A retrospective study of 169 percutaneous skeletal biopsies performed by radiologists at the Mallinckrodt Institute of Radiology and Barnes Hospital between October 1974 and July 1980 showed an overall accuracy of 94%; a negative result had a predictive value of 92%. A review of the English-language literature revealed that nearly 10,000 aspiration or trephine musculoskeletal biopsies have been reported during the past 50 years; historical accuracy is approximately 80%, but this figure is probably an underestimate because true-negative cases may not have been well documented or tabulated. The authors believe that percutaneous skeletal biopsy should be considered a radiological procedure, and that radiologists could and should perform this procedure as part of a team effort.