ReviewThe role of ultrasound-guided fine needle aspiration biopsy in musculoskeletal diseases

•Ultrasonography (US) is a readily available non-invasive tool useful for the detection of musculoskeletal and soft tissue masses•US is increasingly used for guiding procedures and biopsies that are indicated when histopathology will modify patient management.•FNAB does not consists more in the mere aspiration performed with 22-23 G needle attached to a 20 mL disposable syringe.•Several Menghini type semi-automatic biopsy devices with small-caliber (18 to 21 G) needles provide high-quality histopathologic specimens.

Ultrasonography (US) is a readily available non-invasive tool useful for the detection of musculoskeletal and soft tissue masses. Although X-Ray is often the first imaging study for evaluating both bone and soft tissue lesions, and magnetic resonance imaging and computed tomography are mandatory in lesions staging, US is increasingly used for the early assessment of musculoskeletal and soft-tissue masses and for guiding procedures and biopsies. Surgical biopsy or fine needle aspiration biopsy (FNAB) is needed to ascertain the nature of any lesion. FNAB is a low cost technique, safer and less traumatic than an open surgical biopsy. Significant complications are rare, mostly related to the site of biopsy. Knowledge of indications, limitations, anatomical and pathological access, adequate technical expertise in US imaging and in intervention skills are the critical factors of the appropriate and safe use of FNAB. By now, the role of FNAB in musculoskeletal diseases is controversial and there is still a heated debate in the scientific community.