PURPOSE: To evaluate the diagnostic accuracy and clinical utility of percutaneous needle biopsy of the bony lesions. MATERIALS AND METHODS: Among 100 consecutive patients who underwent percutaneous needle biopsy of bony lesions, 96 patients who were diagnosed ultimately by surgery, or by clinical and radiological follow-up over 6 months were reviewed in this study. Biopsy sites were in the long bones in 51, axial bones in 45. Twelve biopsies were performed under CT guidance and the remainder were guided under fluoroscopy. The categories for the suspected diagnosis included 25 primary malignant tumors, 21 benign tumors, 31 metastases, 13 infections, and 6 miscellaneous lesions. RESULTS: Of the 96 biopsies, 86(89.6%) were adequate for the diagnosis out of which 81 were ultimately confirmed as true-positive or true-negative with the overall diagnostic accuracy rate of 94.2%. Diagnostic accuracy according to the suspected diagnosis was 91.3% in primary malignant tumors, 90.3% in metastases, and 100% in infections, benign tumors, and miscellaneous lesions. Respective diagnostic yield was 90.3% in metastases, 84.6% in infections, 84% in primary malignant tumors, 71.4% in benign tumors, and 100% in miscellaneous lesions. Both diagnostic accuracy and diagnostic yield differed little with the lesion location. No complication was observed in our series. CONCLUSION: Percutaneous needle biopsy of bony lesion is a safe procedure, offering high diagnostic accuracy and high clinical utility.