14 February 2022, Monday

Core Needle Biopsy (CNB) Vs Open Biopsy (OB), Which Is Better and Why?


‘‘Core Needle Biopsy’ in skilled hands, offers significant advantages over ‘Open Biopsy’ and therefore, it is the preferred method for obtaining tumor tissue samples.

The goal of a biopsy is to obtain a sample of tumor tissue so that it can be studied by the pathologist to identify the exact nature of the disease and establish its identity, as treatment of any tumor depends on its diagnosis.

Generally, it is possible to obtain a larger quantity of tissue sample (which makes it easier for the pathologist to process and study the material) through an Open Biopsy.

However, the material obtained by Core Needle Biopsy, in most cases, is adequate for a skilled pathologist. In many other ways, the advantages and benefits offered by a CNB are superior to that of an OB.

As mentioned earlier, CNB is a simple, reliable, minimally-invasive, safe and quick procedure. In the following table, a comparison is made between OB and CNB: 

Sr. No.

Points of comparison

Open Biopsy

Core Needle Biopsy


Nature of procedure Invasive Minimally-invasive


Size of incision Depends on depth of tumor. Deeper the disease, larger the incision required to reach it. Ranges from about 3 – 4 cm. up to several cm. Does not depend on depth of tumor. Size of incision always remains the same; about 5 mm. In-fact, therefore, deeper the tumor, more is the advantage of needle biopsy.


Tumors in complex locations like spine, pelvis, sacrum, etc. As these lesions are deep and in difficult regions, open biopsy is highly unsuitable. Most effective procedure for these lesions. Can be done under image guidance like CT scan, etc.


Quantity of tissue obtained Substantial amount of tissue can be obtained. Less tissue obtained – however, adequate for a skilled pathologist.


Drain tube placement following the procedure May be needed; to drain the collected blood (haematoma) Never required


Blood loss May be significant Generally, limited


Ease of procedure Easy Requires skill


Reliability Excellent Excellent in skilled hands


Safety Excellent Excellent


Possibility of fracture following the procedure Likely; especially if the biopsy is from the diaphyseal region (shaft area) of a long bone Very unlikely


Speed Takes much longer time than needle biopsy Few minutes


Anaesthesia May need general or regional anaesthesia Most often, done under local anaesthesia


Recovery from procedure May take a few hours to a day Almost immediate


Post-procedure pain May be significant Usually tolerable, and abates quickly.


Hospital stay May need a few hours or a day’s stay in the hospital Usually an OPD based procedure. Does not generally need hospital admission.


Local tissue contamination Significant Very limited


At final surgery More skin and normal tissue is lost while removing the biopsy scar and track. Minimal loss of skin and normal tissue as the biopsy scar and track is small.


Cost of procedure Much more as compared to Core Needle Biopsy Very reasonable

It is quite obvious from the above comparison that Core Needle Biopsy in skilled hands, offers significant advantages over Open Biopsy and therefore, it is the preferred method for obtaining tumor tissue samples. Nevertheless, there may be some situations where an open biopsy procedure could be the more suitable option.

Once a diagnosis of bone cancer (sarcoma) is made, the next important step is to ‘Stage’ the cancer.

Further Reads:

1. What is Biopsy & Why is it important?


    Dr. Chetan Anchan

    MS - Orthopaedics, Diploma in Orthopaedics,

    FCPS - Mid. & Gynae, MBBS

    About Author - Dr. Chetan Anchan is an expert and well known orthopaedic surgeon and oncologist from Mumbai. He has a vast experience in treating all types of Malignant and Benign, Bone and Soft Tissue Tumors, and Skeletal Metastases.

    To book an appointment, call: +91 – 93244 27302

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