Surgical objective <p>Removal of sufficient representative tumor material for tumor classification and initiation of adequate therapy, ensuring complete subsequent sarcoma resection without contamination of other compartments.</p> Indications <p>Histological confirmation of musculoskeletal findings suspected to be malignant or of unclear status and adjustment of existing systemic therapies.</p> Contraindications <p>Lack of therapeutic use of the biopsy for decision-making or treatment as well as highly palliative situations with greatly reduced prognosis.</p> Surgical technique <p>Skin incision, subcutaneous preparation with fasciotomy and sharp severing of the musculature directly on the bone without ‘spreading’ the scissors. Avoidance of soft tissue barriers, ‘direct access’ to the tumor, meticulous hemostasis to avoid hematomas. In case of an intraosseous tumor, opening of the bone with an awl or bone marrow biopsy needle. The surgical aim is to collect approximately 1&#xa0;cm³ sample.</p> Further management <p>Immobilization of the affected limb if necessary. Partial weight-bearing/no weight-bearing in case of intraosseous findings to avoid pathological fracture if necessary. Presentation to the interdisciplinary tumor board before planning further therapy.</p> Results <p>In the context of a systematic literature review, all primary studies published between January 2014 and December 2024 that compared biopsy techniques (open incisional biopsy and core needle biopsy) were considered. Of the 76 initially identified studies, five met the predefined inclusion criteria. Recent years has shown an increasing trend toward the use of image-guided core needle biopsy.</p>