La radiologia medica

, Volume 123, Issue 4, pp 254–259 | Cite as

Concordance between fine-needle aspiration and core biopsies for osseous lesions by lesion imaging appearance and CT attenuation

  • John Li
  • Zoe Weissberg
  • Thomas A. Bevilacqua
  • Gordon Yu
  • Kristy Weber
  • Ronnie Sebro



To compare the concordance between fine-needle aspiration and core biopsies for osseous lesions by lesion imaging appearance and CT attenuation.

Materials and methods

Retrospective review of 215 FNAs of osseous lesions performed in conjunction with core biopsy at our institution over a 6-year period (2011–2016). FNAs were interpreted independently of core biopsies. We assessed if FNA in conjunction with core biopsy increased diagnostic accuracy compared to core biopsy alone. We also calculated the concordance between FNA and core biopsy by lesion appearance, lesion CT attenuation, lesion histology, lesion location and FNA needle gauge size.


Core biopsy alone provided the diagnosis in 207/215 cases (96.3%), however, the FNA provided the diagnosis in the remaining 8/215 cases (3.7%) where the core biopsy was non-diagnostic. There were 154 (71.6%) lytic lesions, 21 (9.8%) blastic lesions, 25 (11.6%) mixed lytic and blastic lesions and 15 (7.0%) lesions that were neither lytic nor blastic. The concordance between FNA and core biopsy for lytic osseous lesions (136/154 cases, 88.3%) was statistically significantly higher than that for blastic osseous lesions (13/21 cases, 61.9%) [P = 4.2 × 10−3; 95% CI (0.02, 0.50)]. The concordance between FNA and core biopsy was higher for low-attenuation- (110/126) than high-attenuation (58/77) lesions (P = 0.028). The concordance between FNA and core biopsy was also higher for metastases (102/119 cases, 85.7%) than non-metastases (78/96, 81.3%) [P = 0.487; 95% CI (− 0.15, 0.065)]. There was no difference in the rate of concordance between FNA and core biopsy by lesion location or FNA needle gauge size (P > 0.05).


FNA with core biopsy increases diagnostic rate compared to core biopsy alone or FNA alone. The concordance between FNA and core biopsy is higher for lytic lesions than for blastic lesions; and higher for low-attenuation lesions than for high-attenuation lesions.


Osseous lesions Lytic Blastic Metastases Fine-needle aspiration FNA Bone lesions CT attenuation 



The article is not under consideration for publication elsewhere. This article received no funding from any agency in the public, commercial or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© Italian Society of Medical Radiology 2017

Authors and Affiliations

  • John Li
    • 1
  • Zoe Weissberg
    • 1
  • Thomas A. Bevilacqua
    • 1
  • Gordon Yu
    • 2
  • Kristy Weber
    • 3
  • Ronnie Sebro
    • 1
  1. 1.Department of RadiologyUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of PathologyUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of Orthopedic SurgeryUniversity of PennsylvaniaPhiladelphiaUSA

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