Objective: Percutaneous needle biopsy is an effective and safe technique for obtaining diagnostic material from bone lesions. Study Design: We describe the technical details of fine needle aspiration and core needle biopsy performed in our laboratory of orthopedic pathology. Results: With these procedures, we obtained accurate diagnosis in 83% of 7,375 cases, sent by different orthopedic centers in our country, over a period of 21 years (1986–2007). Conclusion: We describe the percutaneous needle procedure (fine needle aspiration, core needle biopsy), the handling of the materials in detail, the different cytological techniques, as well as the advantages of the procedures and how to avoid its disadvantages. We believe that accurate diagnosis with bone needle biopsy mainly depends on the training of the surgical cytologist and the pathologist, who must integrate all the knowledge on the clinical data, image diagnosis, histological procedures and the experience in the histopathological interpretation of bone lesions.

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