclusion: Smaller lesion size (<2 cm) and the medical specialty performing the biopsy were independent predictors of re-biopsy recommendation, with the latter likely reflecting systematic differences in case complexity and procedural environment rather than operator skill. Structured MDT evaluation significantly reduced unnecessary repeat procedures.